Traditional Medicine

Traditional Medicine
• Definition: It is the sum total of all the knowledge
and practices,
whether explicable or not, use in diagnosis,
prevention and
elimination of physical, mental and social
imbalance and relying
exclusively on practical experience and
observation handed down
from generation to generation, whether verbally or
in writing.
Traditional Healer
• Traditional healer is a person who is recognized
by the
community in which he lives as competent to
provide health care by
using:
a. Vegetable, animal and mineral substances and
b. certain other methods based on the social,
cultural and religious
background
c. as well as on the knowledge, attitudes and
beliefs that are
prevalent in the community regarding physical,
mental and social
wellbeing, and the causation of disease and
disability.
Traditional Healer
• From the above definition, traditional medicine is
closely bound to
and integrated with human culture.
• Because culture varies from place to place,
traditional medicine also
varies from place to place.
ORGANISATION OF TRADITIONAL
MEDICINAL PRACTICE
• In the Ghanaian belief system, the world is made
up of two systems;
1. One is physical or natural which is seen, and
2. The other supernatural or spiritual, which is
unseen
• The spiritual world exerts powerful influences on
the physical world.
ORGANISATION OF TRADITIONAL
MEDICINAL PRACTICE
• In traditional medical practice, the aspects which
pertain to the
supernatural are considered more important and
dealt with more than the pathological aspects
which relate to
the natural physical world.
• It is believed that once the spiritual causes of the
illness are treated,
the physical manifestation will resolve
spontaneously or with little
treatment
ORGANISATION OF TRADITIONAL
MEDICINAL PRACTICE
• However, traditional medicine practitioners
(TMPs) tend to emphasize
one or both aspects, the physical or spiritual, as
being
responsible for the disease.
• Based on this three major groups of TMPs are
therefore
recognized.
1. Those who practice without invoking the
supernatural
2. Those who rely completely on supernatural aid
to heal
3. Those who combine both Supernatural and
Physical remedies
ORGANISATION OF TRADITIONAL
MEDICINAL PRACTICE
• Herbalists
• The first group is referred to as Herbalists, a
group which
emphasizes the physical aspects of a disease, and
uses
mostly plant parts as a basis for their treatment.
• Herbalists are by far the largest group of TMPs.
• They are found in all the districts.
• They are very well versed in the knowledge of
herbs and their
practice is largely devoid of magico-spiritual
rituals.
ORGANISATION OF TRADITIONAL
MEDICINAL PRACTICE
• Extraction of the herbs is done through
pulverization involving
chopping on boards, grinding on stones or
pounding in mortars.
• Drying is in the open sun may be done if it is not
going to be taken
immediately.
• The final product may be boiled in water or
dissolve in alcoholic
beverages.
ORGANISATION OF TRADITIONAL
MEDICINAL PRACTICE
• The Hybrid Group
• The second group are the hybrid group, who may
be described as
herbalist-spiritualist, who, in addition to practicing
herbalism, also
deals with the supernatural causes of diseases.
• They indulge in occult practices and are also
common all over the
country.
The Spiritualists
• The final group of TMPs are those who emphasis
the spiritual
causation of disease.
• They are usually identified by their mode of
dressing, hair style
(shaven or dreadlocks), amulets, visible marks
made by incisions on
the arms, chest or face.
• They may have a piece of cloth around their waist
and usually walk
bare footed.
The Spiritualists
• Healing involves possession and communion with
extrasensory
elements.
• They hold periodic celebrations for their gods
and observe strict
taboos relating to diet and sex.
• This group use the methods listed below to
consult the supernatural
for diagnosis
The Spiritualists
1. Interpreting the movements of a small metal
ring hung on a thread
and dangled before the patient.
2. Interpreting the position in which cowrie shells
thrown randomly on
the ground fall.
3. Examining the marks left on sand by an animal
e.g., fox, attracted
by a bait.
The Spiritualists
4. Interpretation of the gestures or utterances,
which may be
unintelligible made by possessed persons in a
trance.
5. Water gazing, in which the diviner
communicates with the
appropriate “spirit” whose image he sees reflected
in a pot of
water.
CAUSES OF ILLNESS AND
SUFFERING
• For those groups who emphases only Spiritual or
Magico-Physical
aspect of diseases, illness and suffering are caused
by
1. Angry deities who punish wrongdoers, eg., those
who violate
taboos;
2. Ancestors and other ghosts who feel they have
been too soon
forgotten or otherwise not recognized;
3. Sorcerers and witches who are hired to inflict
illness or for personal
reasons;
Causes of Illness and Suffering
4. Loss of the soul following a bad fright that jars it
loose from the
body or as the consequence of the work of a
sorcerer or
supernatural spirit;
5. Sprit possession, or the intrusion of an object
into the body;
6. Loss of the basic body equilibrium usually
because of the entry of
excessive heat or cold into the body; and,
7. The Evil eye.
TYPES OF TRADITIONAL
HEALERS
• In a manner similar to western medicinal
practice, the practitioners of
TM specialise in particular areas of their
profession.
• There are 6 (Six) main types of traditional
healers.
TRADITIONAL BIRTH ATTENDANT
• Traditional Birth Attendant:
• These are middle-age and elderly women who
focus their attention
on the pregnant woman.
• They care for her during antenatal, labour and
postnatal periods.
• They are the midwives whose responsibility is to
deliver the baby and
the placenta and to see to the health of the baby
and the mother.
Traditional Birth Attendant
• Their work also extends to sex education,
counselling on
contraceptives and education on nutrition in
pregnancy and lactation.
• It also common for them to treat diseases during
pregnancy, diseases
of the female reproductive system and infertility.
• Her patients are usually members of her
community and are
therefore well known to her
FAITH HEALER
• These are often leaders of African based
churches who apart from
normal church services operate healing sessions
for their members.
• Some have “Clinics” and prayer camps where
patients go to seek
help.
• The clinics are the consulting rooms where
patients go to get
explanation for their present predicament, have
their future foretold
and to confuse their spiritual enemies.
FAITH HEALER
• Faith Healer
• The prayer camps are usually located at the
outskirt of the
community.
• Patients admitted here are given prescribed
period of fasting and
prayers to move God’s healing hand in their favour.
• Faith Healers use the Bible, Holy water, Florida
water and prayer
sessions to heal their patients
DIVINERS/SPIRITUALISTS:
• These are a type of traditional healers who use
methods of
possession, divination and other rituals to
diagnose illness and heal
people.
• They say they are the intermediaries between
their object of worship
and the patients who seek their help.
• They also claim their diagnostic techniques and
powers of healing
come from these spirits.
DIVINERS/SPIRITUALISTS
• Spiritualists diagnose illness through divination.
• When they are satisfied that they have
discovered the cause of the
illness, they then resort to interviewing techniques
to confirm the
diagnosis.
• Patients who consult them are those who think
their illness has a
spiritual dimension/cause or who couldn’t get the
appropriate
treatment at the modern health facility.
DIVINERS/SPIRITUALISTS
• Diviners/Spiritualists:
• Even when herb is given to cure any disease or
problem, a ritual is
performed at a shrine to augment the potency of
the drug.
