Background to the Australian aging population
Like other developed nations, Australia is an aging country. According to the Australian Institute of Health and Welfare, AIHW (2009), it is estimated that 24 percent of the country’s population will be over the age of 65 by 2036. In addition, the report by AIHW shows that the number of people aged over 85 years will increase significantly over the next 20 years. In fact, this is the fastest-growing cohort in the country.
It is worth noting that people aged 65 and above are active and contribute to the nation’s social and economic development. However, studies have shown that aging is highly linked with illnesses and disabilities. The current statistics indicate that approximately 28% of males and 46% of females aged 65 and above are likely to enter residential care (Hogan, 2003). Moreover, AIHW (2009) shows that the number of people entering residential care has forced authorities to increase the number of these facilities. In general, only about 3% of the aged people in Australia are classified as highly dependent within the residential care population. However, it should be noted that more than 76% of this population comprises individuals who are “high care”, with more than 50% having one of the various types of dementia. In Victoria, for instance, it is estimated that more than 40,000 aged people are living in RACFs funded by the commonwealth (Australian Institute of Health and Welfare, 2009).
Apart from the residential care given to the aged and dependent people, a number of other facilities are taking care of the rising number of them. For instance, Extended Aged Care At Home, Community Care Packages, Extended Aged Care at Home Dementia and Transitional Care are some of the most common options available for the elderly. Currently, there is evidence of the increase in the number of consumer-directed care options, where the elderly need care based on consumer purchases.
Need for improved care for the elderly
In all these options, it is evident that the need for modernized nursing practice is increasing each year. These options have placed an intensive demand for innovative workforce responses in the field of nursing. However, a shortage in knowledge, workforce, and initiatives aimed at improving caring practices for the elderly is evident in the country. With the growing population of aged people, there is a major rethink in the current practice for the care of the aged. Arguably, nursing practice in Australia requires a major reconsideration and a new standard for proper care of the estimated large population of aged people in the future. In a broader sense, an innovative workforce, better practice, knowledge, skills and innovative responses for the care of the aged people should be included in the new paradigm for the future practice.
Contemporary demands and strategies for better practice in nursing
Although there are several needs and demands for proper nursing within the context of care for the elderly people in Australia, it is worth addressing the challenges within the context of a few but broad topics.
Person-centred, interdisciplinary care that supports the resident’s psychosocial 7 and clinical needs
First, the contemporary care practice demands person-centered and interdisciplinary care that must focus on support of an individual’s clinical, psychological, and physical needs. In this category of challenges, the emergence, development and increase in “elderly” homes in most parts of Australia provide a good example of the recognition of the rights and personalized care for each resident.
Previous researchers such as Thomas (1996) did exemplary analysis of the future needs for the elderly people in Australia. For instance, such studies indicated that there was an urgent need for a new emphasis on medical treatment and a focus on psychological care in most homes. In fact, the Eden Alternative, which was developed towards the end of 20th century, provides an example of the modern demands for the nursing care in elderly homes. Thus, this paradigm emphasizes on removing stressing issues such as loneliness, boredom and the feeling of helplessness. In fact, it aims at treating “the individual” rather than the disease or illness presented by that particular individual.
Moreover, the contemporary practice demands recognition of the whole person rather than the physical problem observable to the caregiver. The new paradigm requires that the care providers and their inter-professional teams focus on the need to create normal environment. They must bring the elderly people to the “home-like” environment. It has been noted that for this purpose some aspects of the normal home should be of concern. For example, children, pets, flowers, plants, the aroma of fresh foods and other features are good examples of the normal environment that every person desires. In other words, the psychological care presupposes a home-like rather than a jail-like environment.
According to the Aged Care Standards and Accreditation Agency (ACSAA), lifestyle is a significant aspect of aged care. Therefore, standards should be assessed based on a lifestyle approach. Although it is difficult to achieve a home environment, nurses and their colleagues in the interdisciplinary teams are required to have advanced skills to maximize functionality, reduce boredom and depression through lifestyle coordinators. For instance, they should have advanced skills to conduct regular assessment and treatment of physical problems through cooperation with clinicians and dentists. Secondly, they need to have advanced skills in RN, EN and other professional nursing interventions.
Evidence-based care is also a broad spectrum of the needs and demands for contemporary nursing practices. In a modern context, there is an increasing need to base nursing practice on the best available evidence in the field. Governments, funding organizations and professional organizations have recently placed strong emphasis on evidence-based care. However, this new paradigm of the modern care practice has led to the realization that the amount of evidence available is lacking. Thus, there is room and need for more research studies aimed at modeling and developing better practices related to care for the elderly at all levels. Hence, there must be studies in skills, healthy living and lifestyles, environmental demands, health education, mental problems, legal and ethical issues, hospitality, nutrition and management of these homes.
