Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Rhetoric and Reality of Nursing in Aged Care: Views from the Inside

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Rhetoric and Reality of Nursing in Aged Care: Views from the Inside

Article excerpt

Introduction

Population ageing has become a policy focus of Australian and international governments in response to increasing longevity, growing demand for support services amidst policy settings of competition for finite resources. In the next 20 years, the projected growth in the overall Australian population will be 29%; the number of older people aged 65 years and over is expected to increase by 91%, with those aged 85 years and over expected to more than double (Australian Institute of Health &Welfare [AIHW], 2012b). Australia's shifting ageing population demographic is similar to that of other OECD countries, where the average proportion of people aged 65 years and over has grown from 9% in 1960 to 15% in 2010 and expected to reach 27% by 2050 (OECD, 2015). Also comparable to Australia is the anticipated dramatic increase in the global population average aged 80 years and over, from 4% in 2010 to 10% by 2050 (OECD, 2015).

Reflecting international trends, older Australians requiring aged care are increasingly the oldest-old (aged 85 years and over), with multiple, complex co-morbidities, and higher acuity healthcare needs (AIHW, 2012a; DeForge, van Wyk, Hall, & Salmoni, 2011). In addition, more than 52% of permanent aged care residents have a diagnosis of dementia and a further 26% have a mental illness (AIHW, 2012a). Higher acuity together with increasing prevalence of dementia and other cognitive impairments also an international trend (DeForge et al., 2011; Harrington et al., 2012), commonly with dynamic and unpredictable health status fluctuations, requires frequent assessment and timely review of care needs (Ibrahim & Davis, 2013). These aged care client characteristics highlight the need for expert aged care nursing knowledge and practices (Cooper & Mitchell, 2006), however the Australian aged care sector is challenged by skill mix (low proportion of registered nurses [RNs]); high staff turnover and workloads; and limited access to medical doctors (GPs) (Haesler, Bauer, & Nay, 2007; Jeon, Fethney, & Ludford, 2012).

Similar to other OECD countries including Canada, the UK, parts of Europe, New Zealand, and the US, Australia is moving away from institutionalised aged care towards community-based care founded on the principle of ageing in place (Engels & Liu, 2012). As a policy approach ageing in place supports older people to remain living in their own home or other private accommodation for as long as it is feasible, affordable, and safe; in effect separating accommodation provision from the provision of care (Productivity Commission, 2011). Ageing in place, together with innovative community housing models such as those adopted in some Scandinavian countries, means that older people with higher care needs than in previous decades can remain living in community care settings (Productivity Commission, 2011).

In this international context, aged care roles and models of care are also changing in Australia, largely in response to changing consumer expectations and increasing demand for greater flexibility, choice and autonomy (Ratcliffe et al., 2010). Consumer-directed and person-centred models of care are also shifting the locus of control and the culture of care (Brownie & Nancarrow, 2013). These changes require working effectively and collaboratively with families as an essential component of the changing landscape of aged care (Bauer, 2006; Bauer, 2007; Hunter, McMillan, & Conway, 2007). Geriatric nursing, now referred to as nursing care of the older person, is considered a specialised and complex area of practice by the nursing profession (Dwyer, 2011) with advanced practice roles such as nurse practitioners well established in Canada, New Zealand, and the US, including aged care, shown to improve health outcomes (Clark, Parker, Prosser, & Davey, 2013). While models of care associated with such roles are increasingly reported in Australian aged care (Arbon et al. …

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