• The patient is then advised on how to live with
his neighbours, how to
take the medicine and the type of food to avoid
THE HERBALIST
• They are the most numerous of the traditional
healers. They have a
very good knowledge of herbs and other natural
products and their
medicinal uses. The approach healing through the
use of herbs.
THE TRADITIONAL BONE SETTERS:
• These are a small group of traditional healers
who specialize in the
treatment of fractures, sprains and dislocation.
• They normally use sticks to align the bones and
also as a form of
traction. Herbs are also used in the treatment.
• Some group of bone setters also consult the
spirits.
TRADITIONAL CIRCUMCISIONISTS
• They males or female who specialize in male and
female circumcision
• They also have very good knowledge arresting
haemorrhage with
herbs after the circumcision.
Problems that Hinder the
Development of Traditional Medicine
• Knowledge acquisition in traditional medical
treatment:
• Because the traditional medical practitioners, are
generally illiterates,
knowledge is passed orally.
• Information can be lost over time.
Lack of Research
• The illiterate traditional healer also cannot enrich
his/her practice by
reading about other healing techniques and
learning about things
such as basic human anatomy and administration
of quantified
medicinal doses.
• Intuition, try and error are the methods of
gaining new knowledge
Secrecy
• Another major setback concerns the secrecy
involved in the passing
of this knowledge.
• Unfortunately, healers sometimes fear
competition from an
apprentice and may initially teach the apprentice
limited information,
thus dying with the undisclosed information.
• As a result, the apprentice will practice with
incomplete knowledge of
herbal remedies and with less skill than his/her
predecessors.
Secrecy
• They also belief that disclosing such information
that has been
handed down to them by deities is a violation of
tradition, something
that could attract punishment or even death.
•
• A famous case in point is that of the late Nana
Kofi Drobo, a well-
known spiritual healer and a chief in his locality.
• Nana Drobo claimed that he had a treatment for
HIV-AIDS.
Problems that Hinder the Development of
Traditional Medicine
• Secrecy
• There was an attempt by the Ministry of Health
to collaborate with
Nana Drobo to validate the claim so that more
patients can benefit
from his treatment.
• Such collaboration was not achieved since,
unfortunately, Nana Drobo
died under mysterious circumstances.
Secrecy
• The case of Nana Drobo is a clear example of the
conflict between
aspects of traditional system of healing which
thrives on secrecy and
abhors disclosure, and scientific investigation
which requires
knowledge and disclosure of information.
• This conflict poses a challenge which must be
met because the
systems of healing in the country must be
integrated for a more
effective use.
Treating Symptoms instead causes
of the Disease
• Traditional healers lack the knowledge and
equipment to make a
proper diagnosis of a patient’s medical condition
• They end up treating the symptoms instead of
the central cause of a
disease.
Association of the Practice with the
supernatural which tend to coerce the
patient to worship the gods
• The supernatural aspect of traditional treatment
seems to deter orthodox
medical practitioners’ interest in researching
traditional medicine.
• Some traditional healers, before administering
herbal treatment, might ask
their patients to bring an animal to be ritually
slaughtered.
• Some healers may recite magical chants or may
perform a spiritual ritual
before administering the herbal treatment.
Association of the Practice with the
supernatural which tend to coerce the
patient to worship the gods
• Sometimes, the healer may believe that the
wrath of another person,
a spirit, an ancestor, or a witch is the cause the
patient’s illness.
• Typically, the healer gives the patient no rational
explanation for
performing these spiritual rites.
Lack of Standardization and
Regulation
• There are often huge variations in the way
medicines are used in TM,
including herb source, preparation, dose and
indication.
• Also, TMPs are unregulated professional body
where there is free
entry and exit
• There are no requirements to determine who
qualifies to practice
traditional medicine
Role of Traditional Healers in Health
Delivery
• Location/Accessibility
• It is located in the community and hence
accessible to the patient.
• There are no transportation cost and no queuing
as found in orthodox
practice.
• Traditional medicine is largely practised in the
rural areas.
Location/Accessibility
• In fact in most villages, traditional medicine is
the only available
health care and is therefore the first point of call.
• The traditional birth attendant performs valuable
service in
the contemporary Ghanaian society reaching areas
where allopathy
has not touched as yet.
Location/Accessibility
• The spiritualist is also very efficient in handling
psychological aspect
of psychiatric patients allaying their fears and
anxieties (Twumasi,
2005; Anform, 1986).
• In Ghana, traditional medicine caters for about
75-85% of the rural
people and 45-65% of urban dwellers.
Affordability
• Modern pharmaceuticals and medical centres
remain inaccessible to
large number of African people due to their
relatively high cost and
concentration of health centres in urban areas.
• TM on the other hand is available and affordable
to the ordinary
African both in the rural and urban areas
Affordability
• The increasing popularity of traditional medicine
in developed
countries is due to relative low cost, low levels of
technological input,
relative low side effects
• Payment to traditional healers can be money,
goat, chicken, or
whatever the family can afford to give.
Friendly Service
• The growing acceptance of Traditional Medicine
is due to its
friendliness and flexibility
• The patient may be offered a room to stay and
have his privacy. Even
his wife could come and live with him.
• He could set up his own kitchen on the same
compound and begin to
cook his own food.
• No fixed visiting hours.
Integration of Traditional Medicine into
the Formal Health Delivery System
• The administration of TM raises arguments
particularly in the areas of
methods, diagnosis and doses which have made its
integration to
Western Medical Model a huge task.
• A well-structures training programme has the
potential of providing
better healthcare through the adoption of
evidence-based therapy
which is safe, efficacious, affordable and of high
quality.
• Some efforts to integrate Traditional Medicine
into the health delivery
system include:
Integration of Traditional Medicine into
the Formal Health Delivery System
1. The establishment of a programme leading to a
B.
Sc. Degree in Plant Medicine at the Kwame
Nkrumah University of Science and Technology.
• Plant Medicine is only a sub-set of traditional
medicine, but this
training will help speed up the process of
accreditation which will
enhance the practice of traditional medicine in
general.
The establishment of a programme leading to a B.
Sc.
Degree in Plant Medicine at the Kwame Nkrumah
University of Science and Technology.
• The program in KNUST has led to the
establishment of few Scientific
Traditional Hospitals which practice evidence
based treatment like
allopathy.
a. Agbeve
b. Amen Scientific Hospital
c. Top Herbal
d. Givers Herbal Clinic and Fertility Centre
Integration of Traditional Medicine
into the Formal Health Delivery
System
2. The publication of Ghana Herbal Pharmacopoeia,
containing
scientific information on fifty (50) medicinal plants
3. The institutionalization and celebration of a
Traditional Medicine
Week.
Integration of Traditional Medicine into
the Formal Health Delivery System
4. The establishment of the Centre for Scientific
Research into Plant
Medicine in Mampong-Akwapim 1n 1975 to perform
the following
functions.
a. Conduct and promote scientific research relating
to the
improvement of plant medicine;
b. Ensure the purity of drugs extracted from
plants;
Integration of Traditional Medicine into
the Formal Health Delivery System
• Centre for Scientific Research into Plant Medicine
c. Cooperate and liaise with the Ghana Psychic and
Traditional
Healers’ Association, research institutions and
commercial
organizations in any part of the world in matters of
plant medicine;
d. Undertake, or collaborate in the collation,
publication and the
dissemination of the results of research and other
useful technical
information;
e. Establish, where necessary, botanical gardens
for medicinal plants;
Integration of Traditional Medicine into the
Formal Health Delivery System
5. The creation of Traditional and Alternative
Medicines
Directorate at the ministry of Health in 1999 with
the mandate:
a. To initiate, coordinate and monitor all activities
involving traditional
medicine, so as to influence it to move in
accordance with public
and political policies; and,
b. To protect and sustain medicinal plant
resources.