Implementation of Transformational leadership and staff development in nursing care
Transformational leadership and staff development present a wide range of the modern needs for nursing, which should also be implemented in new strategies. In this context, Teaching Nursing Homes (TNH) and Magnet Hospitals provide some of the best paradigms of the modern demands for nursing. In general, three categories of skills are required for nurses in aged care: professional practice, professional development, and administration skills.
In Australia, Magnet hospitals portray a good example of institutions that employ transformational leadership and employee development. According to Shobbrook and Fenton (2002), the US Magnet Hospitals have made a considerable impact in improving the patient care, increasing the quality of the staff performance and reducing employees turnover. Since then, other nations have adopted their example. Whereas Australian hospitals have done that, the elderly care sector is yet to consider the paradigm in their practice.
Within this example, retaining staff will be an important practice in caring for the elderly in Australia. Older workers are likely to have experience in patient care, including the ability to develop good relationships with the elderly people. In addition, they should understand the psychological, physical and behavioral needs of the elderly people. Moreover, it is most likely that the older staff will satisfy the elderly, thus developing a home-like environment. New and young staff must undergo intensive raining and orientation to understand the needs of the elderly.
Nurses in elderly care must be transformational leaders in their field.
According to Covey (2002) and Goleman (2006), contemporary leaders should show some evidence of transformational leadership. For instance, they should display interpersonal and communication skills within their professions. In addition, they must be creative and adaptive, flexible and have visions as well as the ability to generate new and workable ideas. Having the ability to find and use the new ideas while considering original solutions would also be a considerable advantage. As Moiden (2002) states, transformational leaders should use democratic and participative approaches to change management of their work.
Skill development and staffing levels
Skill and levels of staffing make another important demand for contemporary nursing in elderly care in both Australia and other nations that are increasingly aging. A good instance of this has been demonstrated in the efforts by collaboration between Rhonda Nay and Victorian Association for Health and Extended Care (VAHEC). The two institutions have collectively conducted a workshop in which they attempted to help participants explore and discuss the potential examples of care that may address some of the problems associated with residential care of the aged Australians. From the workshop, a number of problems were observed. First, it was realized that medical framework borrowed from the acute field of nursing overrides the contemporary care delivery, with clinical care being an important requirement in the sector. As such, it was noted that residential homes for the aged should remain people’s homes rather than hospitals. Secondly, hierarchical management structure and practice were found to be a common problem in the homes, which prevents the staff from developing their professional skills. Thirdly, the workshop found that lack of job satisfaction among the staff in elderly care homes remains a major problem. In addition, the lack of sick leave and increase in turnover making the practice worse every year. Finally, it was observed that the needs of residents as well as their families were not fully met against which certain measures should be taken. In fact, the practice should include the ability to work with the resident’s family in order to create a home-like environment within the elderly homes.
The workshop remains one of the best initiatives that have produced workable solutions to the problems facing contemporary care for the elderly in Australia. From this and other workshops, seminars and conventions, a set of principles for informing staff decisions have emerged. For instance, it has been shown that there is an urgent need to reflect on the current care context, appreciate the role of unlicensed employees in the residential aged homes and aim at developing the practice provided in the Magnet Hospital examples. Moreover, the need to “eldernise” the practice, makes it person-centered, evidence-based and interdisciplinary.
An important aspect of the principles developed from the workshops is the realization that there is a shortage of qualified and skilled staff in elderly care throughout the country. Therefore, the staff shortage has to be addressed in a manner that will provide the homes with a good supply of nurses in the future. In addition, new ways of operating these homes must offer rewarding as well as satisfactory careers to people joining professional staff in the field of elderly care, considering the fact that the number of the aged people in the country is set to increase over the next two decades (Mueller, 2000). In other words, the elderly care will provide a major source of employment in the country. So, training of staff must begin as soon as possible. Obviously, these principles must be fiscally responsible and ensure that the elderly care field receives continuity of care, in particular, registered nurses must lead in clinical care for the elderly people.
The implementation of quality and sustainable care for the elderly in Australia depends on the ability to address the above mentioned demands and strategies. In fact, Australia will face a major social and economic problem in the future if these strategies are not implemented now. The increase in the number of aged people must be addressed within the above principles if the country is to address the social and economic problems in the future.
Australian Institute of Health and Welfare. (2009). Residential aged care in Australia 2007–08: a statistical overview. Canberra, Australia: AIHW.
Covey, S. (2005). The 8th habit from effectiveness to greatness. Sidney, Australia: Free Press.
Goleman, D. (2006). Social intelligence. Sidney, Australia: Hutchinson.
Moiden, N. (2002). Evolution of leadership in nursing. Nursing Management, 9(7), 20–25.
Mueller, C. (2000). A framework for nurse staffing in long-term care facilities. Geriatric Nursing, 21(5), 262–267.
Shobbrook, P., & Fenton, K. (2002). A strategy for improving nurse retention and recruitment levels. Professional Nurse, 17(9), 534-537.
Thomas, W. (2006). Life worth living. Sydney, Australia: Vander Wyk and Burnham.