Nursing Care for Older Adults: Ethical and Professional Values

This report explores the vulnerability of older adults and the nursing interventions required to provide quality care. It emphasizes the importance of informed consent, highlighting the ethical principles that guide nursing practice, particularly when patients lack decision-making capacity. The report discusses the role of surrogate decision-makers and the need to balance patient autonomy with their best interests. Additionally, the assignment underscores the significance of health education in promoting healthy aging and addressing physical and psychological changes associated with old age, such as cognitive impairment and decreased self-esteem. Tools used in community nursing settings, such as the Health Needs Assessment and Whooley depression tool, are mentioned for their role in identifying and addressing vulnerabilities. The report advocates for a compassionate and empathetic approach to empower older patients and improve their quality of life, ensuring they receive the best possible care.

Running head: VULNERABILITY IN OLDER PEOPLE
VULNERABILITY IN OLDER PEOPLE
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Introduction:
Advancements of the medical science and different scientific inventions made in
technological world for the healthcare centres have helped to increase the life expectancy of
people in different nations. Old age is usually accompanied by several health challenges, in
comparison to other stages of an individual’s life. However, modern health facilities and
medicine are most often endowed with qualified professionals in the area of healthcare, in
addition to presence of adequate medical resources and apparatus, which help in eliminating
diseases and ailments and increase the longevity of old people (Gyamfuah et al. 2015).
increasing the life expectancy of older people in turn remains associated with certain negative
attributes. Although they are living for longer days, different forms of chronic disorders affect
them (SanJose et al. 2015). In some of the situations, it is even seen that older people get affected
by more than one chronic disorders that are termed as ‘co-morbid’ or ‘multi-morbid’ situations,
by healthcare professionals. Older people generally suffer from multiple medical problems and
no single medical concern can be treated or evaluated in isolation. Search multi-morbidity or
coexistence of more than two chronic conditions are quite prevalent among older people, which
in turn is associated with an elevated risk of disability, poor quality of life, adverse drug events,
and poor functional status (Salive 2013). Therefore, it becomes important for nursing
professionals to provide them care, by utilisng their ethical and legal competencies. Moreover,
the care that should be provided to them should be evidence based so that the best form of
quality care is assured to them to develop their mental and physical health condition. Su et al.
(2016) suggest that the older population have not traditionally had access to clear health
promotion advice. This omission on the part of health professionals has led to the vulnerability of
the older patients. Several crucial problems are related with old age such as, a sense of

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helplessness, low self esteem, powerlessness, and poor self efficacy that are often inadequately
addressed by the existing care services and interventions. All healthcare professionals must take
efforts to empower older patients, through which the latter will gain self-determination and
control over self management of healthcare. This can be facilitated by excellent communication
between patient and staff, and delivery of patient-centred care services (Selman et al. 2016).
Therefore, this assignment will illustrate the nursing professional values and interventions that
professionals need to take to care for vulnerable old patients to ensure them better quality life.
Informed consent of the older people:
Before proceeding into the topic if the importance of informed consent for the old
vulnerable patients in the wards, it is important to enlighten the main concept of informed
consent. Informed consent is one of the most important ethical principle that very nursing
professionals need to follow in order to protect human rights of the patients and to ensure high
quality patient satisfaction. Healthcare professionals need to provide information to the patient
about any particular treatment that is being administered to the latter (Hoffman and Delmar
2015). In other words, granting permission in full knowledge of possible consequences of a
proposed treatment, following a complete explanation of its purpose is known as informed
consent (Cohen 2013). They should provide adequate information, which in turn help all patients
gain a deeper understanding of the benefits and probable side effects of an intervention,
following which the service users can decide on taking or refusing the proposed intervention.
Pasina et al. (2014) argue that establishing informed consent for all aspects of nursing care
ensures that nurses practice in an ethically competent way. Such an approach can be achieved by
maintaining the autonomy and dignity of most patients, while seeking their valid and voluntary

