Pediatrician's Role in Coordinating Care for Older Adults

The provided content includes a combination of academic articles, government reports, and online resources related to pediatrics, gerontology, nursing, and healthcare management. It covers topics such as functional decline in older adults, cognitive impairment, fall risk, and clinical supervision. The sources include peer-reviewed journals like BMC Geriatrics, The New England Journal of Medicine, and International Journal of Older People Nursing, as well as reports from the Australian Institute of Health and Welfare and the Australian Nursing and Midwifery Council.

The Older Person &
Supportive Care

Table of Contents
INTRODUCTION...........................................................................................................................3
Risk factors of dementia.............................................................................................................8
Impact of dementia on patients...................................................................................................9
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................11

INTRODUCTION
The growing numbers of older people are living with the chronic health and their
condition are being advert to hospitals with their actual care needs (Boltz and et. al., 2014).
There are so many approaches which have been made to bridge the practice gap between the
palliative and curative models of care. In present report, Port Haven Care Homes are considered.
In this, the role of registered nurse has been discussed to optimise the functional outcomes.
Role of nurse in enacting coordination, supervision and delegation of quality and safe functional
care
It is essential for the nurses to consider the intensity of pain so that proper medical
services can be delivered to the patients. According to the study Achterberg and et.al (2013), it
can be said that around 35 million people with dementia are living all across the world among
which 50% people experience higher pain. However, even after knowing the fact, several
patients are not treated properly. As per the study, the most promising aspect is the use of
stepped treatment approaches that leads the nurses to adopt diverse behavioural intervention
while noticing clear symptoms. Pain in dementia is analysed on the basis of changes in
behavioural aspects and it is also one of the reasons that leads helps in analysing health
complications. It is also analysed that educational and organizational shortcomings sometimes
impede the quality of care and pain management aspects.
In care homes, the registered nurse has huge roles and responsibilities towards patients
which they are accountable to fulfil on regular basis. In day-to-day life, they have to maintain the
activities which are performed by other nurses. In order to deliver quality of services they have
to make proper coordination with doctors (Bray and et. al., 2010). From the view point of
Bodenheimer, (2008), the responsibility of registered nurses is that they have to maintain record
of all individuals, monitor the patients on regular basis and many more. Sometimes they have to
consult with other service health care provider to provide best services to patients. It is their
responsibility to stay up to date that what new technology so that better services can be
delivered. With the help of new technologies the nurse can provide best care services to families
and patients and at the same time challenges and complexities can be reduced accordingly.
Through this, they will support the doctors who are involved in the care of patients.
However, the study developed by Allan and et.al, (2009), states that falls are termed are
the major causes of morbidity in dementia; hence it is crucial for the nurses to ascertain all such

risk factors that exists and that can enhance issues related to falls in older people. In such study,
179 participants (over the age of 65) were recruited from outpatient clinics. In the study, a multi
factorial assessment of baseline risk factors was performed to record all the incidents related to
falls. However, according to multivariate analyses, significant potentially modifiable predictors
are considered major symptoms of orthostatic hypotension. Thus, in terms of conclusion it can be
said that there should be appropriate management of such symptoms; hence suitable strategies
can be made accordingly. At the same time, randomised controlled trails can also be conducted
for the purpose of adopting suitable management of dementia.
Changes are coming in the role of nurses; hence they have to handle a lot of activities
multiply. They have to perform different duties so that patient will feel happy. The level of
supervision which has been provided by nurse should be appropriatebe appropriate (Bystedt,
Eriksson and WILDE‐LARSSON, 2011). The supervision is provided in two ways such as direct
and indirect. In direct supervision, the nurses are personally present and observe patientsobserve
patients and provide them with proper services. In indirect supervision, registered nurses are on
site and they make contact with others and provide reasonable access to the patients. The
Nursing and Midway Board of Australia undertakes several functions which are set by the Health
Practitioner Regulation National Law and which are also essential to be followed by the
registered nurses. NMBA has framed various laws registration standard as well as for
professional codes and also set up the guidelines. They are providing recommendations while
assuming that there is a shared responsibility between employers, department of health and
human services, professional bodies and many more (Choo, Hutchinson and Bucknall, 2010).
Delegation and supervision is always the core responsibility of registered nurse and midwives.
According to Anderson and et. al. (2012), nurses must have to develop suitable care
coordination according to the Patient- Centred Medical home in which there should be direct
communication among nurses and patients. The study states that care coordination is essential for
the nurses because that aids the nurse to become more responsible and efficient about the service
care aspects. Thus, in this respect it can be said that registered nurses should focus on delivering
quality care to the patients so that complex health aspects can be managed accordingly.
However, on the other hand according to Antonelli and et.al. (2008), care coordination activity
services are important because that aids the patients to manage all service aspects in the best

