Promoting Excellence in Older People’s Care in Nursing

This article discusses the challenges faced by Singapore's aging population and the need for excellent nursing care to manage health issues. It includes a case study and a care plan using the senses framework. The article also explores the theories of aging, nursing, and health care intervention. Course code, course name, and college/university are not mentioned.

Running head: PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Name of the Student:
Name of the University:
Author Note:

2PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Introduction
In the context of the rapid aging population, Singapore is anticipating a rise of the
morbidity, disability and dependency that driven by physical fragility. According to Chan et
al., (2013), Singapore is facing one of the toughest economic and social challenges since it is
independent in the form of rapidly aging population. National survey of senior citizen
(NSSC) has been conducted a periodic survey for keeping track of the aged population and
health status of them. According to that survey report, in 2009 a total of 10000 households at
least one individual of 55 years or older were found where 15% of the households were
ineligible for older people focusing on the personal characteristics of the survey, in
Singapore, amongst those 55 years had above, 47% are male where as 53% of older
population are female (Ng et al., 2013). A country based cross sectional study suggested that
while Singapore is a highly developed country by worldwide standards, the older population
was suffering from certain health crisis that increases the burden of the disease had affected
the economic status. A study by, suggested that a considerate number of older individual in
Singapore suffered from health crisis such as major depressive disorder, anxiety,
cerebrovascular accidents and urinary incontinence. Depression impacts older population
different than younger population since the depression generally observed in older people in
Singapore often associated with medical illness and disability which last longer. Depression
often observed in elderly women if they lose their independence of working due to physical
disability or if the family member lives away or feel abundant which further leads to anxiety.
In older adults, cerebrovascular accidents often caused by blocked artery due to series health
disease such or due to sudden fall. In Singapore, prevalence of cerebrovascular accidents
often estimated at 3.65% for adults above 50 years which posing challenges to the health care
system (Chandran et al., 2013). Urinary incontinence is a normal part of aging which is more
common in women over 50 years and affects one woman out of three women in Singapore.

3PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Therefore, in order to manage these health issues for physical and mental well-being of older
population, excellent nursing care is required which would provide them a sense of security,
comfort and enhance quality of life. The aim of the paper is to address health care theories
such as aging theory, nursing theory and health improvement theory in order provide
excellent nursing care to the elderly population of the Singapore. Therefore, in the first part
of the paper will illustrate a case study by applying the nursing theories for effective nursing
care. The second part of the paper will illustrate a care plan for the elderly patient with the
help of senses frame work.
Part 1
Case study
Ms. Maria is an 80 year old woman who is a subacute rehabilitation patient. She was referred
for a psychological evaluation as she had been suffering from anxiety and depression. Few
days back the patient Maria had suffered from right frontal lobe cerebrovascular accident
(CVA) due to which she developed a left-sided hemiparesis. One of her greatest health
concern was that her urinary incontinence along with the subsequent changes occurred in
privacy. The reports showed that the patient has never been married therefore had no
children. She was a successful and independent women however this changed after the
occurrence of CVA. She worked for the welfare of the low-income children as well as their
families. She had been involved in registered home health nursing. The patient reported of
worsening frequencies of urination along with incidences of recurrent urinary tract infections
(UTIs). She reported that this led to the decrease in the quality of her life which had taken
place about 10 years ago. As a result of this, over the years she was forced to focus on this
symptom which had affected her personal and professional life and this made her withdraw

4PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
herself from several activities. This had made her more conscious of her disability. This often
made her feel abandoned increasing her stress and her concerns regarding urinary
incontinence which in turn increased her requests for help.
Due to the increasing number of senior citizens who are entering their silver years, the
government of Singapore is placing some special schemes in order to bring out social support
to help them get through their retirement years. One of this scheme is the Medisave which is
a national medical savings scheme. This helps the people to put aside a part of their income
into this medisave account, which in future will help them to pay for their personal and
immediate family’s hospitalizations costs and certain outpatient expenses in any hospital in
Singapore. Another scheme is the Enhancement for Active Seniors (EASE), which is a part of
the Home Improvement Programme (HIP) (Ng et al., 2015). This allows the patients to enjoy
subsidies from the government. Another is the ComCare Long Term Assistance which is also
known as Public Assistance along with Silver Support Scheme according to which the
government gives payout of $300 – $750 to the 20% of seniors having low incomes
throughout their life and little or no such support from the family. Several other schemes of
the government includes the Pioneer Generation Package (PGP), the Lease Buyback Scheme
(LBS) and finally the Senior Citizen Concession Card. According to this, the senior citizens
are able to enjoy lower fares on the trains and buses after the launch of the Off-Peak Pass
(OPP) (Feng et al., 2014).
Additionally the Singapore’s Ministry of Health (MOH) had established an outline for an
action plan with regards to successful ageing which is was involved of ten areas of focus.
These ten priorities included senior volunteerism, employability, health and wellness, lifelong
learning social engagement and inclusions, housing, transport, aged care services, public
places, and research on ageing (Ramjaun et al., 2013). It was also seen from the research

5PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
reports that the government of Singapore thrived to put the responsibility for the older
population’s health and wellbeing on the senior individuals themselves or their families.
The theories like the ageing theory, nursing theory and others like the health care intervention
theory which helps to bring the explanations in the form of data in order provide guidelines
for action. The theory of ageing comprises of the biologic, the physiologic and the social
theories. An important purpose of theories is to challenge the practise in order to create
approaches that are new and will help to remodel the structures of care that are to be provided
to the older adults. Therefore it is important to implement the theories of nursing for the care
of older people having the aim to support them throughout their process of ageing
(Vaingankar et al., 2016).
The ageing theory
The ageing theory comprises of several developmental theories including the
Maslow's hierarchy of human needs through which the people or the patient her might strives
towards the aspect of self-actualization through various stages. This in turn will help the
patient Marie to realise the importance of any task for herself which will not necessarily be
age-specific in nature. The next is the Jung's theory of individualism that includes the stages
of old age while turning oneself inward in order to reflect for answers. The inner direction for
the patient might mean that the factors which are external for health are most of the time less
important to patient; motivation may have to come from within. Another is the course of
human life, which describes that old age is the time for rest as well as to review one’s life
(Sitar t al., 2013). As a part of this theory, the patient might view old age as a kind of reward
where one would expect commensurate treatment. Finally there is an Erikson's eight stages of
life, where there must be ego resolved for a crisis in each of the stage. In old age it would also
involve a looking back at life in addition to the acceptance death where there is ego integrity

6PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
versus despair. According to this in terms of the patient, the anxiety regarding the issue like
death might be of utter importance. Additionally the importance of the exacerbated due to the
unknown that accompanies diagnostic testing. The patient who is an older adult and has
successfully resolved the crisis who will be comfortable while speaking about death
additionally with the technologist should not negate or ignore such discussions (Chan et al.,
2013).
The nursing theory
The nursing aims to predict as well as describe the phenomenon and also explain the
process of nursing. According to the nursing theory, the older people such as the patient here
Maria must be offered with patient- centred nursing. Nursing theory is able to provide the
principles that help in guiding the practice as well as person-centered care (PCC) (Orr, Elliott
& Barbour, 2014). This is often regarded as a venerable nursing theory mainly at times when
it comes to senior care. The patient centred care is involved in focusing on knowing of the
person in addition to the other factors like respecting the personhood of then patient.
Provision of comfort to the patient apart from maintenance of a supportive physical and
organisational environment is important part of the patient centred care. Additionally the
approaches of the person-centered care towards the senior care are able to create the
conditions which enable the older people to participate in meaningful lives, and potentially
improve their well-being (Chandran et al., 2013). Through the use of nursing theory the
patient Maria can develop a mutual relationship with the nurse or her care givers which will
help her to reduce her feelings of abandonment. Additionally, the person centred care also
demands competence in order positive health outcomes, as well as increased confidence in
the ability of the family for providing care which would also indicate that the person centred
care is taking place.

7PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
The senses framework
In terms of the care of older people like the one mentioned in the care study, the major
emphasis should be on the service development which will help in reflecting the user’s
wishes and of their carers rather than that of the perceptions of the care providers. However it
has been seen that it is quite important to consider what counts for older people and their
family carers, therefore this a good quality of believe and care should be provided so that the
patients as well as the carers can be satisfied. According to (Orr, Elliott & Barbour, 2014) due
to the lack of a therapeutic rationale in regards of the work in long-term care settings in terms
of the older people, there was an identification of six Senses that was believed to be able to
show a clearer direction for staff as well as improve the care older people that they received.
Sense was a term that was selected deliberately which is able to reflect the perceptual nature
and subjective of important determinants of care both for older people and staff. The six
senses involves the sense of security, the sense of continuity, the sense of belonging, the
sense of purpose, the sense of fulfilment and finally the sense of significance. According to
the sense of security, the attention is essential for the older people in terms of the
physiological and psychological needs and in order to feel safe from any kind of threat, pain,
harm and discomfort as well as to feel free from these. According to the sense of continuity
there is recognition along with value of personal biography (Mimi & Ho, 2013). In terms of
sense of belonging the opportunities are able to form relationships that are meaningful in
order to be a part of the community. The sense of purpose allows them to engage in n
purposeful activity. Additionally the sense of fulfilment and the sense of significance allows
the person to meet meaningful goals and to feel valued and recognises as a person having
worth (Van den Block et al., 2015).

8PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Part 2:
In order to complete the needs of the elderly patients and help them to get a superior quality
life senses frame work was proposed. For the sense of framework, it sees beyond the aged
individual’s medical needs and considers the other needs of the individuals so that holistic
approach is employed. Senses frameworks requires care environments where patients enjoys
the sense such as sense of security, sense of belongings , sense of continuity ,sense of
purpose, sense of achievement and sense of significance. Refereeing to the case study of
above discussed, Maria, an 80-year-old women who is a sub-acute rehabilitation patient. She
was referred to the psychological evaluation due to the depression. She experienced
cerebrovascular accidents and her biggest health concern is urinary incontinence. Therefore, a
care plan can be designed considering the health concerns such as cerebrovascular accidents,
depression and urinary incontinence with the help of the sense frame work in order to provide
health life. The care plan is following:
Need Goal Nursing
interventions
Rationales
1. restoring the
function after
cerebrovasvular
accidents
Short term goal :
To improve the
individual’s level of
functioning so that
they can become
independent and
take initiative for the
self-care.
1) Monitoring and
diagoniss of the
factors that
contributed to the
immobility of the
patient.
2) Walking in the
park for three times
a day with the help
1) According to
Østbye et al., (2013),
this intervention
would help nurses to
identify the
causative factors that
causes the
cerebrovascular
accident.

9PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Link to senses :
Referring to the
above case study,
Maria needs a sense
of purpose. She
needs a goal aspire
along with
purposeful activities
and challenging per
suites. Since few
days back the patient
had suffered from
right frontal lobe
cerebrovascular
accident (CVA) due
to which she
developed a left-
sided hemisphere
sense of purpose
would provide her
purpose ful
activities.
of nurses would
manage her problem
related to the
cerebrovascular
accidents.
3) Motor skill
exercises in order to
restore the normal
functioning so that
she gain her
independence again.
4) assisting with the
activities of the
hygiene , toileting
and fooding.
2) According to
Knodel et al, (2015),
walking in the park
would help her to
restore her normal
functioning.
3) According to
Mimi & Ho (2013) ,
motor skill exercises
is the best for
restoring physical
functioning since it
strengthen muscles
4) According to
Alligood, (2013), it
is excellent for CVA
patients since it
provides the
personal hygenie
and reduce the
complications of the
patients.
2. mange depression Short term goal : 1) Provide a safe 1) According to Ng,

10PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
and anxiety
Short-term goal for
the patient is
managing depression
and anxiety for
physical and mental
well-being of the
patient. This would
manage her
depression and boost
her self-esteem and
provide sense of
independence.
Link to senses :
Of six sense, sense
of security relevant
to the patient Maria
as observed in this
case study
environment to the
patient in order to
reduce the sense of
insecurity and
decrease the anxiety
and depressions.
2) Professional
therapist can be
appointed to treat the
anxiety and
depression at the
same time. These
therapy includes
cognitive behavioral
therapy which would
help her to adjust her
thoughts nad actions
with the help of the
professional.
3) Anti-depressants
such as serotonin
reuptake inhibitor
can be administrated
for immediately
reduce the
(2014), providing a
safe environment to
the patient is
essential in order to
manage anxiety and
depression. The
providing safe
environment would
give her a sense of
security since she
lives alone and feel
abundant frequently.
2) According to
Ramjaun et al.,
(2013), cognitive
behavioral therapy is
effective to reduce
depression.
Cognitive behavioral
therapy would help
her to adjust her
thoughts and behave
accordingly.
3) According to
Vaingankar et al.,

11PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
depression and
anxiety of the
patient.
4) Motivational
therapy can be
arranged for the
patient for
improving the
communication
skills and boosting
the self-esteem of
the patient.
(2016),
antidepressant has
effective short term
effect since it reduce
the depression and
anxiety within short
time span. However,
it has a side
psychological
effects.
4) According to
Nyunt et al., (2015),
motivational therapy
is effective for
reducing the
depression,
especially for the
elder patient. It
would provide to
build strong social
network with the
surroundings and
community
members.
3. Managing the Short term goal : 1) Bladder training All of these

12PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
problem related to
the urinary
incontinence.
Reducing the urinary
incontinence of the
patient
Link to sense :
Sense of
significance related
to Maria. Since she
had urinary
incontinence, she
felt worthless.
Management would
provide her a sense
of worth.
after delay urination
after you get to the
urge to go. This time
is useful managing
the patient.
2) Double voiding
would help people to
empty the bladder of
the patient.
parameters will help
determine the
adequacy of the
urinary
tract function (UTI).
With the practise of
decreased fluid
intake even during
the several hours
before bedtime will
be able to decrease
the urinary retention
incidence as well as
the overflow
incontinence thereby
promoting some rest.
Appropriate use of
undergarments can
be helpful in
diminishing the
embarrassing aspects
of the occurrence of
urinary incontinence
The increase in the

13PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
3) Treat leakage
around the catheter
by eliminating the
leakage.
4) Fluid and diet
management for the
patient.
amount of fluids
during the day will
be able to increase
urinary output
and thereby
discourage that
bacterial growth.
Additionally the
consumption of
alcohol, coffee, and
tea tends to have
a natural diuretic
effect and which acts
as the bladder
irritants
Conclusion
In conclusion it can be mentioned that the government of Singapore has taken commendable
steps and has shown to have a great foresight regarding the health care needs of the older
people in terms of the f demographic shifts as well as the mapping of health care that has
remained an elusive problem. Although there have been rise of some problem due to the
aspect of social engineering mentality that is generally associated with demographics. This
demographics leads to the social policy plans that is involved in failing to recognise the fact
that ageing itself is a diverse experience, which is other than the varying by race, race,

14PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
religion and income. For provision of effective care to any of the group of patients involves
being responsive to both their physical and emotional needs. Most of the patients want a care
that is what an individual deserves and which should be unique for then patient. There are a
diverse group of individuals who comprise of the elderly group which are related to the
disorders of age. There are also certain spans a continuum which are required only on the
minor adaptations along with the modifications which require the major one. This depends on
the status of health of the individual. In order to provide care often educational interventions
are also required. The circumstances of the individual older person along with his or her
family as is experienced in the private sphere of the home or is shaped in many of the senses
by the public sphere. This is generally demonstrated by the amounts which is available in
Medisave and Medishield that can be taken out. There is also a need to match the needs of the
older persons with their families. This not just exists as commodified services which tends to
require a high amount of institutional processing or red tape. For the better welfare of its
people, Singapore must be able to recognise the value of integration of the private and the
public spheres in a better way.
It can also be deduced from the case above that the older adults who suffer from CVD tend
become more dependent over time where there often rely on their families to support them
during their deficits. However in the absence of the family, most of the time the patients rely
on their care givers for support. On this term, there is the application of the various models of
health care like the ageing theory, the nursing theory as well as the senses framework. These
theories help to describe the ageing population on the context of the location of the
population, the identification of the theories also help to distinguish among the major
characteristics of the ageing population. Similarly there is also a differentiation of the
gerontologic approach from a geriatric approach in caring for the elderly. It also can
recognise the factors which is important to the delivery of effective care for the elderly. Most

15PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
of the health care professions are most of the time noticeable for nursing. Additionally there
is occupational and physical therapy, have recognized their role in the treatment of the
elderly.
References
Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health
Sciences.
Chan, A., Malhotra, C., Malhotra, R., Rush, A. J., & Østbye, T. (2013). Health impacts of
caregiving for older adults with functional limitations: results from the Singapore
survey on informal caregiving. Journal of Aging and Health, 25(6), 998-1012.
Chan, A., Malhotra, C., Malhotra, R., Rush, A. J., & Østbye, T. (2013). Health impacts of
caregiving for older adults with functional limitations: results from the Singapore
survey on informal caregiving. Journal of Aging and Health, 25(6), 998-1012.
Chandran, M., Tan, M. Z. W., Cheen, M., Tan, S. B., Leong, M., & Lau, T. C. (2013).
Secondary prevention of osteoporotic fractures—an “OPTIMAL” model of care from
Singapore. Osteoporosis International, 24(11), 2809-2817.
Feng, L., Nyunt, M. S. Z., Feng, L., Yap, K. B., & Ng, T. P. (2014). Frailty predicts new and
persistent depressive symptoms among community-dwelling older adults: findings
from Singapore longitudinal aging study. Journal of the American Medical Directors
Association, 15(1), 76-e7.

16PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Knodel, J., TEERAWICHITCHAINAN, B. P., Prachuabmoh, V., & Pothisiri, W. (2015). The
situation of Thailand’s older population: An update based on the 2014 Survey of
Older Persons in Thailand.
Mimi, M. Y., & Ho, S. S. (2013). Pain management for older persons living in nursing
homes: a pilot study. Pain management nursing, 14(2), e10-e21.
Ng, R., Chan, S., Ng, T. W., Chiam, A. L., & Lim, S. (2013). An exploratory study of the
knowledge, attitudes and perceptions of advance care planning in family caregivers of
patients with advanced illness in Singapore. BMJ supportive & palliative care, 3(3),
343-348.
Ng, T. P., Feng, L., Nyunt, M. S. Z., Feng, L., Niti, M., Tan, B. Y., ... & Yap, K. B. (2015).
Nutritional, physical, cognitive, and combination interventions and frailty reversal
among older adults: a randomized controlled trial. The American journal of
medicine, 128(11), 1225-1236.
Ng, T. P., Feng, L., Nyunt, M. S. Z., Larbi, A., & Yap, K. B. (2014). Frailty in older persons:
multisystem risk factors and the Frailty Risk Index (FRI). Journal of the American
Medical Directors Association, 15(9), 635-642.
Ng, T. P., Feng, L., Yap, K. B., Lee, T. S., Tan, C. H., & Winblad, B. (2014). Long-term
metformin usage and cognitive function among older adults with diabetes. Journal of
Alzheimer's Disease, 41(1), 61-68.
Ng, T. P., Jin, A., Feng, L., Nyunt, M. S. Z., Chow, K. Y., Feng, L., & Fong, N. P. (2015).
Mortality of older persons living alone: Singapore Longitudinal Ageing Studies. BMC
geriatrics, 15(1), 126.

17PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Nyunt, M. S. Z., Shuvo, F. K., Eng, J. Y., Yap, K. B., Scherer, S., Hee, L. M., ... & Ng, T. P.
(2015). Objective and subjective measures of neighborhood environment (NE):
relationships with transportation physical activity among older persons. International
journal of behavioral nutrition and physical activity, 12(1), 108.
Orr, L. C., Elliott, L., & Barbour, R. S. (2014). Promoting family-focused approaches within
adult drug services: The potential of the ‘Senses Framework’. International Journal
of Drug Policy, 25(5), 888-896.
Østbye, T., Malhotra, R., Malhotra, C., Arambepola, C., & Chan, A. (2013). Does support
from foreign domestic workers decrease the negative impact of informal caregiving?
Results from Singapore survey on informal caregiving. Journals of Gerontology
Series B: Psychological Sciences and Social Sciences, 68(4), 609-621.
Østbye, T., Malhotra, R., Malhotra, C., Arambepola, C., & Chan, A. (2013). Does support
from foreign domestic workers decrease the negative impact of informal caregiving?
Results from Singapore survey on informal caregiving. Journals of Gerontology
Series B: Psychological Sciences and Social Sciences, 68(4), 609-621.
Ramjaun, A., Nassif, M. O., Krotneva, S., Huang, A. R., & Meguerditchian, A. N. (2013).
Improved targeting of cancer care for older patients: a systematic review of the utility
of comprehensive geriatric assessment. Journal of geriatric oncology, 4(3), 271-281.
Sitar, M. E., Yanar, K., Aydin, S., & Cakatay, U. (2013). CURRENT ASPECTS OF
AGEING THEORIES AND CLASSIFICATION ACCORDING TO
MECHANISMS. Turkish Journal of Geriatrics/Türk Geriatri Dergisi, 16(3).
Vaingankar, J. A., Chong, S. A., Abdin, E., Picco, L., Jeyagurunathan, A., Zhang, Y., ... &
Subramaniam, M. (2016). Care participation and burden among informal caregivers

18PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
of older adults with care needs and associations with dementia. International
psychogeriatrics, 28(2), 221-231.
Van den Block, L. (Ed.). (2015). Palliative care for older people: a public health perspective.
OUP Oxford.