Developing a Culture of Care: Geriatric Nursing Practice Report

This report analyzes the evolution of care within the XYZ healthcare center, specifically focusing on geriatric nursing practices. It begins with an introduction to the advancements in healthcare and increased life expectancy, highlighting the need for improved quality of life for the elderly. The report then outlines the shift from a biomedical model to a bio-psycho-social model of care, emphasizing its positive impact on patient satisfaction and overall health outcomes. Findings from observations of nurses and interactions with patients and caregivers are analyzed, revealing both positive aspects like compassionate care and negative aspects such as time constraints and patient dissatisfaction with communication. The report delves into the current caring culture, identifying factors contributing to patient dissatisfaction and emphasizing the importance of geriatric nursing attributes. The analysis includes a detailed case study of a patient and recommendations for improving care, suggesting that the healthcare center should focus on comprehensive care and address the patients' emotional needs and include them in decision making. The report concludes with a call for healthcare professionals to prioritize patient-centered care and improve the quality of life for geriatric patients.

Running head: DEVELOPING A CULTURE OF CARE
DEVELOPING A CULTURE OF CARE
Name of the student:
Name of the university:
Author note:

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Introduction:
With the advancement in the medical field along with the scientific innovations and
technological revolution, it has now been possible to save lives of huge number of people. Many
of the individuals who previously faced premature death or suffered due to severe acute as well
as chronic disorders are now been able to be saved by the healthcare professionals (Catteau et al.
2016). The medical advancement has thereby helped in extending the lifespan of individuals
allowing them to live for larger number of years. When data was collected in the year 2014 to
2016. It was seen that the life expectancy at birth for males is 80.4 years while that of females
are 84.6 years. It was seen that in the past 10 years, life expectancy has increased by 1.7 years for
males as well as 1.1 users for females. The life expectancy has increased from 47.2 in males and
80.8 years in females from the year 1881 to 1890 in such great extent. However, although the life
expectancy has increased and modern healthcare are enabling people to love for long, but the
quality of life of the aged people has not evolved at the same pace (Vanderberg et al. 2017). It
was found that a huge number of old individuals of the nation are suffering from different types
of chronic disorders that may range from obesity, arthritis, diabetes to many others like
cardiovascular disorders, hypertensions, loss of mobility and falls, constipation and many others.
Dementia, Parkinson disorders, delirium, depression and many others are also seen to be
associated with them. Often almost of the old age people are seen to suffer from co morbid
situations that make their lives with difficult, dependent and of poorer quality. Therefore, it
results in huge pressure on the different healthcare professionals working in the geriatric wards,
as such patients are not only higher in number in comparison to other specialties but also require
long term care (Boltz et al., 2016). All these put extra pressure on the geriatric department nurses
to meet the standards and provide the best quality care for the patients. This assignment would

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show how changes are tackling place in the department of the Xyz healthcare centre and further
recommendations that would help in development of service.
Overview of specialty area of nursing practice and highlighting of the changes:
The XYZ healthcare center provides care to geriatric patients who mainly get admitted
here due to various chronic disorders. The healthcare professionals working here provide
compassionate as well as empathetic care to the patients trying their best to develop their quality
of life. Over the past decade, the healthcare centre has been able to manage a number of changes
that had been found to have positive effect on the heath of the geriatric patients (Wilson et al.,
2017). The most important change that had been initiated is the geriatric department is the
gradual shift of the biomedical model of healthcare and nursing to that of the bio-psycho-social
model of nursing. Researchers have stated this to be one of the most important models that the
healthcare professionals should include in their care because evidence stays that this model of
care has higher patient satisfaction and even positive outcomes on the health of the individuals.
Previously, the nursing professionals used to follow the biomedical model of care (Sun et al.,
2017). This model of care mainly focuses on the different physical as well as the biological
aspects of the old patients. Doctors and other healthcare professionals only provide importance to
cure, diagnosis and treatment of the disorders of the patients. However, such model of care was
not helping to provide best quality health to the patient. Many researchers are of the opinion that
such a model of care can never influence the culture of safety and compassionate care in the
healthcare centers (MewShaw et al., 2017).
This type of care that was previously conducted by the nursing professionals used to
ignore the view that health as well as illness is relative and they are socially constructed.

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Therefore, only caring about biological determinants may not ensure successful social life and
mental; stability. This model of care made the nursing professionals suggested that health
problems are individual and thereby they used to ignore the social factors that could lead to
illness. This model of care focused too much on treatment and therefore used to provide much
significance of medical interventions only. Therefore, the healthcare provided to the patients was
half hearted and they never used to completely recover from ill health. Their disorders were
properly controlled but often the disorders used to return back resulting in readmissions, loss of
finance and higher level of suffering (Brody 2017). With the advancement of the new health
professional leaders, the healthcare section of the geriatric department had gone under changes in
pattern of providing care and developing better models that would ensure best quality life of the
professionals. In order to ensure that the old aged patients get the highest quality care, the bio-
psycho-social model of care was advised by the leaders to be taken up by the healthcare
professionals. This is the model of care which actually follows a conceptual framework that
mainly includes the improvements of the patients in both the sectors of healthcare as well as well
being. This is mainly done by directing the efforts of the healthcare professionals towards
effective addressing of the social, economical as well as environmental determinants of the
health. This model is mainly based on the understanding that in order to achieved health gains of
the patients, social, economic and different environmental determinants must be addressed. The
nursing professionals understood that old aged patients go through different emotional as well as
mental and physical turmoil that make them stressed and results them to be dependent. Such a
feeling of dependency and being burden on others affects their mental stability (Pierre and
Conley 2017). Therefore, the nursing professionals of this organization ensured that they are
getting holistic care that helps in developing a connection of the mind-body-spirit-emotion-