Integration of Traditional Medicine into
the Formal Health Delivery System
6. GHANA TRADITIONAL MEDICINE PRACTICE
COUNCIL
• Act 575, 2000 of the Parliament of the Republic
of Ghana, the
Traditional Medicine Practice Council to
i. Set standards for the practice of traditional
medicine;
ii. Issue certificate of registration to a qualified
practitioner and
license premises for a practice;
Integration of Traditional Medicine into
the Formal Health Delivery System
• GHANA TRADITIONAL MEDICINE PRACTICE
COUNCIL
iii. Determine and enforce a code of ethics for
traditional medicine
practice in conjunction with an association of TMPs
recognized by
the Minister of Health referred to in the Act as “the
Association”;
iv. Promote and support training in traditional
medicine;
v. Approve, in consultation with such educational
institutions as it
may determine, the curriculum for training in
traditional medicine
in the institutions;
Integration of Traditional Medicine into
the Formal Health Delivery System
• GHANA TRADITIONAL MEDICINE PRACTICE
COUNCIL
vi. Collaborate with the Ministry of Health to
establish centres for the
provision of traditional medical care within the
national health care
delivery system;
vii. Advise the Minister of Health on matters
relating to and affecting
the practice of traditional medicine;
viii.Collaborate with the appropriate agencies for
large-scale cultivation
of medicinal plants and for the preservation of
biodiversity;
Integration of Traditional Medicine into
the Formal Health Delivery System
GHANA TRADITIONAL MEDICINE PRACTICE COUNCIL
ix. Advise the Food and Drugs Board, in writing, on
rules for
registration, advertisement, manufacture,
packaging, preparation,
labelling, sale, supply, exportation and importation
of any herbal
medicine;
x. Advise the Ghana Standards Board, in writing,
on standards for safe
and hygienic preparation of herbal medicine;
xi. Monitor fees payable by clients for services
provided by TMPs; and,
xii. Perform such other functions as are ancillary to
the object of the
Council.

GERONTOLOGY
DEFINITION
• Gerontology is the broad term used to define the
study of aging and/or the aged.
• This includes the biological, psychological and
social
aspects of aging
• The older adult is considered as one older than
65
years
OLDER ADULT
• The older adult are often divided into three
groups:
1. The young old (ages 65–74),
2. The middle old (ages 75–84), and
3. The old old, very old, or frail elderly (ages 85
and
up).
• Geriatrics specifically refers to medical care of
the
aged.
GERIATRIC NURSING
• Geriatric nursing therefore refers to the nursing
care
of older people with health problems, or those
requiring tertiary care.
• Gerontological nursing includes health
promotion,
education, and disease prevention.
THEORIES OF AGING
• These are attempts by Scientists to explain why
people grow old and die in the absence of disease.
• The process of biological aging differs not only
from
species to species but also from one human being
to
another.
• Some general statements can be made
concerning
anticipated organ changes
• However, no two individuals age identically.
THEORIES OF AGING
• Varying degrees of physiologic changes,
capacities,
and limitations will be found among peers of a
given
age group.
• Also the rate of aging among different body
systems
within one individual may vary, with one system
showing marked decline while another
demonstrates
no significant change
THEORIES OF AGING
• For example, Biological theories believe that
people
age and die because of changes in the human
body.
• Psychological theories support the idea that an
older
adult’s life ends when they have reached all of
their
developmental milestones.
•
• For example, Maslow’s Hierarchy of Needs states
that
a person’s final stage is self-actualization.
THEORIES OF AGING
• From a psychological perspective, once an older
adult
reaches self-actualization, they approach the end
of
life.
• Moral/spiritual theories support the idea that
once
an older individual finds spiritual wholeness, which
exceeds the need to inhabit a body, and they die.
THEORIES OF AGING
• Sociological theories explain that when an older
adult’s usefulness in roles and relationships ends,
end
of life occurs.
BIOLOGICAL THEORIES OF AGING
• These are theories which seek to explain the
biological
process of aging but so far none has been widely
accepted by researchers.
• The process of aging is too complex for any one
factor
explanation.
Biological Theories of Aging
1.Genetic Programming Theory
• This theory maintains that deterioration and
death is
encoded in the genes of every organism and is
subject
to minor modification.
• The proponents of this theory believe that a
biochemical mechanism within the cells account
the
number of cell divisions or replications and allow a
limited number of divisions.
Biological Theories of Aging
• Genetic Programming Theory
• This limit controls the life span.
• In humans, 50 cell divisions are allowed and this
sets
life span at about 110 years.
Biological Theories of Aging
2.Wear and Tear Theory
• This theory holds that the body ages because of
continues use.
• The human body is comparable to a machine
whose
parts eventually wear out with use.
• Aging is viewed as gradual deterioration of the
various
organs in the body.
Biological Theories of Aging
3. Errors in DNA Theory
• This theory suggests that mutation (alterations)
in
DNA do occur.
• These errors lead to errors in Amino Acid
synthesis.
• Such errors impair cell function and division
leading to
aging and organic/somatic death.
Biological Theories of Aging
4. Immunity Theory
• This theory focuses on the immune system
comprising
of the WBCs, bone marrow, thymus, spleen and
lymph
nodes.
• The immune system seeks and destroys foreign
agents
such as viruses, bacteria and cells undergoing
neoplastic changes.
• Immune response declines steadily after young
adulthood.
Biological Theories of Aging
4. Immunity Theory Cont’d
• With decreasing T-cell differentiation and
production,
infections, immune disorders and cancers increase
which eventually results in the death of the aging
individual.
T Biological Theories of Aging
5. Accumulation of Metabolic Waste
• Some biologists also suggest that organisms age
because their cells are poisoned by metabolic
waste
leading to progressive organ malfunctioning.
Biological Theories of Aging
7. Free Radical Theory
• This theory postulates that free radicals i.e.
unstable
molecules are produced during the normal process
of
respiration and metabolism.
• The free radicals e.g. lipofuscin cause damage to
cells
and the immune system.
• According to the theory, accumulation of free
radicals
contribute to the physiological changes of aging
and
variety of diseases.
Sociological Theories of Aging
1. Disengagement Theory (Elaine Cumming and
W.E.
Henry, 1961)
• The theory views aging as a progressive physical,
psychological and social withdrawal from the wider
society.
• Physically; the aged slow down their activity to
conserve
energy
• Psychologically; they withdraw their concern
from the
wider world and focus on those aspects of life that
immediately touch them.
Sociological Theories of Aging
• Disengagement Theory (Elaine Cumming and W.E.
Henry, 1961)
• Socially; mutual withdrawal is initiated which
result in
decrease interaction between the aging adult and
other members of the society.
