NURS812_Reading journal

NURS812_Reading journal

Whenever you read a good book, somewhere in the world a door opens to allow in more light. Vera Nazarian

Citation Description of literature e.g. type of research, commentary, policy, govt. Key points Relevance to assignment / discussion/ practice Critique / thoughts / reflections (date read)

Tenbensel, T., Miller, F.A., Breton, M., Couturier, Y., Morton-Chang, F., Ashton, T., Sheridan, N.F., Peckham, A., Williams, A.P., Kenealy, T., & Wodchis, W.P. (2017). How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Qubec and New Zealand.International Journal of Integrated Care, 17. How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Qubec and New Zealand 3 Abey-Nesbit, R., Jamieson, H. A., Bergler, H. U., Kerse, A., Pickering, J. W., & Teh, R. (2023). Chronic health conditions and mortality among older adults with complex care needs in Aotearoa New Zealand. BMC Geriatrics, 23, 318. https://doi.org/10.1186/s12877-023-03961-8. 4 Cheung, G., To, E., Rivera-Rodriguez, C., Ma'u, E., Chan, A. H. Y., Ryan, B., & Cullum, S. (2022). Dementia prevalence estimation among the main ethnic groups in New Zealand: a population-based descriptive study of routinely collected health data.BMJ open,12(9), e062304. https://doi.org/10.1136/bmjopen-2022-062304

5 Huque, H., Eramudugolla, R., Chidiac, B., Ee, N., Ehrenfeld, L., Matthews, F. E., Peters, R., & Anstey, K. J. (2023). Could Country-Level Factors Explain Sex Differences in Dementia Incidence and Prevalence? A Systematic Review and Meta-Analysis.Journal of Alzheimer's disease : JAD,91(4), 12311241. https://doi.org/10.3233/JAD-220724 6 Wang, A. Y., Hu, H. Y., Ou, Y. N., Wang, Z. T., Ma, Y. H., Tan, L., & Yu, J. T. (2023). Socioeconomic Status and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 39 Prospective Studies.The journal of prevention of Alzheimer's disease,10(1), 8394. https://doi.org/10.14283/jpad.2022.81 7

I work in long term care facility in the hospital level of care. The aim of our company is to provide comprehensive care to the residents which includes physical, social, mental, spiritual and other components that sums up in delivery of person centered care. The residents in age care facility are frail and they are highly dependent on others to carry out their daily activities. Almost all of the residents in hospital level of care are having one or more long term conditions, among which dementia, diabetes and heart failure are mostly prevalent (Samra, 2024).

Long term conditions are those which develop gradually over the time and it is very difficult to reverse them however, we can slow down their progression and improve the quality of life of person suffering from these conditions. Long term conditions are very common in New Zealand and become the alarming issue of health care system as these are the leading reason for the health loss in New Zealand. The increase prevalence with time results in high health care costs which results in ethnic inequalities of health. As people become aged there is increased pressure of long term conditions on society and health care system becomes very constrained to provide the quality care to the population due to limited resources and set amount of budget ( Millar & Richards, 2017, p.23-25 ). The ministry of health frames policies to contain long term health conditions which are followed at the community level which includes district health boards, primary care centers, Age residential care facilities etc. The facility in which I am employed works on the principle of inclusion, independence and patient centered approach. 3

In area of my practice 60 % of the residents are having dementia along with other conditions like Diabetes, heart failure and osteoarthritis. It becomes very tricky when it comes to age care residential facilities as they have complex needs which are due to age related frailty and advanced stage of long term conditions. Various models has been implemented in our facility to meet the individual needs of the resident and also making sure that families are also included in planning of care. Patient centered approach, holistic model and even palliative approach is used to meet the requirement of the resident. In support of this a study was conducted which concludes that cognitive impairment is most commonly found in people who had their inter RAI assessment done furthermore, cardiovascular diseases, cancer and diabetes are also very common with ethnic inequalities. Therefore, it is clear that thee I shuge variability in distribution of long term condition among the different ethnicities and the impact of it also varies from person to person which includes various factors like genetic history, physical health, social status, spiritual factors etc. 4