way. Proper coordination is essential so that health problems can be discussed suitably and
according to that specific action can be taken.
According to Boltz and et. al., (2014), critical nurse have to work on shift also and assess
proper medical treatments. As per view point of Ramirez, the critical nurse has to proper monitor
the hygiene condition and nutrition food given to the patients. However, according to Beddoes
and et.al. (2016), it can be said that dementia brings many changes in health aspects of a person
and at the same time it leads to alter the behavioural changes in the physiological aspects. It also
depicts that nurses are required to emphasize on proper delivery of services so that patient’s care
dimensions can be managed accordingly. The study also confronts that measuring vulnerability
to functional decline is crucial at the time of selecting appropriate participants in research and
health service evaluation. The research work has come up with the final outcomes that showcase
the validity of adoption of proper intervention in health care perspective.
According to Beth Anne Scahwamberger, it is depicted that registered nurse has to work
in both place i.e. in hospitals and clinics. Their shifts are entirely dependent upon the patients
and co-workers. These nurses have to arrive before doctors and set the clinic.
The Activities of daily living, this term is used in healthcare in order to provide self-
service to the patients.
 Bathing and showering
 Grooming and personal hygiene which include brushing, combing etc.
 The patients have to move from one place to another while performing their activities in a
proper manner. In short, it can also be considered as the functional mobility.
 Self-feeding does not include any cooking or chewing activities.
The nurse has to measure individual ability while performing the activities daily.

The aim of care homes is to build existing theories which is related is related with the
supportive care in order to support the older people. Bernstein and Remsburg (2007), the nurses
should be updated with their technologies in order to provide proper services to the services
users (Harrington and et.al., 2012). In delegation, it involves transfer of authority in which a
competent person has to perform a specific activity. In Port haven care homes, the registered
nurse provides better services to patients so that they can meet with their requirements.
Patient health status – The nurse is required to be update with the status of patients.
Through this, they can provide proper treatment to them.
Level of knowledge – The knowledge of nurse should be high. They should have
confidence skills to serve the best quality of services to the patients.
Monitored and communicate – whatever outcomes are there they have to monitor in a
proper way and analyse the results properly. With the help of this, they can get best results and
improve services also (Lyons, 2014). They are required to communicate with patients in an
appropriate manner to know about their problems. It helps the patients to properly tell about their
problems to nurses.