• According to the theorists, the process is one of
double withdrawal.
• The individual disengages from the society and
the
society from him/her.
Sociological Theories of Aging
• Disengagement Theory (Elaine Cumming and W.E.
Henry, 1961)
• They view disengagement as a gradual mutually
satisfying process by which the individual and the
society prepare in advance for the ultimate
disengagement (death).
• They see the elderly as ‘wanting’ to disengage
and
doing so by reducing the number of roles he plays,
severing many relationships and weakening the
remaining relationships.
Sociological Theories of Aging
• Disengagement Theory
• Society also encourages it by transferring
functions
previously performed by the aged to the young
thus
minimizing disruptions and problems that will
occur as
result of death.
Sociological Theories of Aging
• Activity Theory (Robert J. Havighurst, Bernice L.
Neugarten, Sheldon S. Torbin, 1968).
• The theory states that except for the inevitable
changes in biology and in health, older people are
the
same as middle age people, with essentially the
same
psychological and social needs.
• In this view the decreased social interactions
proceeds
against the desires of most aging men and women.
Sociological Theories of Aging
• Activity Theory (Robert J. Havighurst, Bernice L.
Neugarten, Sheldon S. Torbin, 1968).
• The older person who ages optimally is the
person
who stays active and who manages to resist the
shrinkage of his social world.
• According to this theory, the aged must
maintains the
activities of middle age as long as possible and
then
find substitutes for those activities he is forced to
relinquish.
Activity Theory
• This theory suggests ways of maintaining activity
in
the presence of multiple losses associated with the
aging process, including;
1. substituting intellectual activities for physical
activities when physical capacity is reduced,
2. replacing the work role with other roles when
retirement occurs (religious ministry)
Activity Theory
3. establishing new friendships when old ones are
lost.
• Declining health, loss of roles, reduced income, a
shrinking circle of friends, and other obstacles to
maintaining an active life are to be resisted and
overcome instead of being accepted.
Sociological Theories of Aging
• Role Exit Theory (Zena Smith Blau, 1973)
• According to the proponent of this theory,
retirement
and widowhood terminates the participation of the
elderly in the principal institutional structures of
the
society i.e.
a. job and
b. family.
• According to him, the opportunities open to the
elderly for remaining socially useful are severely
undermined.
Sociological Theories of Aging
• Role Exit Theory (Zena Smith Blau, 1973)
• He regards loss of occupational and marital
statuses
as particularly devastating since these positions
are
master statuses or core roles and anchoring points
of
adult identity.
Sociological Theories of Aging
• Social Exchange Theory (J. J. Dowd, 1975)
• According to the theory people enter into social
relationship because they derive rewards from
doing
so – economic, sustenance, recognition, a sense of
security, love, social approval, gratitude and the
like
• When these rewards are removed without
replacement, the older individual may loss the
desire
to continue living
Spiritual Theories of Aging
• Spiritual Theories of Aging
• According to spiritual theories of aging, once an
older
individual finds spiritual wholeness, which exceeds
the need to inhabit a body, and the person
approaches the end of life.
• The theory believes that the movement toward the
aging process results in greater satisfaction with life,
resulting in greater maturity and improved
understanding of the world and the individual’s
position within it.
Spiritual Theories of Aging
• The steps toward attaining this enhanced perspective
involve self-reflection and a progression toward
selflessness, as well as an interconnectedness and
communication with the past and things beyond this
world.
Psychological Theories
• Psychological Theories
• Psychological theories support the idea that an older
adult’s life ends when they have reached all of their
developmental psychological milestones.
• Theories focusing on the psychological dimension
include
Maslow’s Hierarchy of Needs.
• This theory states that an individual goes through a
series
of developmental steps through life commencing with the
need to obtain safety and fulfil biological needs such as
food and water.
Psychological Theories
• The steps become progressively more challenging
until the final stage in a person’s life, known as self-
actualization.
• According to Maslow’s theory, self-actualization is
obtained when a person develops an understanding of
themselves within the world and accepts who they
have become.
• From a psychological viewpoint, once an older adult
reaches self- actualization, they have reached the final
stage of life.
Physical Changes Associated With
Aging
• As older adults continue to age, each body system
undergoes
changes.
• The changes occur in response to exposure to
environmental
injury, illness, genetics, stress, and many other factors.
Physical Changes Associated
With Aging
• The changes are sometimes noticeable, such as grey
hair, wrinkled skin, and stooped posture.
• However, there are also many unnoticeable changes
within the aging body that are quite undetectable to
the naked eye.
AGE RELATED CHANGES
IN THE CARDIOVASCULAR SYSTEM
• Heart
• One major change is that the geriatric heart becomes
larger
and occupies a greater amount of space within the chest.
• This may be a symptom of pathological cardiac
diseases, such
as cardiomyopathy.
• Consequently, an older individual whose heart size has
increased may require a more comprehensive
cardiovascular
assessment in order to differentiate normal from
pathological
cardiac changes.
THE HEART
• Despite the increased size of the geriatric heart, there is
a total reduction in the amount of functional myocardial
muscle mass.
• In addition, the force of each heart contraction
diminishes
• This decreases the amount of blood that is pumped
through
the circulatory system. i.e. reduced cardiac output
THE HEART
• The heart valves which control the flow of blood
within the chambers of the heart and between the
heart and lungs to the circulatory system become
stiffer with calcification, or calcium deposits.
• This stiffness often prevents the full closure of these
valves, resulting in both non-pathological and
pathological heart murmurs.
THE HEART
• The complex system of electrical impulses that controls
the
beating of the heart is also often affected by the normal
anatomical changes in this critical organ system.
• Consequently, premature contractions and arrhythmias
are
auscultated more frequently among older adults than in
the
younger population.
• These arrhythmias are often not pathological in nature.
CARDIOVASCULAR SYSTEM
• Decreased force of contraction and ineffective closing of
cardiovascular valves, leads to slower blood flow through
the body.
• This may have several consequences for older adults.
• First, slower circulation often results in slower healing of
wounds.
CARDIOVASCULAR SYSTEM
• Second, slower circulation also impacts the length of
time it takes for medications to take effect as a result
of altered medication metabolism and distribution.
• This is important to keep in mind when administering
medications to older adults and evaluating their
effectiveness in treating disease symptoms
CARDIOVASCULAR SYSTEM
• In the peripheral vascular system, the valves in the
veins of the lower extremities also become
incompetent, resulting in non-pathological
accumulation of fluid in the lower extremities
(dependent oedema).
• Hardening of the arteries, less elasticity of the veins
result in increase in blood pressure as we age
CARDIOVASCULAR SYSTEM
• Nurses may recommend interventions to older adults to
slow the onset of these normal changes of aging, such as
diet, exercise, and when necessary, medication.
• Regular exercise has a role in preventing normal
changes
in the cardiac system and preventing cardiac disease
cannot be emphasized enough.
RESPIRATORY SYSTEM
• Older adults’ lungs tend to lose elasticity as they age.
• Loss of water and calcium in the bones also causes the
thoracic cage to stiffen.
• These make the lungs less flexible impairing the ability
to effectively inhale and exhale
RESPIRATORY SYSTEM
• INFECTION
• There is often a decreased amount of cilia lining in older
adults’ respiratory systems.
