From making sure that organisational systems are working smoothly and schedules run on time, through to ensuring that all the boxes have been ticked regarding policy changes, a lot is going on.

Yet at the heart of all the bustle, it is arguably those on the front line, the carers and nurses working in the daily routine that bring and see a much needed quality, humanity.

Scientific studies that have taken a look at the lives, input and wisdom of carers, have only fortified the notion that the people who are actually doing the work, are the ones that know what works and what doesn’t.

Changing Landscapes

A recent study was published in The British Journal of Social Work that investigated the changing policy landscape for aged care and the front line staff who are tasked with seeing change implemented.

The study looked at the impact of the introduction of consumer-directed care and its aim  to provide residents with greater autonomy and choice over their care services.

The study looked closely at front line staff and their perceptions about the changing policy, including  its impacts on facilities and residents.

What the study found was that carers had keen insight into what was working and what elements were causing frustration and confusion.

Insight

The study highlighted that carers found that the coordination of care, communication and the consistency of care delivery, were extremely important components affecting consumer directed care (CDC).

These components they saw impacting client relationships and quality of care.

Understanding carer insight and adjusting both the process of information gathering and policy creation, is where aged care organisations and policy makers can benefit most from the keen insight that carers can provide.

The study displayed the ability of carers to identify key areas of consideration when deliberating on changes to aged care and community care.

There is arguably a central role for carers in the process of policy creation, as they are integral to cultivating positive relationships, ensuring consistency and continuity in care, and managing the needs and expectations of clients.

Additionally, it is carers that are consistently facilitating support and advocacy of care options that work for both the residents and care staff.

The Invaluable Nature Of Rapport

An integral component of any smooth running facility is the rapport that carers have built between themselves and clients, over long nights, days, months and years.

Across ups and downs in moods and health, carers have created bonds built on trust, consistency and powerfully, providing dignity.

As the report states, rapport “is an invaluable component of community care that needs to be incorporated into CDC models”.

Understanding The Tricky Elements

The study showed that carers understood the nuances of the balance between empowering clients in self-determining choices, and when to exercise their duty of care towards their clients.

That balance is incredibly vital in facilitating the effectiveness of CDC in local and international facilities.

The study encouraged that the insights of carers allowed for deep and honest discussions about how policy changes were implemented, their effectiveness, and possible roadblocks along the way.

In attempting to navigate the design and implementation of “appropriate, quality, accessible and sustainable services to support older people’s needs” those on the front line and their insights have been and will always be crucially needed and relevant.

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Within the aged care space they are usually responsible for hundreds of patients at any given time and are the first responders day or night.

Not only are our nursing professionals expected to consistently provide excellent care but to navigate the many tricky gray areas when it comes to whole spectrum of care.

The burden of responsibility, workload and breadth of care must be acknowledged when it comes to championing and supporting our nurses.

It may be in entering into the dialogue of the gray areas of care, that particularly challenge and drain, that progress may be made in tackling those areas.

Currently there is a great need to provide community and resources to assist some of our most valuable personnel.

Gray Areas

It is not commonly understood that within caring for residents, nurses on a daily basis have to make calls regarding the approach to care that aren’t outlined in clinical guidelines or standards.

There are far more situations than we realise where doctor, resident, family members, nursing staff and carers may not be in agreement, not because anyone is wrong but because there is no black-and-white answer.

For example, when a resident may be close to death, intricate decisions must be made regarding how much monitoring they should be given, i.e. how many resources should be used from the collective facility towards this end-of-life stage?

While some elements are stipulated in standards there are many areas that fall outside clear cut rules and must be decided by a cross-sectional team.

Nurses have persistently found themselves in the position to either fight for certain resources to be given, mediate between team and family members, all the while seeking to provide excellence in care.

It is these moments, that arise commonly and without warning that place considerable strains upon nurses.

The long term consequences of having to navigate these gray areas alone arguably increases the likelihood for burnout and emotional and mental stress.

This likelihood increasing all the more the need for robust discussion and support network facilitation.

Ethical Silent Treatment

Naomi Cross is a registered nurse, who at one time, was new in her role as bereavement coordinator at Johns Hopkins Hospital.

As she started in her work it became apparent to her that discussions, across medical and management teams, regarding ethics were not a regular part of the patient care approach.

In response to a certain situation with a family, Cross felt that the taboo nature of dealing with ethics had to lead to patients not being given a proper level of care.

In short, it is in the fostering of ethical discussion, learning and openness that medical staff and particular nurses who are many times of the front lines, can be equipped to navigate tricky situations for the best possible outcomes for patients.

Seeking Change

In response to the need that she saw, to equip medical staff, especially nurses to deal with these gray areas well, she embarked on a lengthy, challenging mission to seek to establish an open ethics dialogue and resource pool for those in her department.

“Some days, I felt like I was banging my head against a wall,” she says.

“In the beginning, I was cussed at. I was cussed at by professionals—by doctors and nurses. I think that I had to really develop a tough skin, and I had to come at it from a very rational standpoint, and, sadly, from a monetary standpoint.”

Not To Be Ignored

It is when nurses are ignored that they burn out. It is when the daily grind of nursing is prioritised without the partnership or support of ethics training that nursing staff become stretched mentally and emotionally thin.

With the increasing need of nurses in our health care sector, nurse burn out or nurses quitting is not a safe, sustainable or acceptable trend to allow to endure.

Front Line Support

As nurses generally spend more time with residents, arguably this means that the likelihood of having to deal with a complex situation is high.

Between navigating the resident’s wishes, family members, doctors and carers, the cacophony of voices and opinions can be immense.

When it comes to ethical complexities, Martha Turner of the American Nurses Association explains that burn out can happen powerfully in nurses for two main reasons.

Nurses are consistently finding themselves in situation where the right thing to do is uncertain or the nurse can see the humanly appropriate action to take but they are constricted in seeing it through (perhaps due to hospital or facility policy).

Moving Forward

Ethics must be on the health care agenda. Psychologists, psychiatrists, nurses and all host of medical staff have attested to the vital need for open ethical discussion.

Not only will an open dialogue on ethics, and resources to assist with wrangling complex topics, help our most vulnerable patients and residents, it is likely to assist in the wellbeing and progress of our core medical personnel for the long run.

Nurses are integral to the function of the health care and aged care sectors.

In upholding them in their work, in helping to navigate the areas that drain and strain their work, the ripple effect of progress and excellence in care will have unimaginable and tremendous benefits across society.

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