Protecting autonomy in 'Care of the Elderly

‘Oh ****** on a bike!’ I muttered to myself as I walked onto the ‘Elderly Care’ facility I worked in. The on duty nurse was rushing around like a pyromaniac in a petrol station,still dispensing the after lunch medications, and looking nowhere like ready to give me the handover on the thirty residents we looked after. The phone's were ringing ballistically, unanswered in the background, and two unfamiliar care attendants were standing aimlessly at the office desk. Nurses Announcements Archive Article

Protecting autonomy in 'Care of the Elderly

The reacent snow fall had blocked three staff arriving to work and so now, where there should have been two nurses and four care attendants from the permanent staff working, there only five staff, one nurse, two permanent Care Attendants (C/A's), and the two agency 'never been here before' C/A's. The nurse, not having had time to deploy the troops in a more efficient manner had left poor Tweedledum and Tweedledummer with not a clue as to what was to be done. Beds were still unmade, laundry was stacked in the lounge waiting to be sorted and put into wardrobes, residents were still waiting in the dining room to be escorted either to the toilets or to occupational therapy The two permanent C.A's were pelting around in the mistaken belief they'd get the work done quicker if they worked together.

I told the nurse to leave the medicine round; that I could finish it , the handover was deemed more important, with that I felt I could get on with the rest of the work.Howevr as previously unanswered callers were now calling back insistently I was starting to get frustrated. Forty five minutes after the nurse should have finished the handover, we were still getting bogged down.

Then I had a 'eureka' moment.

'Miss A', previously a very agile and verbose eighty three year old had a room was beside the nurse's station. Recently we had been a little concerned about her as she appeared to be getting quite depressed, declaring herself 'useless' and having no purpose in life.

Not even giving myself to think about it, I dived into her room where she sat, predictably gazing out the window. ''A', I'm desperate for some help, any chance you could answer the phones for me, just for twenty minutes?' She'd galloped out and was sitting at the phone desk almost before I could finish the sentence. Her (newly acquired) haughty voice could be heard in the background as we continued with our report, 'I'm terribly sorry, the nurse is awfully busy at the moment, may I take a message?' After my colleague left, I rambled around to suss out how else I could 'utilize' our resources.

I finished the medicine distribution after putting the C/A's working together, achieving some inroads into making beds, escorting residents to occupational therapy, supervising the lounge area and toileting incontinent residents. I was still left with a serious shortfall with catching up and finishing the other jobs. Leaving a very exuberant and willing 'A' to man the phones I trotted into the lounge.

Miss's 'B' and 'C', two octogenarian sisters were fighting over the TV remote control - with little to do in the afternoons if they refused to go down to occupational therapy, sniping at each other was the only other pleasure they indulged in. There were about seven other residents in the lounge that afternoon, all ready to join the snipers and fire verbal bullets at each other.

I explained the problem I was faced with to them - no one available to sort the laundry. Again, the reaction was instantaneous as wheelchairs, walking frames and shuffling bodies were mobilized into working units. Later as I carried on with my own nursing duties I spotted the first of the cordon - 'B' and 'C' trundling down the corridor in their wheelchairs, neat bundles on clothes on their laps, and one of the agency C/A's in tow, commandeered by the women to help with distribution.

For teatime a few more residents had wanted to get in on the action and were now taking it on themselves to instruct the agency C/A's on what residents needed help with their meal, and where they sat. This facilitated the other workers and myself to carry on with our other duties, mine being supervision and yet another medicine round.

Only at one stage did a row nearly break out, a normally very aloof and recalitrant 'Miss E', was now straightening up her less agile table companions, 'You're flecking well able to help yourself to eat, you still have one working hand' or 'stop shouting for the staff and puour your own milk'. As I made moves to intervene, some of them amazed me by slowly picking up the milk jug and helping themselves.

There are some medical personnel who will do their nut at the idea of residents helping out with laundry, the phones and mealtime duties. Me, as long as there's no breach of Health and Safety issues, I've no problem whatsoever. In the effort to protect our elderly in care from any issues that might adversely affect them, in my opinion, we've inadvertently created another problem, that of reduced personal autonomy and self worth. The buzz and renewed invigoration I witnessed on the unit that day made me wonder, could we be doing our elderly a disservice by caring too much, and should they be allowed more say and input into the day to day activities of what is, after all - their home?.

Florence Horsman Hogan.

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