Reflection of practice in regards to principles and model of care

In my age care facility almost 60 % of the residents having dementia which comes under Long term condition. Dementia is condition which is characterized by loss of cognition, impaired physical function, altered behavior, emotional imbalance and lack of social involvement. As dementia is umbrella term and underlying region might be anything however when it comes to age care facility, most of the conditions already runs its course. Most of the residents in age care facility are over the age of 80 years and they are mostly dependent on others for activity of daily living and also they are not capable to make their decisions due to lack of insight. Sometimes decisions made by them are not safe which put them in danger of self-harm. According to the principles of care we need to take a person as a whole therefore, we need to keep in mind about all the factors which are contributing to current health of person while framing the long term care plans, initial care plans and diversional therapy care plans etc. Liaising with families to know about the cultural, spiritual and physical needs to effectively frame the plan of care and supporting families as it might be traumatic for them to leave a family member in age care homes. Delivery of holistic care using a team approach that is entitiled to full fill the needs of the rsdiens and working under the models of care like Te Whare Tapa Wha . This model focusing on physical health, Mental health, Family helath and Spiritual health. In our facility we did assessments with help of didfferent teams like nurses , doctors, diversional therapist, rehab therapist and families. Outcomes of assessment is used to frame comprehensive care plan which aims to enhance quality of life and based on individual needs of the resident.

Dementia and complexity of care

Question one: What inequalities exist in relation to the health issue under consideration?

Dementia is one of the common causes of stay of Person in age care residential facilities due to extensive effect on quality of life of person.

According to the research on prevalence of dementia showed 3.8%-4% in the age of 60+ is having dementia legally diagnosed and its goes up to 14% in the age above 80 years. Among population above 60 years having dementia 5.4% are Maori, 6.3% Pacific Islander, 3.7% European and 3.4 % are Asians. Additionally, Pacific Islander and Maori are having highest prevalence of dementia above 80 years of population that is about 22% of total population. 5 There is no difference in dementia prevalence in terms of gender however socioeconomic status impact the prevalence of dementia and cognitive dysfunction.6

In support of this we can say that Maori and pacific islanders are having low socioeconomic status and that is related to their higher prevalence in dementia additionally there are many factors which underpins the low socioeconomic status like eduaction, health status , opportunity in jobs etc.

Who are at advantage:-

According to the report non maori are twice likely to enter in age residential care as compared to maoris. When I take this tomy facility more then 80 % of the residents are new zealander European and are having dementia, contrary to that Maoris and paicificer are having highrer prevalence of demntia as we have discussed above

Question three: How did the inequalities occur? What are the mechanisms by which the inequalities were created, maintained or increased? Socioeconomic factors: - As Maoris and pacific islander is having low socio economic status as compared to other ethnicities in new Zealand therefore they are more likely to be remained uneducated , jobless, altered health status. This gives the upper hand to educated population to use the medical facilities as they are more likely to know the processes to get into the age are facilities and use the services

Biological factors :- As we know that Maoris and pacificer are having more co morbidities as compared to other ethnicities and reason for it is obesity, genetic factors , lack of exercise, understanding the importance of health, diet etc. Due to higher section of population suffering from the long term conditions they are most likely to be neglected and delayed from having the appropriate services

Educational factors:- education is very important to explore any helath services because every field is having norms and criteria to attain services . due to inequity in educated population the services are more likely to be distributed unequally.

Workplace comments :- after discussing the above factors and comparing them to my facility I can see less number of maori peple managed to wnd up in Age care facility as compared to other ethnicities. There is no specific research carried out o explore thses factors however if I overview my workplace then education and access to helath services is clear factor behind this. People with dementia has impaired cognition and status of EPOA,s to get their person into the age care facility matters a lot.