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environment. This helped to empower patients, allowed them to determine the needs, and
accordingly provide treatment. Therefore, the change from biomedical model of care to the bio-
psychosocial model of care ensured better health outcomes of the patients and they were found to
be more satisfied by the comprehensive treatment that was conducted for them.
Analysis of the findings from observation or from stories of patients and caregivers:
After thorough observation of the attitudes and behaviors of the nurses with the
caregivers, a number of both positive as well as negative points had been noted. The main
positive aspects that were noted was that the healthcare professionals were kind, caring,
affectionate and compassionate in their approach to the patients. It was seen that the nursing
professionals used to take a holistic approach where they used to conduct detailed analysis of the
social as well as financial backgrounds of the patients along with effective handling of the
biological determinists of health. One of the old patients was found to be satisfied by their
approach who was suffering from hypertension and cardiac disorders. He stated that not only the
nursing professionals ensured him proper medications but also analyzed the social determinants
(Nakagawa et al. 2014). The professionals found out that he has to face huge stress due to
financial issues for which he smokes and drinks a lot. He also has to care for his ill wife and
therefore cannot go for exercises and physical activities that are resulting him to put on weight.
Moreover, he is seen to live on canned food as he is not able to cook due to his instable gait.
Therefore, he has become socially excluded and to cut out boredom he drinks alcohol and
smokes tobacco (Erikson and Salzamnn 2017). Therefore, after analyzing this, the nursing
professionals were seen to develop a detailed care plan where they had advised the patient proper
diet plan, cognitive behavioral therapy for overcoming alcohol and tobacco abuse, referred to a
governmental aide for financial stability, provided a caregiver for her patients and educated him

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about the importance of freshly cooked food. He was asked to visit the community clubs on
weekends and were advised to conduct fall risk assessment. This ensures addressing social and
psychological determinants as well. However, some of the patients were seen to complaint about
another factor that included the behaviors and attitudes of the nursing professionals. The patients
said that the nursing professionals do not provide enough time to them and are always in a hurry
(Wessel 2015). They mainly put more focus on completing their interventions rather than
communicating with the patients or sharing their pain. The patients have stated that they feel
very lonely in the healthcare centers, as they do not have anyone to share their concerns or the
things that they are feeling. They stated that they sometimes feel depressed and want to go back
to their homes. It was seen that the patients had no complaints about the clinical part of the care
that they were receiving but was somewhat unsatisfied about the caring attitude of the nursing
professionals. One of them was seen to be stating “I believe that we have lots of issues regarding
their health and these might make the professionals tired of us. We have nothing in our hand”.
Such statements showed that the patients felt depressed about their condition and considered
themselves to be a burden on both their caregivers and the healthcare professionals. One of the
patient stated that once he had asked the nursing professionals to repeat the diet plan more than
two times as he was not being able to understand (Kaspar and Hartig 2016). The nursing
professional got irritated and told him that he would not waste his time by telling him the diet
plan and that he would tell it to his family members so that they can understand. This made the
patient feel sad and disrespected and he became gloomy thinking that he is disempowered and
dependent on others. Therefore, in a way, some important aspects were missing which did not
satisfy the patients although they were getting a bio-psycho-social model of treatment for their
health conditions. Although informed consents were taken by the healthcare members before

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they began their interventions, still the patients felt that they were not included in the decision
making as the nurses gave very little scope to express the views of the patients. When the views
were expressed, the professionals either stated that the decisions taken by professionals are more
beneficial and always override the concerns stated by the professionals (Lewis et al. 2016). They
stated that they are very busy and it is important for them to complete their work so that they can
attend all patients. Therefore, it was very important to know the reasons that resulted in
dissatisfaction of the patients although they were not able to understand the exact reasons that
resulted in such scenario.
Analysis of the current caring culture:
On close analysis, it was found that there were certain aspects that had resulted in
dissatisfaction of the patients. The main issues were that the professionals were not having
proper knowledge about the attributes of nursing that are extremely important when providing
care to geriatric patients. Geriatric patients have reached the stage of lives where they are mostly
seen to have poor quality lives due to inability of conducting their regular activities that they
used to do when they were young (Daly et al. 2015). They become more dependent on their
caregivers as their physiological systems become weak and they go through different chronic
ailments. They face issues with their mobility that greatly restricts their lives. They gradually
start to feel lonely and socially excluded and think that they can never come back to their happy
days. All such feelings make them go through different emotional turmoil that makes them
sensitive to every aspect. They expect love, care, affection, importance and prioritization from
people surrounding them and when they fail to get these they become depressed and anxious.
They feel lonely and morossed and hence they suffer deeply emotionally in addition to their
physical disabilities and suffering. Therefore, nursing professionals have to be very careful about