Legislative requirements – The Nursing and Midwifery Board of Australia has provided
the legislative requirements which have to be properly performed. Through these the services
will be provided in proper ways.
There are five rights of delegation considered by nurse such as; right activity,
circumstances, person, communication, supervision and evaluation. In health and care homes,
there are many people who are suffering from many diseases and nurse has to take care of them
properly (McHugh, Berez and Small, 2013). In care homes, there are also nurses who are non-
registered and sometimes they are providing services. The registered nurse are playing essential
role as compare with non registered staff. The following are the some list which explains the
duties and responsibilities of registered nurse.
 They observe and record the behaviour of patients.
 They coordinate with the physicians and other health care professionals for making
proper care plans.
 If they have to provide emotional and psychological support to patients then they have to
create harmonious environment.
 They have to carry out requisite treatment and medication.
 Check the stock on regular basis for which they have to maintain the inventory level and
place the order if required.
 Maintain the hygienic and healthy environment which should be comply with the health
care procedures.
According to Antonelli, Stille and Antonelli (2008), working environment plays an
essential role in offering standard services to services users. These nurses are working in
different areas but unregistered staffs are not working in different areas (Australian Nursing
& Midwifery, 2016). There mind is prepared to work for a long period of time even in
holidays also. They spend most of time in walking, standing bending or lifting. If any
patients are suffering from diseases then they are supposed to work closely in proper
manner. They also assume that there role is clinical nurse manager, labour and delivery,
patient’s educator, chief care nurse and many more.

(Source - Nursing job growth, 2017)
As per report of Bureau of Labour Statistics, it has been shown that between year 2012
and 2022, there will be growth in employment opportunities.
There are some responsibilities of professionals and recipients towards delivering best
quality of services to patients. Beddoes-Ley and et. al., (2016), the responsibilities of
professionals is to provide proper guidance to nurse; proper training should be given to them so
that they can also be updated with the new latest technologies (Registered Nurse Responsibilities,
Duties and Job Prospects, 2017). They have to also evaluate outcomes so that proper decisions
can be taken. They have also to notify in timely manner if they are unable to perform their
activities in ethical form or due to other reasons. Through this, the other people will come to
know these problems. Instead of them other people can provide proper services to customers
(Resnick and et. al., 2013). Through this, it will maintain reputation of care homes in the global
competitive market.
Risk factors of dementia
The following are the risk factors which are associated with health issues of patients.
Illustration 1: Nursing job Growth

Behavioural factors – In this, there are many patients who are suffering from various
risks such as, taking alcohol, tobacco, nutritional choice and many more. The nurse has to
understand their problems in an appropriate manner to provide them with proper treatments.
Psychological factors - In these, the factors include high blood pressures overweight
and many more; however at the same time, motivation and attitudes and beliefs is also included
in this. The patient needs motivation from their families to get well soon (McHugh, Berez and
Small, 2013).
Impact of dementia on patients
In the country there are many people who are suffering from dementia. This disease’ has
huge impact on people social, psychological function etc. In this, there are lot of people who
describe that due to this disease they are losing the confidence and are not able to cope with the
challenges (Alzheimer’s Australia, 2016). In this, the individual become frustrated, feels
stressed, suffer from pain and many more. If this situation occur than nurse have to take care of
the people properly.
In this disease, people are not able to do work properly (American Nurses Association,
2012). In this older people suffer from this disease and the registered nurse has to properly take
care of them. They have to support them and make proper conversation so that their issues can be
resolved. It is responsibility of nurse in order to provide them with best services.
According to Bystedt, Eriksson and WILDE‐LARSSON (2011), dementia also occurs
when brain is damaged by other disease. It has been observed that dementia brings several
changes in the attitude and behaviour of the person and at the same time it also affects the mental
stability of the patient experiencing dementia. Dementia is associated with varied risks and
challenges and weight loss can occur even when the normal intake of food is maintained.
Memory loss is one of the problems that appears in the case of dementia; however at the same
time problems also arise due to wasting of muscles. For instance- when the patient becomes
bedridden, it leads to development of bed sores and at the same time it also brings several other
issues in the body and muscles.
CONCLUSION
It has been concluded from the above report that role of registered nurse is important as
compared with non-registered staff. They are providing better services to patients. Nurses are

also required to focus on the daily activities of the patients. The older people need support from
nurse because they are suffering from many diseases. It is their responsibility to provide them
with proper services. In care homes, registered nurses have to perform their duties in appropriate
manner to deliver best quality of services to patients.