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consent to the therapy or intervention in question. Thus, informed consent is essential for nursing
care.
Many other professionals feel that it would be a waste of time in the busy schedules to
make the old patients understand the importance of the interventions and then apply them (Grady
et al. 2015). These activities of the healthcare professionals may expose them to legal obligations
as failure to take informed consent of old patients is unethical. Besides, getting involved in legal
obligations affecting the career of the nurses, it also has negative impacts of the patients. An
incident from the clinical placement involved an older patient suffering from terminal illness,
who considered providing valid consent futile as she had become dependent on her family
members. This led to the onset of depression and anxiety about the current health condition.
Therefore, in order to ensure patient satisfaction and to keep them free from anxiety and
depression, it is important for the healthcare professionals to ensure taking informed consent
from the patient. This makes them feel empowered as they feel that their decisions are still
respected and that they have the capacity to take decisions for their own lives. However, it is not
always the healthcare professionals, who do not follow proper nursing interventions, values and
ethical principles in their professions.
Sometimes the older and venerable patient may not have the capacity to make informed
consent. I have often come across many patients who do not have capacity to make consents.
They may differ from severe mental health or physical health issues that do not provide them the
strength and capacity to understand and thereby make the correct decisions (Blumenthal et al.
2015). In such situations, I believe that the nursing professionals should be well aware of the
different steps that they need to take when such vulnerable old patients are unable to five their
consents. When the nursing professionals observed that the old patient does not have decision-

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making ability like that of in the cases of dementia and others, they should immediately try to
look for the surrogate decision maker who has the right to take decisions on behalf of her.
However, in many situations, I have also gone through experiences where I have seen that the
patients do not have capacity to make decisions . There are many situations also where I noticed
that there is also not always enough time to find his surrogate. At that time I believe that the
professionals have the right to proceed with the treatment taking in consideration that the best
intervention for saving the life of the patient is followed. In many cases, older patients are often
seen to designate a trusted loved person to make decisions on their behalf even when they are
competent to understand and take decisions or provide consents. In such situations, the
healthcare professionals’ duty is to do according to the family member’s decisions (Falcone et al.
2015). Thus, taking into consideration the decisions and preferences of the family is crucial for
delivering optimal health services.
While seeking for informed consent from the vulnerable older patients, it is extremely
important for the healthcare professionals to develop an understanding of the component that
should be incorporated in the asking of the informed consent. I believe that I should first describe
the patient with the proposed treatment of behavior with simple languages that would be free
from any technical jargons. This would ensure that the patient understand the proposed plan and
thereby knows what he is confirming (Johansen 2016). The old patient should also be made to
understand the individuals who would be performing the treatment as well as the procedures. I
have to provide the patient with the purpose, expected outcomes, benefits and possible risks of
the proposed treatment or the procedures. The alternatives should be also discussed along with
the benefits and risks of the alternatives of the proposed treatment. The client’s right to refuse the
treatment the proposed treatment or the procedures should be ensured (Betancourt et al. 2016).

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The older persons have the right to refuse the treatment but healthcare professionals should be
able to recognize the vulnerability of the patient that is whether the patient is refusing the
treatment due to fear and anxiety. I believe that proper compassionate and empathetic approach
is significant in empowering the patient in assuring quality life. By this, nurses need to save the
lives of the old patients and give them chances of better living. The tool commonly used in
community nursing settings include the Health Needs Assessment tool, which is a systemic
approach aimed at ensuring optimal utilization of health services for improving the health of the
population. This tool is generally used for gaining a sound understanding of the wants, expressed
and unexpressed needs of the patients (Ewing et al. 2013). Use of this tool therefore helps in the
identification of an effective intervention that can meet the needs of the patient, thereby
improving the overall health. Vulnerability of older adults are also measured by the Whooley
depression tool in community settings. It helps in indicating presence of depressive disorder in
the patients, thereby helping in their treatment (Colquhoun et al. 2013). Fall risk assessment tools
are also utilized for screening older patients at a risk of injurious falls. Both of these tools were
used in the community practice that helped to identify an estimated 12 older adults, who were
vulnerable. Thus, in addition to taking appropriate measures for obtaining informed consent from
the patients, efforts must be taken for enhancing health education and improving health literacy.
Health education:
Healthy aging is an important criterion that every aging individual should develop a
concept. The concept of health aging is mainly seen to optimise the various opportunities for
developing good health of the patients so that they not only can age well. This attribute also
helps old individuals to take active part in the society and at the same time enjoy an independent
as well as high quality life. In order to prevent old individuals from being a burden, it is very

