LONG TERM CARE IN HOSPITALIZATION AND EFFECTS OF ITS ON THE PATIENT AND FAMILY

1. RakeshKumar
M N (Prev)
RAKCON
Long term care in Hospitalization and effect of it on
the patient and family

2. INTRODUCTION
• As a major component of the health care delivery system, long-
term care (LTC) is receiving increasing attention in both developed
and developing countries. LTC is closely associated with disabilities
emanating from chronic conditions that are mostly related to
human aging. Developed countries have seen a steep rise in chronic
conditions, and the trend will continue. A rise in chronic conditions
and functional limitations will create a growing demand for LTC
services in the developing world as well. Thanks to better
sanitation, nutrition, and medical care, longevity is increasing in
developing countries. The social environment in these countries is
also changing. Both men and women are increasingly being drawn
into the work- force to improve their standards of living. Their
lifestyles are becoming hectic but sedentary.
A broad understanding of long-term care as a distinct segment of
the health care delivery for managing any LTC organization.

3. DEFINITION
• Long-term care is a variety of services that includes medical and
non-medical care to people who have a chronic illness or disability.
Long-term care helps meet health or personal needs. Most long-
term care is to assist people with support services such as activities
of daily living like dressing, bathing, and using the bathroom. Long-
term care can be provided at home, in the community, in assisted
living or in nursing homes.
OR
• When a person requires someone else to help him with his physical
or emotional needs over an extended period of time, this is long-
term care EG:WALKING,BATHING,DRESSING etc

4. TYPE OF LONG TERM CARE
Temporary long term care (need for care for
only weeks or months)
• Rehabilitation from a hospital stay
• Recovery from illness
• Recovery from injury
• Recovery from surgery
• Terminal medical condition

5. CONTINUE...
Ongoing long term care (need for care for
many months or years)
• Chronic medical conditions
• Chronic severe pain
• Permanent disabilities
• Dementia
• Ongoing need for help with activities of daily
living
• Need for supervision

6. OTHER FORMS OF ONGOING CARE:
• Subacute or transitional care
• Assisted living facility
• Adult day care
• Home care

7. HOSPICE
• For people who are terminally ill and in need
of care. This care can be provided in the home
or in a day hospital setting. Care of dying is
common experience in long term care. Caring
behaviours of staff at the time of death,
allowing family to be involved with the
resident and providing spiritual support are
important and valued nursing functions

8. CLIENTS OF LONG TERM CARE
• Older adults
• Children and adolescents.
• Young adults.
• People with HIV/AIDS.
• People needing sub acute or high-tech care.

9. THE INSTITUTIONAL SYSTEM
• Independent or retirement living.
• Residential or personal care.
• Assisted living.
• Skilled nursing.
• Subacute care.
• Specialized care.

10. NURSE’S RESPONSIBILITIES IN LTC
FACILITIES
• Assessment
• Care planning
• Care –giving
• Communication
• Management

11. ASSESSMENT
• it is not a comprehensive assessment; it is a minimum assessment.
Important pieces of information are not captured, such as the client's self-
concept, spirituality, sense of power, knowledge of health condition and
self-care practices, sexuality, patterns of solitude, sense of purpose,
immunity, stress management, use of alternative therapies, and attitudes
regarding health status and death. Because these are important areas for
consideration in the long-term care of residents, you may want to
supplement the MDS with these additional assessment data.
• Although the MDS assessment tool must be formally completed
periodically, high-quality care relies on the nurse's assessment of residents
with every nurse-resident contact. For example, when administering a
medication, you can observe the resident's coloring and respirations, note
any change in mood, and ask about the status of a previous manifestation.
• Often residents do not have the ability to identify and report changes in
their own health status, and astute nursing assessment is thus crucial. The
need to be alert to changes in status is reinforced by the reality that
physicians typically do not to see on a daily basis and must rely on nurses
to detect and report manifestations.