• These hair-like structures play an important role in
removing foreign particles from the respiratory system.
• Older adults may have a decreased cough reflex as
part of the normal changes of the neurological system.
RESPIRATORY SYSTEM
• The combination of loss of cilia and decreased
cough reflex place the older adult at high risk for
choking, aspiration of food products, and the
development of pneumonia and other
infectious respiratory diseases
• Nurses can help older adults choose the right exercise
and encourage regular exercise participation.
RESPIRATORY SYSTEM
• Exercise help to prevent both age related changes and
pathological changes in the respiratory system.
• Quitting Smoking is also beneficial.
INTEGUMENTARY SYSTEM
• There is decreased in the amount of subcutaneous
tissue
resulting in loses its elasticity and insulation.
• Consequently, lines of wrinkles appear on the skin and
intolerance to cold weather.
• The number of sweat glands diminishes as people age,
leading to less perspiration and dry skin among older
adults.
INTEGUMENTARY SYSTEM
• There is also redistribution of fat from the extremities
(bony face, hands and feet) to the abdomen.
• There is also loss of body image.
• The dryness of the skin, in combination with decreased
perspiration, leads to the need to bathe less frequently.
INTEGUMENTARY SYSTEM
• Proper environmental control (Heating systems, warm
clothing) and adequate hydration are essential to prevent
these devastating consequences of normal aging
changes.
• Fingernails and Toenails become thick and
brittle, and thus, nail care may become more difficult for
the aging adult to accomplish independently.
INTEGUMENTARY SYSTEM
• Changes in vision and pain perception may further
complicate the task of nail care.
• Nurses may need to assist older adults with nail care.
• Another change in the older adult’s integumentary
system occurs in the hair.
• This is one of the most obvious effects of aging and
among the most feared.
INTEGUMENTARY SYSTEM
• The hair of older adults may become grey, fine,
and thin
• Some older adults may experience the loss of hair, or
alopecia, which may or may not be hereditary.
• There are also changes in hair distribution.
• Women have more facial hair while nose and ear
hair become prominent in men
GASTROINTESTINAL SYSTEM
• Inflamed gums or periodontal disease is common
among older adults.
• Moreover, sensitive teeth and tooth loss is seen
regularly among older adults.
• Tooth and gum problems often prevent older adults
from being able to chew (masticate) food.
GASTROINTESTINAL SYSTEM
• This may lead to a decrease of food choices
• Mostly prefers of soft food
• Nurses must consistently assess client’s ability to chew
food and refer clients with identified problems for
further oral evaluation.
GASTROINTESTINAL SYSTEM
• Decreased peristalsis of the oesophagus slows the
passage of food through the alimentary canal, which
often results in the need for older adults to chew food
longer and eat more slowly.
• There is also decreased gastric motility, HCl
production, and absorption of nutrients.
• These changes put older adults at high risk for the
development of nutritional deficiencies.
GASTROINTESTINAL SYSTEM
• Constipation
• The decreased peristalsis of the large intestine slows
the
passage of food.
• The increased time undigested/partially digested food in
the bowel allows for greater time for water absorption
resulting in a higher incidence of constipation
GASTROINTESTINAL SYSTEM
• Bowel Incontinence
• Bowel incontinence is defined as an involuntary
unexpected leakage of liquid stool.
• Causes of bowel incontinence include
1. Neurological disease,
2. Poor mobility,
3. Haemorrhoids
4. Diarrhoea,
GASTROINTESTINAL SYSTEM
Bowel Incontinence
5. Childbirth injuries,
6. Ulcerative colitis, and
7. Dementia
URINARY SYSTEM
• The kidneys, which are responsible for concentrating
urine and
filtering metabolic products for elimination, experience a
total
loss of nephrons and glomeruli as people age.
• The bladder tone and volume/capacity may decrease as
well.
• This results in a high incidence of urinary incontinence
or
involuntary loss of urine among older adults.
• Studies have shown that between an average of 34%
women
and 17% men experience daily incontinence (Gray,
2003).
MUSCULOSKELETAL SYSTEM
• With use, the cartilage covering articular surfaces can
wear down
• The production rate of lubricating synovial fluid also
declines with age, further contributing to the wear of the
articular cartilage.
• Many people also experience arthritis, an inflammatory
degeneration of joints, with advancing age.
MUSCULOSKELETAL SYSTEM
• The Changes in the musculoskeletal system have a
great
impact on the health and functioning of older adults.
• As people age, there is a decrease in total muscle
and bone mass.
• The decrease in bone mass occurs as bones lose
calcium, causing the bone structure to shrink and
weaken.
MUSCULOSKELETAL SYSTEM
• All these place the older adult at a higher risk for
fractures.
• Muscle mass also diminish with age.
• This result in weaker physical strength and slower
movement
• It is important to note that both the decrease in bone
and muscle mass may be slowed with exercise.
THE NERVOUS SYSTEM
• The nervous system depends on specialized sensory
receptors to gather information about the internal and
external
environment.
• The receptors include those needed for
a. vision,
b. hearing,
c. smell,
d. touch,
e. equilibrium, and
f. pain sensation.
THE NERVOUS SYSTEM
• Sensory decrements have a psychosocial impact upon
the
individual; however individuals adapt because these
changes
are gradual and most are able to adapt to the changes.
• Vision changes that occur as one ages are significant.
• With age, the lens of the eye thickens, yellows, clouds
and
becomes less elastic.
THE NERVOUS SYSTEM
• The thickening of the lens reduces the amount of light.
• As the lens becomes less elastic, it loses its ability to
focus
on close objects.
• This occurs in middle age and is called "presbyopia.“
(inability to focus on near objects)
• The changes in elasticity also create a narrowing of the
visual
field, and diminished depth perception.
THE NERVOUS SYSTEM
• The yellowing of the eye, changes in size and thickening
of
the cornea make it difficult to see at night.
• With age the fluids in the eye (aqueous and vitreous
humour) become cloudy reducing light sensitivity.
• The cornea becomes thickened and less transparent
with
age.
THE NERVOUS SYSTEM
• The thickened cornea scatters light inside the retina
making glare more of a problem.
• Lastly, the changes in the eye also effect colour
perception making it difficult to distinguish between
blues, greens and violets.
THE NERVOUS SYSTEM
• THE EAR
• The ear consists of the outer ear, middle ear, and inner
ear.
• Presbycusis is the hearing loss associated with the
aging
process.
• Other age changes involve the collapse and narrowing
of the
auditory canal and thickening of the earwax.
THE NERVOUS SYSTEM
• This increases the difficulty in hearing.
• Generally, with age there is a decrease in the number of
taste and smell receptors and slower nerve
transmissions, although the losses are highly variable.
• The loss of taste and smell receptors means that food is
less appetizing to the older adult.
• Older adults are less likely to detect the bad taste of
spoiled food
and a reduced ability to smell may make them unable to
smell
smoke, gas leaks or other toxic fumes.
• Many elderly individuals experience changes in balance
due to
changes in the vestibular system; located in the ear.
• Changes in these systems can cause postural
hypotension due to
the inability to quickly respond to changes in position.
