Older People’s care, nursing, and a glimmer of hope - a personal and professional perspective

Lynn MacDiarmid is an Advanced Nurse Practitioner working in the Community Hospitals in Leicestershire. She is a part-time PhD Student at De Montfort University and sits on the England Region Council in the British Geriatrics Society. She is also a member of the CNO Shared Professional Decision-making Council – Research. She tweets @LynnMacD89

I have worked in Community Hospitals for the past 15 years and prior to that, Trauma Orthopaedics for 15 years.

I grew up with my wonderful Dad requiring hospital care from time to time due to a long-term condition, and later in his life requiring more and prolonged periods of care in hospital, ultimately ending up in a  rehabilitation ward…and having to fight for him to receive the right care for him to be able to return to his own home (when we were advised a care home was the ‘only option’), which is what he always wanted – right up to when he died.  He never went into a care home. His determination and success in that determination showed me that anything is possible when you challenge the hardest things put in front of you – and he taught me to always try to do the right thing, however hard that might be.

Things have changed considerably since I first worked in our community hospitals – where we used to have patients on the wards for prolonged periods of time for rehabilitation. Our GPs would visit the wards once a day for an hour to review the patients and would pop back when someone was unwell, or we had a new admission. The focus has shifted over the years to more acute care management, where we now treat infections such as sepsis on our wards and avoid acute hospital transfers as well as providing rehabilitation. However, along with this has been the national pressure to discharge patients as quickly as possible, and perhaps not allow them the time to get to be the best they can not only from a physical, but also psychological perspective.

The challenges we face as nurses in older people’s care are some of those challenges that we faced as a family. Factors such as the importance of good rehabilitation and the difference it can make to older people’s lives – allowing them to live longer, healthier lives; the recognition of frailty and being able to plan when this is recognised and delivering timely, evidence-based, compassionate care. These factors are in contrast with the pressure to ensure that patients waiting for ambulances, spaces in Emergency departments, and beds on wards are not waiting prolonged, unacceptable periods for care.

We have opportunities to create hope for the future generations of nurses and our patients by demonstrating and sharing the positive outcomes of our care and ensuring that this carries as much weight as other interventions such as surgery, for example. We have opportunities to demonstrate that nursing remains a caring profession which champions patient safety and positive outcomes for patients and their families, friends, and carers.

Nurses have opportunities in the future for driving through change and ensuring patient safety through participating and leading research in older people’s care. We should demonstrate that, as a profession, we are educated, articulate and passionate in advancing our practice for the ultimate benefit of patients and their families. We have an opportunity to do this through working with older people in designing appropriate research and implementing outcomes from that research for their benefit. This can ensure that the nurses of the future have a solid, ever-growing evidence base for delivering exceptional care across the country and that they can do this though evidence-based practice with and for our patients.