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much essential for themselves to develop knowledge about the different activities that would
ensure healthy habits and healthy ways of living (Wang et al. 2015). As individuals age, they
become exposed to different types of physical changes like that of the degenerative changes
which may occur in hearing, seeing, feeling and responding skills. Moreover spatial variability,
motor coordination as well as mobility are also hampered most body systems may get affected
(Stenholm et al. 2014). While some of the procedures are normal steps of aging, some of the
physical disabilities occur due to unhealthy practices in the previous years (Ravi et al. 2016). For
examples, excessive smoking habits throughout life may lead to cardiovascular disorders in the
old age. Moreover, excessive alcohol drinking contributes to development of liver cirrhosis
issues, high blood pressure and many others. It has also been found that improper food and diet
might result in occurrence of obesity affecting lives. Besides, physical changes in health
psychological changes take place in old patients making them vulnerable to modifications of
perception and memory, learning as well as problems solving sense of self and personality,
psychological state and attitude, problems with memory and many others (Bibas et al. 2014).
Due to all these changes, some older adults might suffer from poor self-esteem and a decrease in
sense of fulfillment. Confidence is lost and the satisfaction of living better quality life is affected.
Therefore, with proper health education, old patients who are vulnerable to develop the issues
can uptake activities that would ensure healthy aging and reduce their suffering from any mental
health issues.
This can be explained with the help of an example. Many old aged individuals remain highly
vulnerable to develop mild cognitive impairment such as, diminished spatial orientation,
decreased numeric ability, and loss in verbal memory, slower inductive reasoning and changes in
verbal ability. The mental functions get affected that in turn affect the daily activities of life

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(Wilson et al. 2013). Healthcare professionals mainly state that regular physical exercises,
having diet of omega 3 fats, a diet low on fat but rich in fruits and vegetables as well as
intellectual stimulation are some of the ways by which mild cognitive impairment can be
declined (Kvedar et al. 2014). Effective social engagement and memory training are also
essential parts that prevent such form of disorders. Hence, if patient performs all the mentioned
activities after developing good knowledge about prevention of such disorders, such issues
would not affect them. However, the same activities are also curative in nature and when
healthcare professionals can educate a vulnerable old patient of mild cognitive impairment with
the mentioned activities, the individuals can gradually develop better life. However, I have
realized from my own experiences that providing education to an elderly patient is not that easy
as different forms of barriers may rise.
Vulnerable old patients may have visual impairments, sensory losses, hearing deficiency,
deficiencies in smell and taste, in sense of touch as well as mental illness besides having chronic
disorders (Silver et al. 2015). Therefore, I need to know the proper techniques by which
vulnerable old patients would be provided health literacy. I should maintain a positive and
patient attitude and should treat the older patient as intelligent and capable of learning. This
would encourage them and empower them to develop knowledge that would help them to modify
their lifestyle and habits. The professionals should take few minutes for effective talking and
problem solving sessions before they begin teaching. They should also identify the significant
cultural as well as social factors that may affect the teaching as well as learning procedures of the
vulnerable old patients. The professionals might apply different types of tactics so that they can
accommodate the disability that is affecting their learning process (Bujnowski et al. 2014). For
examples, I can encourage the patient to use glasses for overcoming the barriers of visual

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impairment or using of hearing aids in order to overcome the hearing issues. While teaching I
should try to assess the space by which the patient is absorbing the instructions. I should stop if
the old patient feels stressed or tired. I should be very careful to fear the duration as well as
frequency of the teaching to match the learning ability of the patient so that the patient does not
feel stressed (McGee et al 2016). I should make sure that the patient has understood what is
being taught by repeating the sentences for clarity and asking for continuous feedback. In
addition to health education, there is a need to implement evidence based practices in nursing for
ensuring overall health and wellbeing of all patients in the community.
Evidence based practice in nursing:
Evidence based practice or the EBP can be defined as the process of making clinical
decisions by which the healthcare professionals are able to select a particular intervention that
remains based upon different evidence. This procedure also remains combined with clinical
experiences as well as patient experiences. This is the most important activity by which the
healthcare professionals become successful in choosing the most up-to-date intervention and care
services. A nursing professional is also a human being and she might not have knowledge in all
aspects of healthcare (James et al. 2014). Nursing professionals mainly need to ask themselves
five important steps in order to search the correct papers and thereby try to find answers in the
filtered papers. The first step is asking a question that needs to be resolved to develop knowledge
and provide the best care to patients. The second step is to find proper information or evidence so
that proper answer can be found. This is done by inserting the correct keywords in the different
databases and thereby finding proper and up to date articles that help to provide information. The
third step mainly comprises of appraising the information present in the articles critically and
thereby developing ideas that the information can be held valid and authentic or not (Grrenhalgh