• This often causes dizziness or light headedness when
one
moves quickly from a lying or sitting position to standing.
• The somatic receptors respond to touch, pressure, cold,
pain,
pleasure or body position.
• It is generally believed that these receptors become
less
sensitive with age.
• Elderly individuals therefore experience decrease
ability to feel pain,
• The decrease in receptors make it more difficult for
the elderly person to cope with changes in
temperature.
REPRODUCTIVE SYSTEM
• WOMEN
• Aging women experience follicular depletion in the
ovaries as a result of a decrease in circulating
hormones.
• This further leads to a decrease in the secretion of
oestrogen and progesterone (Masters, 1986).
REPRODUCTIVE SYSTEM
• Natural breast tissue is replaced by fatty tissue,
changing the external appearance of the breast.
• The labia shrink and may hang in folds because of lack
of subcutaneous tissue.
REPRODUCTIVE SYSTEM
• The vulva may appear to be dry and have pale
appearance, loss of rugae, and the introitus
atrophies.
• There is a decrease in vaginal lubrications and a
shortening
and narrowing of the vagina.
• The strength of the orgasmic contraction diminishes,
and the
orgasmic phase is decreased.
REPRODUCTIVE SYSTEM
• Normal changes of aging women may result in an
increased
time to respond during sexual activity and
dyspareunia (painful intercourse).
• Older women may have an inhibited sexual desire,
orgasmic
dysfunction, and vaginismus as a result of a decrease in
circulating hormones
REPRODUCTIVE SYSTEM
• To counteract these changes, the older woman may
need
1. vaginal lubricants to reduce friction during sex
2. Increase period of foreplay prior to the sexual act to
allow the body enough time to physically respond to
sexual feelings
REPRODUCTIVE SYSTEM
• MALE
• Specific changes of aging that occur among older men
include an increased length of time needed for erections
and ejaculation.
• Erections become more dependent on direct penile
stimulation.
• Semen volume is decreased, and the refractory
period between ejaculations increases.
REPRODUCTIVE SYSTEM
• Older men also find that pubic hair is thinner, and the
testicles may shrink in size.
• As with the aging female, the aging male may need to
increase the time for foreplay in order for
the body to respond physically to sexual feelings
REPRODUCTIVE SYSTEM
• Impotence which is common among older men is
a result of
1. increased illness,
2. medication usage
3. surgery within this population.
• It a disease and should not be seen as a normal change
of aging.

REPRODUCTIVE SYSTEM
• WOMEN
• Aging women experience follicular depletion in
the
ovaries as a result of a decrease in circulating
hormones.
• This further leads to a decrease in the secretion
of
oestrogen and progesterone (Masters, 1986).
REPRODUCTIVE SYSTEM
• Natural breast tissue is replaced by fatty tissue,
changing the external appearance of the breast.
• The labia shrink and may hang in folds because
of lack
of subcutaneous tissue.
REPRODUCTIVE SYSTEM
• The vulva may appear to be dry and have pale
appearance, loss of rugae, and the introitus
atrophies.
• There is a decrease in vaginal lubrications and a
shortening
and narrowing of the vagina.
• The strength of the orgasmic contraction
diminishes, and the
orgasmic phase is decreased.
REPRODUCTIVE SYSTEM
• Normal changes of aging women may result in an
increased
time to respond during sexual activity and
dyspareunia (painful intercourse).
• Older women may have an inhibited sexual
desire, orgasmic
dysfunction, and vaginismus as a result of a
decrease in
circulating hormones
REPRODUCTIVE SYSTEM
• To counteract these changes, the older woman
may
need
1. vaginal lubricants to reduce friction during sex
2. Increase period of foreplay prior to the sexual
act to
allow the body enough time to physically respond
to
sexual feelings
REPRODUCTIVE SYSTEM
• MALE
• Specific changes of aging that occur among older
men
include an increased length of time needed for
erections
and ejaculation.
• Erections become more dependent on direct
penile
stimulation.
• Semen volume is decreased, and the refractory
period between ejaculations increases.
REPRODUCTIVE SYSTEM
• Older men also find that pubic hair is thinner, and
the
testicles may shrink in size.
• As with the aging female, the aging male may
need to
increase the time for foreplay in order for
the body to respond physically to sexual feelings
REPRODUCTIVE SYSTEM
• Impotence which is common among older men is
a result of
1. increased illness,
2. medication usage
3. surgery within this population.
• It a disease and should not be seen as a normal
change of aging.
Physical Care of the Elderly
Nutrition
• Factors affecting the nutritional status of the
older
adult include:
1. The general health status; a person who feels
unwell
cannot eat well
2. Dentition; if one cannot chew effectively, one
may
not have appetite
3. Emotional status; a person experiencing
depression
or cognitive changes will also have less appetite
for
food
Physical Care of the Elderly (Nutrition)
4. The cost of the food. Their limited pension
incomes
may not be able to buy food rich in protein and
vitamins.eg meat, milk, fresh fruits and vegetables
5. The availability and transportation of the food to
the house. Shopping requires physical exertion.
Lifting cans from the top shelve or bending to
select
an item close to the floor can physically exhaust
the
elderly.
6. Difficulties with food preparation and storage
Physical Care of the Elderly (Nutrition)
• Nursing intervention
• Explain/reinforce the importance of nutrition to
health or disease control.
• If they understand the rationale, they are more
likely
to cooperate with the nurse.
• Find out the food preference. Food likes and
dislikes.
• This helps you to select nutritious and acceptable
food
for the elderly.
Physical Care of the Elderly (Nutrition)
• Provide variety of nutritious food.
• Health assistant may go to shop with the elderly
if this
is possible.
• Discuss what needs to be bought with him/her.
• Provide oral care/assist before meals.
• He/she can also be assisted to the toilet before
meals
• Serve meals attractively. This is more appealing.
Physical Care of the Elderly (Nutrition)
• Provide social environment for meals by
encouraging
the elderly to eat on the dining table.
• Encourage significant others to join the elderly at
meals
• Place fluids and beverages in easy reach and
encourage him to take it frequently
• Have weekly weight checks
Ambulation
• Walking exercises most of the body’s muscles
and increases joint
flexibility.
• It improves respiratory and gastrointestinal
function.
• Ambulating also reduces the risk for
complications of immobility.
• However, even a short period of immobility can
decrease a person’s
tolerance for ambulating.
Ambulation
• If necessary, make use of appropriate equipment
and assistive devices
to aid in patient movement and handling.
• Ask the patient to report any feelings of
dizziness, weakness, or
shortness of breath while walking.
• Decide how far to walk.
• Place the bed in the lowest position to ensures
safety when getting
the client out of bed.
Ambulation
• Depending on the nurses’ assessment she can
walk with the client.
• She can also encourage client to take walk within
the premises
• Client can also walk with other clients.
• Where necessary the nurse can recommend
assistive devices such as
canes, Zimmer frames etc.
PHYSICAL SAFETY
• A safe environment allows the patient to move
about as freely as
possible and relieves the family of constant worry
about safety.
• Fall prevention interventions include a thorough
assessment of the
environment in which the older adult lives.
• Rugs and furniture that may be fall hazards
should be removed and
appropriate lighting and supports should be added
to areas in which
older adults ambulate.