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their attitudes and behaviors when they are treating the patients. It was seen that the nursing
professionals failed miserably in develop “therapeutic relationship” with the patients. This term
mainly means that nurses should develop relationship with the patients that remain based on the
mutual trust and respect along with the nurturing of the faith and hope and being sensitive to self
as well as others (Liebel et al. 2015). It also involves assisting with the gratification of the
physical, emotional as well as spiritual needs of the patients through knowledge as well as skills.
Therefore, the first issue was that the professionals were not incorporating the patients and their
suggestions and decisions entirely in the care planning. Researchers state that patients should be
entitled to information that would enable them to judge their progress of their treatment and
thereby help them to make relevant decisions. The patient should be involved in partnerships so
that they can feel that the professionals are respecting their suggestions and consider their
feedback to be valuable (Bell et al. 2016). Being in the healthcare centers is a lonely experience
for patients and therefore simple reassurances that there are persons who care about the patients
and identified what he or she is going through is tremendously helpful in developing patient
satisfaction. Therefore, empathy is another attribute that nursing professionals who are caring for
the patient is important. This makes the patients feel that the professionals are genuinely feeling
and understanding their concerns and re trying their best to help them overcome them.
Development of trust as well as professional intimacy is also important attributes that are found
to be extremely important for the development of effective relationships with the patients.
Different important traits of geriatric nursing that are extremely important were seen to be
missing from the healthcare professionals (thakur 2015). The first one was that expression of
positive approach was seen to be absent which included showing of warmth, respect as well as
caring of the patients. The professionals also could not express their empathetic nature by which

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they needed to make the patients feel that they can visualize the concerns of the patients by
putting them in their one shoes and thereby can understand their pain and suffering. Being
acceptive is one of the most important criteria that is extremely important in geriatric nursing.
The professionals needed to enable patient at his or her own pace. They also need to be sensitive
to the patients where they are perceptive of the feelings of the patients and thereby avoid
threatening behaviors. The nursing professionals should not be judgmental about the patients and
hence try to make them feel comfortable in the healthcare centre. Besides the basic lack of
knowledge required for geriatric nursing, it was seen that the organization did not have proper
nurse patient ratio. The number of the patients was seen to be higher than the professionals could
handle effectively (Cooke 2016). Therefore, as the professionals were trying to serve huge
quantity of students, the quality of the care was not appropriate that would ensure better life for
the patients. The nursing professionals were being tired and burned out as the jobs were highly
demanding and needed them to be physically as well as mentally present to the service users.
This might be also another reason where the professionals were not being able to provide the best
care to the patients.
Recommendations for improvements to the caring culture:
The healthcare organization need to introduce a training session for the development of
the attributes of the nursing professionals. It is seen that although they are well aware of the ways
about how to provide bio-psychosocial model of care in their practice, they do not have proper
nursing principles that would help them to care for old aged patients. Caring for old patients
require patience, sensitivity, acceptance, compassion and empathy in a higher degree than that of
treatment of younger patients (Peterson and Munaretto 2018). Therefore, the training should be
such that it would help the professionals to understand first the psychology of the old patients

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and try to make them feel comfortable in the situation they are. The training of the special skills
that need to be present among the nursing professionals should then follow these. This training
session should be theoretical and then it should be followed by the practical sessions by expert
nurses who have worked in geriatric nursing. Being congruent, unambiguous, positive, strong,
secure, empathetic, compassion, accepting, sensitiveness and being non-judgmental are some of
the major traits that need to be leant. They should be discussed about the importance of
therapeutic relationship and how this should be ensured in the care culture of the patients.
Another important initiative that needs to be taken is by the human resource department of the
organization (Mody et al. 2015). They should introduce more nurses in the system so that the
nurse patient ratio is apt for treating the patient in a quality manner. Moreover, the present nurses
should be counseled about their issues and concerns so that they feel that the organization is
careful about their needs and demands. They should arrange for feedback giving and receiving
sessions for this. Extra incentives and motivational strategies can be also developed for helping
the professionals cope with the stress and manage their burning outs effectively.
Conclusion:
From the entire discussion above, it is understood that geriatric nursing requires special
attributes by which they can help the patients not only to maintain their health but also to help
them lead better quality lives. It is found that bio-psycho-social model of care ensures a holistic
approach by which professionals can provide a comprehensive care for the patients by which
they can address not only the biological but also the psychological and social determinants of
health. Every professionals need to develop therapeutic relationship with old patients and ensure
their dignity and autonomy of the patients by making them feel involved in care and empowering
them properly. Also proper nurse patient ratio should be present in the organization so that

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geriatric nursing that is a highly demanding professional does not result patients in burning out
and hence affecting the care quality of patients.
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