Compassion Satisfaction in Nursing Related to Aged Persons
SNPG903 Assessment Task 2
The present report is based on the analysis of the level of compassion satisfaction coupled with compassion fatigue within the nursing care related to aged persons in the Australia. It may be added that the older generation of older people are the asset of the society and they have done various things for the society. It may be assumed that the care of aged persons in not a service towards them, rather it may be assumed as the return of their services and sacrificed rendered by them for the sake of society. The researcher has been working in the field of aged care for about 02 years and came to know about the various issues related to it. Based on the analysis of the issues related to aged care, proposal is made for a potential project having the positive impacts on improving the compassion satisfaction as well as the human flourishing in this area of nursing care. The report includes the overview of the specialty area of nursing practice highlighting the practice changes which have influenced the nursing care from the perspective of compassion satisfaction or compassion fatigue. Further, the attempts have been made to present the evidence of analysis of the findings from observation and the stories from aged people who have been receiving care. The stories of their carers are also embedded in the report. The analysis of current compassionate culture in regards to attributes, enabling factors and consequences while using the effective workplace culture framework has also been done. The intensive efforts have been put to present the synthesis of the information above-mentioned in developing the recommendations for further improvements in the field of compassion satisfaction as well as human flourishing in current workplace cultures.
2. Critical synthesis of historical, social and political underpinnings of nursing care in regard to aged care
The aged care is also known elderly care or eldercare. It is related to meeting the needs of senior citizens regarding assisted living, day care, residential care, etc. The role of trained nurses in this field is very important and keeping the needs of the aged persons, the comprehensive consultation process was started in Australia. One of such program is CHSP which stands for Commonwealth Home Support Programme. It is the history of aged cares in Australia those governments at both the levels i.e. Commonwealth as well as state or provincial governments had agreed for joint works on aged care. Till todat there are provisions for funding and management of care of people aged 65 years and over. In case of Aboriginal and Torres Strait Islander people the age limit is 50 years and above. Apart from this, another program named My Aged Care was also launched in the year 2016 in which there is provision for referrals for health professionals including nursing staff. Going on social point of view, the aged cars is related to medical and non-medical in nature. In the medical care the requirement of skilled-nursing care is needed. The skilled nursing services are provided at the home of the patients or aged persons. The government has also enacted laws to making provision of incapacity. In this condition, when a petition is filed with court regarding the medical incapacity of a person, a board of 02 doctors or health professionals is required to make reports for evidence of incompetency. Thus, it can be seen that there is need to nursing care for aged in various stages and various walks of life and it may not be always associated with the medical care alone.
3. Relationship between human flourishing in the nursing workforce and positive patient outcomes
It is needless to say that the positive patient outcomes are definitely possible through the supportive practice environments and good nursing workforce (Figley, 2013). A research was conducted by Florence Nightingale about 150 years ago had revealed that trained nurses have the capacities of making the differences in creating the safe care environments and it improves the patient outcomes. With the change of time, the hospitals have been restructuring and reengineering various policies for increasing efficiency and reducing the costs. This is achieved by decreases in time of hospital stays, increasing nursing workloads as well as the sparse staffing, etc. The studies have revealed a large chunk of nurses are in the stage of burn-out, dissatisfied and emotionally exhausted in their job (Yoder, 2010). It can be seen that in the stage of hospital restructuring, very little attention was paid to the effects on nurse and patient outcomes. It is also important to put here that there is a close relationship in retaining a qualified nursing professionals and achievement of good patient outcomes. It has been found that the where patient satisfaction is found to be higher, nurses’ burnout levels are lower. The high levels of stress coupled with the burnout results in low job satisfaction (Wee & Myers, 2003).
4. An overview of aged care and nursing practice and practice changes influencingthe nursing care from a compassion satisfaction or compassion fatigue perspective
There are physical as well as emotional demands for patient–nurse relationship. The nurses are involved in nursing the patients with full protracted and traumatic continuumof diagnosis, the treatment regimens and the difficult management of suffering patients. It causes chronic stress on dealing nurses.Further, the compassion satisfaction is related to fulfillment by caring and overcoming the various emotional exposures that are encountered during the work (Hooper, et.al., 2010). The nurses may avoid the compassion fatigue by establishment of meaningful memories. Some nurses are able to sustain the caring capabilities inspite of heavy workpressures, exposures to dreading events as well as the multiple stresses. At nurse is exposed to burnout due to mental, physical or emotional fatigue. It happens due to job stresses (Coetzee & Klopper, 2010). It also causes the emotional exhaustion as well as the lack of personal accomplishment. These are also associated with patient dissatisfaction as well as adverse outcomes. It also causes the leaving of the profession by nurses and also the effect on personal life. If the compassion fatigue remains unresolved, it may cause the physical as well as the emotional exhaustion (Sacco, et.al., 2015). It may hinder the performance and also the patient care. A nurse suffering through the compassion fatigue is unable to nurture others, sleeping problems coupled with depression.It has been experienced in nursing care of aged persons that the aged persons have complex kinds of problems and understanding of those problems in quite necessary for the nursing staff who is involved in the care of such aged persons. Further, care of different kinds of aged persons also pose stresses on the young nursing staff who are forced to think about their own old age and consequent sufferings. All these conditions causes the fatigue and the compassion satisfaction is reduced to the great extent.