PHYSICAL SAFETY
• Many homes have placed a patient’s mattress on
the floor to prevent
injuries from falling out of bed.
• The use of wall-to-wall carpeting also pads a
patient’s fall, resulting in
less injury on impact.
• The patient’s intake of medications and food is
monitored.
• A hazard-free environment allows the patient
maximum
independence and a sense of autonomy.
PHYSICAL SAFETY
• Because of a short attention span and
forgetfulness, wandering
behaviour can often be reduced by gently
persuading or distracting
the patient.
• Restraints are avoided because they may
increase agitation.
• Doors leading from the house must be secured.
Risk factors of falls among the elderly
1. Age-related changes:
• reduced visual capacity; problems differentiating
shades of the same
color, particularly blues, greens, and violets;
cataracts; poor vision at
night and in dimly lit areas; slower responses to
risk factors of fall;
urinary frequency
2. Lack/Improper use of mobility aids:
• using canes, walkers, wheelchairs without being
prescribed, properly
fitted, or instructed in safe use; not using brakes
during transfers
Risk factors of falls among the elderly
3. Medications:
• particularly those that can cause dizziness,
drowsiness, orthostatic
hypotension, and incontinence, such as
antihypertensives, sedatives,
antipsychotics, diuretics
4. Unsafe clothing:
• poor-fitting shoes and socks, long robes or pants
legs
5. Disease-related symptoms:
• postural hypotension, incontinence, reduced
cerebral blood flow,
edema, dizziness, weakness, fatigue, brittle bones,
paralysis, ataxia,
mood disturbances, confusion
6. Environmental hazards:
• wet surfaces, waxed floors, objects on floor, poor
lighting
7. Caregiver-related factors:
• improper use of restraints and bedrails, delays in
responding to
requests, unsafe practices, poor supervision of
problem behaviors
Medication
• Older people use more medications than does
any other age group:
they use 30% of all prescribed medications and
40% of all over-the-
counter medications.
• There is altered absorption, distribution,
metabolism, and excretion.
• Variability in these processes in older people is
caused, in part, by a
reduced capacity of the liver and kidneys to
metabolize and excrete
the medications and by lowered efficiency of the
circulatory and
nervous systems in coping with the effect of
certain medications.
Medication
• Many medications and their metabolites are
excreted by the kidney.
• With advanced age, body weight, total body
water, lean body mass,
and plasma albumin (protein) all decrease, while
body fat increases.
• Consequently, agents that are highly protein-
bound have fewer
binding sites and higher pharmacologic activity,
whereas fat-soluble
agents have more binding sites, and therefore
enhanced storage and
delayed elimination.
Medication
• The nurse administering medications to older
people must be aware
of the following:
1. Medications removed from the body primarily by
renal excretion
remain in the body for a longer time in people with
decreased renal
function.
• Often dosages must be reduced, because over
dosage and
medication toxicity at usual therapeutic dosages
are common.
•
Medication
2. Medications with a narrow safety margin (eg,
digitalis glycosides)
must be administered cautiously.
3. A decline in cardiac output may decrease the
delivery rate to the
target organ or storage tissue.
4. The circulatory and central nervous systems of
older people are less
able to cope with the effects of certain
medications, even when
blood levels are normal
Medication
5. Idiosyncratic or unusual responses to
medications may manifest as
toxic reactions and complications.
6. As a result of a slowing metabolism, medication
levels may increase
in the tissues and plasma, leading to prolonged
medication action.
7. Many elderly people have multiple medical
problems that require
treatment with one or more medications.
• The possibility of interactions between
medications is further
magnified if the older person is also taking one or
more over-the-
counter medications.
Medication
8. A high-fibre diet or other laxatives may
accelerate gastrointestinal
transport and reduce absorption of medications
taken concurrently.
9. If, for any reason, a patient is not dependable
about taking
medication, the nurse must be sure that the pill or
capsule is
actually swallowed and not retained between the
cheeks and the
gums or teeth.
Emotional Support
• The social world of the elderly continue to
dwindle as a result of
1. Reduce activity
2. Decreased in finances
3. Death of spouse
4. Loss of age mates
Emotional Support
• Loss of spouse affect men and women differently
• The difference in marital status is a result of
several factors: women
have a longer life expectancy than men do, women
tend to marry
older men, and women tend to remain widowed,
whereas men often
remarry
• There may be the need for the older client to
move in with younger
children.
Emotional Support
• Older clients can also accept adult relatives to
move in with them to
help in the household Chores and Bills
• They can also move into smaller apartments and
get hired assistance
with household chores
• There are also ‘elder homes’ care services where
specialized staff are
available.
•
Community Support
• Many community supports exist that help the
older person maintain
independence.
• Informal sources of help, such as family, friends,
the mail carrier,
church members, and neighbours, can all keep an
informal watch.
• Area Agencies on Aging perform many
community services, including
friendly visitors, home repair services, and home-
delivered meals.
Community Support
• Homemaker and chore services can be obtained
at an hourly rate
through these agencies or through local
community nursing services.
• If a person is unable to pay, these services may
be subsidized through
government, NGOs or the Church.
• Other community support services are available
to help the older
person outside the home.
Community Support
• Senior centres have social and health promotion
activities, and some
provide a nutritious noontime meal.
• Adult day care facilities offer daily nursing care
and social
opportunities; these services also enable family
members to carry on
daily activities while the older person is at the day
care centre.

Home Nursing
• Home Nursing is a professional nursing care provided
in the patient’s place of residence which may include
private homes, apartments, homeless shelters,
nursing homes, and older adult housing.
• The home care service may be provided either on
part-time, intermittent, hourly or on shift basis.
Home Nursing
• Historically, home care consisted primarily of nurses
providing private-duty care in clients’ homes
• Some families also provided care for their own ill
members.
• However, the delivery of professional nursing services
in home settings has increased in frequency, scope,
and complexity in the past decades.
Home Nursing
• Home care today involves a wide range of health care
professionals providing services in the home setting to
people recovering from an acute illness or injury or
those with a disability or a chronic conditions
• Care of patients in the home is different from the care
of hospital patients who conform to hospital routines
and schedules for eating, bathing, taking medication,
and visiting by their families and friends.
Home Nursing
• Home care nursing is unique.
• As nurses cross the threshold of the patient’s home,
care must be adapted to the patient’s schedule,
customs, and needs.
• The hallmark of a home care nurse is her ability to
blend skills with flexibility to provide quality patient
care.
Type of patients nurse at home
1. The aged
2. Patients recovering from hospitalization
3. Patients with chronic debilitating illnesses e.g.
diabetes mellitus, congestive heart failure, sickle cell
anaemia, AIDS
4. Women with high-risk pregnancies
5. Patients with certain psychiatric diseases e.g.
epilepsy
6. Postpartum care
Importance of Home Nursing
1. Receiving Care in the comfort of your home
• It allows patients to receive health care services in the
comfort of their own homes
2. It is cost-effective.
• Home care is relatively cost–effective.
• In America, it is estimated that the average daily cost
of hospitalization is $1,878 while the cost of average
home care is $186 (US), $187 vs 155 in Japan
Importance of Home Nursing
3. Leads to early discharge from the hospital: this
reduces cost and depopulates the facility.