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2014). The fourth step is mainly used to integrate different types of appraised evidences with
their own clinical expertise and thereby meeting the preferences of the patients. The last step is
proper evaluation of the result that the nurse gets after he or she applied the evidence-based
practice in his own treatment plans. In case of vulnerable old patients, there are various types of
disorders with which patients are admitted or need help to overcome the disorder. Appropriate
implementation of the steps would improve the quality of life of the patients. Therefore, I should
always have the capability to develop my practices on a continuous basis so that the best quality
care is provided to patients ensuring their speedy recovery.
Most of the old patients suffer from poor functioning of the motor skills for which they
both have complete loss of mobility and restricted mobility in their lives. As a result they
become highly prone to fall that may result in fractures or pain in the affected areas. It also has
the potential to result in threatening situations resulting in even death of the old patients (Wright
et al. 2014). Moreover, it is also seen that such restricted mobility makes them go through
various kinds of psychological and social problems that result them to live poor quality lives. It
is mainly seen that they develop depression due to loss of independent activities. As they become
dependent on other people for their activities of daily life, they may feel loss of self-esteem,
confidence as well as feel social isolated, as they cannot interact with the society. Therefore, in
order to develop the condition of the patient, I might need to gather knowledge about the
interventions that they could apply to develop to prevent the patients from falls (Rantakokko,
Mänty and Rantanen 2013). Therefore, I would be searching the databases in order to find out
information and develop knowledge by which professionals should be able to provide high
quality care to patients (Jensen et al. 2015). After finding out the different papers about
interventions that can be applied to older patients who are vulnerable for fall, I would then need

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to critically analyze the level of evidence of the paper on falls. There are several levels of
evidences that are followed by healthcare workers.
The first level of evidence or the systematic reviews is the most trusted and the best level
of evidence that should be given the first priority by the healthcare professionals. This is then
followed by the second level of evidence which are the randomized controlled trials [RCTs],
Level III or the Quasi-experimental studies, Level IV or Non-experimental studies, Level V or
Care report/program evaluation/narrative literature reviews and Level VI or opinions of
respected authorities/consensus panels. With the help of these, the professionals would be able to
distinguish the level of priority for the articles and hence select the best of them. For examples,
the professionals came across papers that describe the various ways of effective assessment and
management of the falls would be selected an incorporated in their own studies (Benetps et al.
2015). I would undertake assessment and documentation of the different types of intrinsic risk
factors, assessment as well as documentation of the extrinsic risk factor as well as patient care
environment. This can be facilitated by utilizing fall risk assessment tools for the older adults
such as, the Falls Efficacy Scale and the 8 steps in Responding to a Fall tool, which in turn
would help me identify the likelihood of an older patient from suffering injurious falls
(Halvarsson, Franzén and Ståhle 2013). Individualized post fall assessment as well as physical
assessment following fall of the patient would be ensured and additional safety precaution by
specialist can be also used. I would also take efforts to conduct an extensive search of evidence-
based literature to gather information on fall risk assessments for the geriatric population.
Therefore, I can go through the evidences to select the best interventions and hence bring out
ways for effective treatment (Townsend and Moragn 2017). While some literature might provide
guidelines for undertaking multidisciplinary plan of care for fall prevention, others might focus

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on the basic attributes of staff education on fall prevention steps. I would also implement a
nursing model theory that would facilitate the delivery of healthcare services and enhance my job
satisfaction.
The Roper-Logan-Tierney Model for Nursing:
This is often referred to a nursing theory that is based mainly on the activities of daily
living that are referred to as the ADLS. The healthcare professionals are mainly seen to use this
as a mode of checklist to determine the ways by which lives of vulnerable old patients have
changed due to illness, injury as well as admission to a hospital. It plans for increasing not only
independence of the patients but also develops quality of the life of the patients. Many of the
researchers say not to only use as the checklist but rather as the nurse’s approach to that of
organization of the care for old vulnerable patients. There is a need to make evidence based
changes in the care plan.
I can look at the changes of the dependence- independence continuum so that they can
correctly evaluate whether the person is improving or not and thereby make changes to the care
style based on the evidence provided. The different activities that are listed in the theory is the
maintaining a safe environment, communication, breathing, eating and drinking, elimination,
washing and dressing, controlling temperature, mobilization, working and playing, sleeping
(Boltz et al. 2016). It is expected of us to determine the performance and knowledge of the
patients in these twelve aspects to determine the health status of the situation. This theory also
states that there are five important factors, which influence the activities of daily living. These
factors are mainly seen to be incorporated in the theory of nursing model is developed. If the five
factors are not incorporated, the resting assessment that in ultimately received is considered to be