REFERENCES
Achterberg, W. P., & et. al., (2013). Pain management in patients with dementia. [Online].
Available through: <http://bora.uib.no/handle/1956/12347
acprof:oso/9780199554133.003.0020>. [Accessed on 18th May 2017].
Allan, L. M., & et. al., (2009). Incidence and prediction of falls in dementia: a prospective study
in older people. PloS one. 4(5).
Alzheimer’s Australia. (2016). [Online]. Available through:
<https://www.fightdementia.org.au/about-dementia/what-is-dementia/>. [Accessed on
18th May 2017].
American Nurses Association. (2012). [Online]. Available through:
<http://www.nursingworld.org/carecoordinationwhitepaper>. [Accessed on 18th May
2017].
Anderson, D. R. & et. al., (2012). Primary care nursing role and care coordination: An
observational study of nursing work in a community health center. Online Journal of
Issues in Nursing. 17(2). pp.11-3.
Antonelli, R. C., Stille, C. J., & Antonelli, D. M. (2008). Care coordination for children andyouth
with special health care needs: a descriptive, multisite study of activities, personnel
costs, and outcomes. Pediatrics. 122(1). pp.e209-e216.
Australian Institute of Health and Welfare. (2012). [Online]. Available through:
<http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=1073742294. [Accessed
on 18th May 2017].
Australian Nursing & Midwifery Council. (2007). [Online]. Available through:
<http://www.nmb.nsw.gov.au/Delegation-and-Supervision/default.aspx/>. [Accessed on
18th May 2017].
Australian Nursing & Midwifery. 2016. [Online]. Available through:
<https://www.anmac.org.au/>. [Accessed on 18th May 2017].
Beddoes-Ley, L. & et. al., (2016). A profile of four patterns of vulnerability to functional decline
in older general medicine patients in Victoria, Australia: a cross sectional survey. BMC
Geriatrics. 16 v(150).

Bernstein, A. B., & Remsburg, R. E. (2007). Estimated prevalence of people with cognitive
impairment: results from nationally representative community and institutional surveys.
The Gerontologist. 47(3). pp.350-354.
Bodenheimer, T., M. D. (2008). Coordinating care -- A perilous journey through the health care
system. The New England Journal of Medicine. 358(10). pp.1064-71.
Boltz, M., & et. al., (2014). Activity restriction vs. self-direction: hospitalised older adults'
response to fear of falling. International Journal of Older People Nursing. 9(1). pp.44-
53.
Brunero, S., & Stein-Parbury, J. (2008). The effectivenes.
Bystedt, M., Eriksson, M., & WILDE‐LARSSON, B. O. D. I. L. (2011). Delegation within
municipal health care. Journal of Nursing Management.19(4). pp.534-541.
Dawson, M., Phillips, B., & Leggat, S. G. (2012). Effective clinical supervision for regional
allied health professionals–the supervisee’s perspective. Australian Health Review.
36(1). pp.92-97.
Lyons, D. L. (2014). Implementing a Comprehensive Functional Model of Care in Hospitalized.
Nilsson, A., Lindkvist, M., Rasmussen, B. H., & Edvardsson, D. (2012). Staff attitudes towards
older patients with cognitive impairment: need for improvements in acute care. J Nurs
Manag, 20(5). pp.640-647.
Registered Nurse Responsibilities, Duties and Job Prospects. 2017. [Online]. Available through:
<http://www.topregisterednurse.com/registered-nurse-job-description-and-duties/>.
[Accessed on 18th May 2017].
Resnick, B., & et. al., (2013). Physical capability scale: psychometric testing. Clin Nurs Res,
22(1). pp.7-29.
Susan W. Muir, Karen Gopaul, Manuel M. Montero Odasso; The role of cognitive impairment in
fall risk among older adults: a systematic review and meta- analysis. Age Ageing 2012.
41(3). pp.299-308.