• This has created a new, acutely ill population who
need skilled care at home.
4. Aging Population; as the population ages, the
incidence of chronic diseases that require home care
intervention is expected to increase.
Importance of Home Nursing
5. Technology advances in medicine; sophisticated
medical technologies have allowed patients
previously required to remain in the hospital setting
to receive necessary health care services at home.
(Mobile ventilators, cardiac monitors, X’ ray
machines, potable nebulisers, inhalers etc).
Importance of Home Nursing
6) Changes in family status; the number of single-
person households is growing resulting in increased
reliance on organisations such as home care
agencies to provide care once performed by families.
• Sick clients separated from their loved ones often
require outside services to receive necessary care.
• Older people living alone will need assistance with
basic task from home care agencies.
Importance of Home Nursing
7. Increased self-care responsibility; people are
becoming more actively involved in making their own
health choices.
• When possible people prefer to receive care in their
own homes rather than in an institution.
• Most people are glad to have the opportunity to
remain in the comfortable surroundings of their own
homes while being treated for their illnesses.
• It makes provision for dignified death for clients
suffering from terminal illnesses.
The Home Health Care Team
• Physician
• Role:
• Diagnose and Certifies that the patient has a health
problem to receive home care.
• Prescribe and certifies a plan of care for treatment of
the patient receiving home care
The Home Health Care Team
• Nurse
• Role
• Provide direct care to the patients and families.
• Teaches patient and family self-care.
• Conducts research to ensure cost-effectiveness and
quality of care.
• May be administrator of a home care agency and
serve as a consultant to staff.
• Coordinates services of other healthcare providers
The Home Health Care Team
• Physical Therapist
• Role
• Provides direct care such as muscle-strengthening
exercises, gait training, and massage.
• Teaches patient and family to promote self-care
The Home Health Care Team
• Occupational Therapist
• Role
• Evaluates the patient’s functional level and teaches
activities to promote self-care in activities of daily
living.
• Recommends if there is the need for job change or
change of role in the same job.
• Assesses the home for safety and provide adaptive
equipment as necessary
The Home Health Care Team
• Speech Therapist
• Role
• Provide direct care services to patients with speech,
language or hearing needs.
• Teaches patients and families to facilitate speech and
language ability as well as eating and swallowing
The Home Health Care Team
• Social Worker
• Role
• Assist patient and family in dealing with the social,
emotional and environmental factors that affect their
wellbeing.
• Make referrals to appropriate community resources.
• Provide assistance with securing equipment and
supplies and with healthcare finances.
The Home Health Care Team
• Home Health Aid
• Role
• Implement the plan of care designed by the nurse.
• Assist patient with hygiene and some level of house
keeping
Resources Used in Home Nursing
1. Professional Care Givers
2. Lay Care Givers; these are family members, friends,
neighbours and sometimes church volunteers who
have no formal training in the provision of health
care services.
• They however perform activities such as assisting with
activities of daily living, giving simple medication and
calling for help if client develops sudden crisis.
Resources Used in Home Nursing
3. Equipment;
• Infection Control; this involves sinks and soap for hand
washing, sterile and clean gloves, bleach (parazone),
container for preparing the bleach, plastic aprons,
face mask, eye shields, boilers, microwaves and
container for sharps.
• For wound care; sterile dressings (sterile cotton and
gauze), lotion, adhesive tapes, scissors, receivers for
used swabs etc.
Resources Used in Home Nursing
• Equipment;
• For monitoring; thermometer, stethoscope,
sphygmomanometer, glucometer and strips.
• For ensuring Safety; canes, clutches, Zimmer frames,
wheelchairs, beds with side rails
4. The patient’s drugs
5. Funds
Specific Roles of the Home Care Nurse
• Patient advocate
• Advocacy is the protection and support of another person’s
rights.
• It is very important in home nursing.
• Patients may need help in negotiating through complex health
care
systems or with problems involving insurance.
Specific Roles of the Home Care Nurse
• Patient advocate
• The Home care nurse can mobilize services needed to improve
patient’s living environment.
• She also communicates patient’s needs to other health care
providers.
Specific Roles of the Home Care Nurse
• Coordinator of Services
• The Home Care Nurse is generally the coordinator of all other
health
care providers visiting the patient including the physician, physical
therapist, occupational therapist, etc.
• The home care nurse is the primary source of communication
and
coordination of the patient’s care with primary health care
providers.
• She is also responsible for coordinating community resources
needed
by the patient. E.g. meals delivered at home, cancer association,
pain
association, diabetic association, etc
Specific Roles of the Home Care Nurse
• Educator
• The home care nurse spends most of her time teaching patients
and
their families about the disease condition, treatment/medication
and
wound care.
• She identifies the learning needs and together with the patient
and
family develop goals of teaching information necessary to
promote
wellness.
Specific Roles of the Home Care Nurse
• Emotional care
• Clients with debilitating chronic diseases that become
progressively
worse over time must deal with a number of emotional issues.
• As physical status deteriorates, clients endure many losses.
• Even patients with relatively good functioning must cope with the
knowledge of a diagnosis, and the awareness that the condition
may
advance.
Specific Roles of the Home Care Nurse
• Emotional care
• Clients will confront changes in their social life, loss of privacy
and
loss of activities that help to define them as a people.
• As functional skills decline and pain and discomfort increases,
the
nurse needs to reassure and educate the client on the disease
process
to enable them makes decisions on their personal relationships
and
lifestyle.
Specific Roles of the Home Care Nurse
• Medication
• Home care nurses administer drugs to their clients.
• The timing of medication must suit client’s daily routine as much
as
possible.
• The “seven rights” must be observed during drug administration
in
the home.
Specific Roles of the Home Care Nurse
• Medication
• The home care nurse also teaches client and family members
about
the name of the drugs, dosages, expected clinical action and
possible
side effects.
• The nurse scrutinize the bottles, and document the prescription,
dosages and frequency and clarifies with the patient and family
members if the dosage and frequency printed on the bottle is
what
client actually takes
Specific Roles of the Home Care Nurse
• Emergency management
• The Home Care Nurse assesses potentials for emergencies and
natural disasters and discusses preparedness regarding such
events
with clients.
• The nurse ensures that emergency response systems are
functioning
and are within the reach of client.
• (These systems provide a mechanism for clients to call for help
if they
cannot get to the phone. A client wears a medallion around his
neck
or wrist which he presses to initiate a call to an ambulance or care
giver to check on him).
Specific Roles of the Home Care Nurse
• Emergency management
• Nurses must be prepared to respond to any emergency in the
home.
• They should be equipped and ready to provide appropriate
interventions for medical emergencies, to activate the medical
emergency response system and to protect client in the event of
fire
or natural disaster.
• They must be prepared CPR or mouth – mouth resuscitation if
indicated. They should also carry first aid supplies with them
Specific Roles of the Home Care Nurse
• Documentation
• Documentation is an essential component of home care nursing.
It is
a skill that every home care nurse must master.
• The success and survival of home care nursing depends on
accurate
documentation.
• It is important for insurance claims by the client and the home
care
agency and for evaluation of the care delivered.
• Where legal issues arise it becomes the in defence or
prosecution.