Part 3 - Best care for older people in hospital

Older people and clinicians describe how we can make a difference through communication, teamwork and using evidence based strategies.

The quality of care we provide will affect an older person's independence and outcome Scene setting shots

Susan Clinical Nurse Specialist - Continence
We need to have more of a holistic approach. I think that when were looking at projects such as the Best care for older people it really makes us stand back and go oh wow, this is -theres a person under all this, you know, under all this paperwork theres a person and all these little aspects of this persons care are all interlinked together. You know how this person walks, what this person eats, how this person goes to the toilet. Theyre all connected, they all make up the individual, so we need to make sure that when we are assessing, that were assessing the individual not just patient number you know 356.

Luke Graduate Nurse
The earlier that you learn things the sooner that you can start putting them into practice and for student clinicians, the theory is put into practice quite often straight away. Youre doing, youre doing student placements all the time and therefore, if youve got the knowledge of the Toolkit already ingrained then youre going to be able to put that into practice while youre a student and therefore when you jump into to being a professional, it already there and youre already able to use it.

Ray patient hospitalised with a stroke
The patient has to be asked very clearly and get from them exactly what it is that they would like to get back to doing. If you can marry those two together. If the patient has a goal, it might be an unachievable goal at this stage, but if we ask them, then we can say oh, well before we can get there, well need to achieve this, and this, and this, so you set about enabling goals that you can get the patent to do, and if youre working towards the person-centred goal with your person-centred care, what a great marriage itd be.

Lyn Hilda's daughter
Communication, I think thats the biggest thing, communication between everyone in the wards - the staff and the patients. Each section talk to each other. Have a group session and even bring the family, involve, even a family grouping. Let them know that there is something there, out for them to go home to, if theyre not going home to their own home, to a nursing home. There is life that they might have to change, that theyve got to --there is something for them. Dont just let them go and out the door, and say bye.

Marilyn Multiple hospital stays
And I think as a patient, a long term patient, I see myself as part of that team too. Because Im there for them to work with and if they communicate with me what they want, how I can help them help myself get better.

Susan Clinical Nurse Specialist Continence.
We dont want anyone to fall, you know, we dont want anyone to choke, we dont want a lot of things to happen, so we tend not to, at times, let people stay as their normal functioning self. Sometimes empowering people goes against, you know, what weve learnt, and, you know, the clinical check lists that we tick off each day: and, you know, how do we deal with that as a group of individuals working with someone when their, maybe their agenda is different to ours.

Dora Clinical resource nurse
The breakfast groups that we have here are great because the patients get out of their rooms, they go into the dining area, and the physios and OTs are with them and they support them, but they can make their own coffee and tea and toast.

Luke Graduate Nurse
I encourage patients to express what they want to get out of the day. Quite often that would be Ive got family coming in at this time, Id really like to go downstairs, is that OK with you? Thats fine, you know, we can make that happen. Well work around that to give them that hour of family time. Certainly think its one of the things that we can do to put them at the centre of their care and to make them feel like more of a person, rather than just a patient.

Dora Clinical resource nurse
Once I was listening to a patient calling out, and I was actually at the nurses station and several other staff were around me complaining about the noise coming from that particular room. So I got up and went to see what the challenge was. I said why are you making such a loud noise? Why are you calling out so strongly? And she said it was the only way that I get heard. And all she needed was to be re-positioned and she was comfortable and she could go on with her day. And so instead of it being about how it was affecting all of us sitting at the station, it should have been about her, thats why she was with us, and we just needed to put her back into the focus.

Ray patient hospitalised because of stroke
Clinicians, I would say, look for any opportunity that you can. A smile is a lovely start. People respond so much to that. Um.. a kind word, being somebody who is, likes to listen to a few words from me before they rush off to the next job.

Dora Clinical resource nurse
When we can stop and prioritise whats important for our patients, then maybe we can change what we thinks important, or if we could talk to another colleague and say look Im just really busy and I wont be able to get to this, this and this, or even if its just a this, get some help and when we all do it together, when its a group effort, when its not just a medical process or a nursing, or were just doing physio, when were all doing it together well, well get there.

Susan Clinical Nurse Specialist Continence.
We all know that anyone that works in the health care profession works, you know, really, really hard, theres no question about that. I think what we want is for people to do things a little bit differently. We want people to take a slightly different approach when theyre caring for people, and I think that word care is probably quite fundamental in what were talking about. That hospital stay needs to be just a small part of their life and we need to keep it as that, we need to make sure that when they leave hospital they go back to life, because thats the important part.

Associate Professor Peter Hunter, Geriatrician
The sad fact remains that a lot of older people come into hospital and whilst we are very good at treating the underlying medical condition, were not terribly good at dealing with all the other things that happen to older people when theyre in hospital and we call that functional decline. Older people are at risk to having a number of things happen to them in hospital. They can become confused, they may develop incontinence, their mobility may worsen, they may become depressed and anxious, and to date we havent been terribly good at actually treating that. We know its the simple things that actually significantly improve the care of older people. Straightforward things such as the right environment for older people and also the right care. We know that a team-based approach to care is really important in the care of older people, involving and listening to patients and their families and carers is so important. And theres the detail that we sometimes forget. Its whether the meal tray is in reach during meal time, whether theres plenty of fluid available during the day to prevent dehydration, its getting people out of bed and making sure they are kept ambulant and mobilising during the course of the day. Its making sure that we look out for the problems of depression and anxiety and actively manage those with the patient. Its about making sure we orientate people so they dont get more confused. The beauty of the Toolkit is that actually breaks down all the strategies that have evidence into manageable bites that the clinicians can actually use to improve the care of older people. It is an absolute delight and pleasure looking after older people. All we actually need to do is arm people with the right skills and the right attitude to look after older people well, and this Toolkit goes a long way to actually being able to provide people with the right set of strategies, the right set of clinical guidelines to help them do the best by their patients.To access the toolkit, go to the website.

Filling music for the last couple of minutes, with credits rolling.