5. Analysis of the findings from observation and the stories from people receiving care as well as their carers
A federally-funded research in collaboration with Canberra University was conducted many years ago for investigating the viabilities of Nurse Practitioner (NP) model in in relation to Residential Aged Care. It formed the platform for offering the residents, staff as well as the General Practitioners the advanced levels of cares with the aim of having positive outcomes. Based on the studies and experimentations, the nursing practitioners have assisted in introduction of a streamlined medication through “sachet” system and it has resulted reduction of medication errors. It also resulted in reduction and avoidance of hospitalisations and the NPs were able to do the direct liaison with hospitals and involved themselves in intravenous therapy too. The aged persons receiving the care have revealed that when the nursing staff understands the situation and disease as well as the complications, they receive the medication comfortably and relieved of various kinds of complications.
6. Analysis of the current compassionate culture in terms of the attributes, enabling factors and consequences using the effective workplace culture framework
It is being experienced that there is shortage of nursing staff in almost all the hospitals. The nurses are compelled to perform the shift duties and the normal working hours of the nurses are increasing highly than that of prescribed working hours (Kelly, Runge, & Spencer, 2015). This expose the nurses for mental as well as the physical stresses. Besides, the hospitals and other medical care centers have tended towards innovations, but they have failed to even think about increasing the manpower/strength of the nursing staff. The excessive or long working hours for short terms and the emergency handling situation may be acceptable for shorter durations. But in the long run, it leaves permanent stress and impairs with the compassion satisfaction and leads to compassion fatigue. It has also been found that the nurses are deployed or given additional duties as in-charge of the stores of medical equipment or the equipment kept in medical wards. In the eventuality of the damage and loss of such equipment, the nursing staff incharge of that equipment has to pay from their salary or remuneration for replacement of the said equipment (Hegney, et.al., 2014). This situation leads to dissatisfaction and agony in the minds of the concerned nursing staff. It may be clarified that such situations generally occur in military hospitals. The increased workload and other things also put the nursing staff in maintaining balance in personal and professional life. All these conditions, lead to compassion fatigue and compassion satisfaction is reduced to alarming levels.
7. Integration of contemporary nursing care in the development of an evidence based clinical practice
It is needless to say that nursing staffs are in critical shortage. The Australian Department of Health and Ageing and has aimed for producing the resilient as well as sustainable nursing workforce for aged care. A special program is prepared for newly trained registered nurses working with for the cause of older people. In this program, the supervised practical experience is being given for one year in Australian residential care facilities coupled with the study of about 71 weeks specially prepared for the nurses. The name of this program is “ACGNP”. It may be further clarified that the enrolled nurses work with the registered nurses and are involved in basic nursing cares and that tasks which care less complex in nature (Willetts, et.al., 2017). The complex nature tasks are undertaken by the registered nurses because they are more qualified in nursing degree in comparison to enrolled nurses and also have the more experience of handling complex situations. Further, the graduate nurses at the level of registered nurses are supposed to have developed cognitive, communication as well as technical skills and thus they are able to analyse, evaluate and transmit the knowledge. The strength of registered nurses deployed for the aged care is about 15% of total workforce. Whereas the enrolled nurses are qualified to the level of diploma and they have the enough skill to work under the supervision of registered nurses only. To meet the demand of the workforce in the aged care, a third category of workforce in the name of the personal care assistant or assistant in nursing has been introduced. The personal care assistant is required to hold Certificate in Aged Care. It is important to note here that category of personal care assistant is deployed up to 68% workforce in the area of aged care. It is also important to add here that Aged Care Act 1997 was passed the by federal government which looks in to various aspects of working professional of aged care( Courtney, Minichiello & Waite, 1997). However, it may be added that even afterso much efforts put by the governments, there are increased signs of consumer as well as staff dissatisfaction in relation to quality of aged care. The data reveals that the numerous complaints have been filed in the areas of health as well as personal care. In spite of various steps taken, the significant gaps have been seen in knowledge and skills still of registered nurses. It cannot be denied that the graduate nurses require the desired level of competence for working at advanced levels and to manoeuvrethe environment involving the patinets and aged care team. They are also required to be involved in individual centred care planning, advanced level of assessment and analysis skills; supervision or delegation skills;clinical leadership as well as governance skills apart from the communication and counselling skills for working with aged people coupled with liaison-skills too. It has also been experienced time and again that some registered nurses are unable to deliver the evidence-based practices which they have acquired during course of their practice to the resistance caused by management. This creates practice dilemmas in case of newly registered nurses. To reduce the said situations, the concept of developing the Registered Nurses as preceptors and mentor for the graduate nurses was evolved. The program is expected to develop the facilitation as well as supervision skills and it will also explore the various methods of managing odd situations.
8. Recommendations for improvements to compassion satisfaction and human flourishing in current workplace cultures
From the above discussion, it is clear that Australia has been facing the unprecedented challenges in meeting the growing healthcare requirement of aging population. With the enhancement of medical facilities and decrease of mortality rate, the number of aged person is on increase. This is associated with the increased demand for healthcare services and it may be said that the traditional methods as well as health professionals’ styles is not sufficient to meet the changing needs. In these conditions, to improve the compassion satisfaction and human flourishing in current workplace cultures following recommendations are made:
(i). There is need of the emergence of nursing practitioners who would be able to provide the specific healthcare services. These services may be related to prescribing medications, preparing and suggesting the exact kinds of referral along with specific investigations and diagnosis. In this category of professional, the requisite educational qualification would be the master level and they should be registered with a national registration authority. It is estimated that this program will increase the compassion satisfaction of the nurses and will encourage them to attain higher education up to master level.
(ii). It has also been that there is system of health funding through government funds, public health insurance schemes. With such schemes there are provisions of gaining remunerations for the services rendered by the Nursing practitioners and the medical doctors. This may be lead to tension free treatment of the patients. But, it is necessary to put here that this Medicare Benefits Schedule contains the list of health services that are available at rebates and also the range of medications that can be prescribed. The irony of the system is that Nursing Practitioners have access to only four items whereas hundreds of items are available to the medical practitioners. The nursing practitioners also face problems in reimbursement for their services. This bias is needs to be removed and the nursing practitioners may be given access to more items and the reimbursement of their fee should be upto 100%.
(iii). It has been also seen that there is need of internal work motivation among the nursing professionals.
(iv). The hospitals as well as other workplaces, where the nursing professional are employed in work, should provide the positive work environments. This will not only to improve the quality of nursing care and but also will reduce the compassion fatigue and increase the increase the compassion satisfaction and human flourishing.
(v). There should be provisions of the earned or paid leave system where the nurses can give their mind and body a break from tough works of patient care and other complications. In case of long working hours, there may be provisions of break and subsequent mental relief to the nurses.
(vi). The nursing staff may be encouraged to enhance their education and they may be provided the sponsorship for doing so. It will result in retention of trained staff and related compassion satisfaction.
(vii). There may developed the support system for the newly graduated nurses. The necessary support may be provided by the medium of guidance and mentoring from the senior nurses, medical staff and management where they are deployed for working.
(viii). For the purpose of gaining confidence and expertise of nurses, they may be allowed to work in a single-acuity units for specific period of time and the frequent job changes should be avoided.
The roles of nursing professional in all the fields of medical care are crucial and the aged care is not an exceptional. However, it can be added that the nurses involved in aged care have more responsibilities and liabilities than other fields. They are exposed to various extreme and odd kinds of situations where they have to exhibit adequate knowledge and expertise in dealing with the cases. In the start of the career the nurses of different category may be enthusiastic but in the long run, the various conditions of their services leads to compassion fatigue, decrease of compassion satisfaction as well as the human flourishing. It has been found that the hospitals and medical settings have done various improvements and attained the innovations in various but to the great irony the medical settings have been unable to ensure the nurses’ compassion satisfaction and the human flourishing. With the change of time and seeing the requirement the federal government have introduced the various level of courses i.e. certificate course, diploma course, degree course and the post graduate or master level course for the nurse. There is provision of suitable placement for them after completion of the course but the basis irony remains unsolved i.e. there is there is lack of compassion satisfaction among the nurses. But it can be said that the problem is not without remedies. Though the profession of nursing itself is full of challenges, but the nursing professionals are required to have the individual life like other human beings. For this purpose, the government has to change and adopt some policies in terms of remuneration reimbursements, leave and relaxation of nursing professional, the guidance and mentoring etc. The government is also supposed to take steps for increasing the number of educational institutions for the nursing education for the purpose of meeting the demands of the nurses. It may be said that in future with the adoption of new technology and other developments the conditions of nurses’ compassion satisfaction and human flourishing will improve.