12. CARE PLANNING
• Regulations require that a care plan be written for each resident
within 7 days after completion of the assessment. The care plan is
an interdisciplinary one; nurses coordinate the input offered by
each discipline and ensure that the plan is written in a correct,
timely manner .
• To the extent possible, the resident and the family should actively
participate in the development of the care plan.
• A care plan is not merely a paperwork requirement but a working
tool to guide nursing actions; it is a blue-print for nursing actions.
Goals and actions that are no longer relevant need to be revised.
• All members of the team, particularly nursing assistants who
perform most direct care activities, must be familiar with the care
plan.

13. CARE GIVING
• Environment
• Routines
• People
• Independence

14. COMMUNNICATION
• Proper communication helps the nurse for identifying and
obtaining timely treatment of complications and new
health problems and also nurse must make sure that
physicians learn of changes in residents condition in a
timely manner.
• Provide the physician with complete information that can
aid in medical decision making. Eg: current and usual vital
signs, clinical manifestations etc
• Avoid making diagnosis. report the clinical manifestations
and allow physician to make medical judgement.
• Take order directly from the physician
• If there is anything wrong in the order question the
physician.

15. MANAGEMENT
• Delegating assignments
• Supervising other staff
• Evaluating performance
• Implementing disciplinary actions
• Completing reports
• Reviewing and auditing records
• Communicating needs to other departments
• Investigating, reporting and recording incidents and accidents
• Handling complaints
• Ordering supplies
• Communicating with regulatory agencies and other parties

16. HOLISTIC NURSES RESPONSIBILITIES
IN LONG TERM CARE FACILITIES:
• Assisting residents to achieve a higher potential of
functioning
• Supporting residents in their efforts to promote health
and prevents complications
• Learning about the unique life stories of residents
• Ensuring that residents receive care that is consistent
with their values and beliefs and respecting cultural
differences
• Strengthening resident’s abilities to live in harmony
with their health condition
• Helping residents boost their natural healing abilities

17. HOLISTIC NURSES RESPONSIBILITIES
IN LONG TERM CARE FACILITIES:
• Facilitating hope and a sense of purpose in
resident’s lives
• Providing a nurturing and helping care giving
environment
• Offering opportunities for residents to
experiences joy and satisfaction
• Protecting residents from threats to their health
or well-being and promoting highest quality of
life
• Adhering to accepted standard of nursing
practice

18. CARE PERSONNEL IN LONG TERM
CARE CENTERS
Patient & Family
• Actively participate in the rehabilitation
process so that they can achieve the
best outcome possible.
Social Worker
• Provides support and counselling as needed for
the patient and their family, and facilitates a safe
and effective discharge plan.

19. CARE PERSONNEL IN LONG TERM
CARE CENTERS
Rehabilitation Assistant
• Works under the supervision of the Physiotherapist and/or
Occupational Therapist to provide individual or group therapy
programs
Respiratory Therapist
• Evaluates, treats and cares for patients with breathing disorders

20. CARE PERSONNEL IN LONG TERM
CARE CENTERS
Physiotherapist
• assist nursing and other Long Term Care staff in
providing safe care that maximizes the residents
abilities and reduces risk of injury to both residents
and employees.

21. CONTINUE...
• Activation of physical capacity
• Restoration of function
• Improved or maintained mobility
• Safe transfers
• Reduction of falls and fall related injuries
• Reduction in pain
• Activation of physical capacity
• Restoration of function
• Improved or maintained mobility
• Safe transfers
• Reduction of falls and fall related injuries
• Reduction in pain

22. CONTINUE...
• Decreased incontinence
• Less incidence of pressure sores
• Improved quality of life
• Workplace safety and injury prevention
• Safe transfer methods
• Education on care concerns
• dealing, pain management

23. NEURO PSYCHOLOGIST
• Traumatic stroke can affect behaviour, thinking, memory, and other
brain functions in obvious or subtle ways. They can perform an
evaluation to help determine the degree of stroke impairment.
• Parkinson’s disease, a progressive disorder, can cause several
neurological problems. A neuropsychologist’s exam can provide a
baseline to help them determine disease progression and
decreased function.
• Alzheimer’s disease and other types of dementia can interfere with
memory, personality, and cognitive abilities. A neuropsychologist
can perform an exam to help them identify it in its early stage.
• brain injuries can cause a wide variety of symptoms. A
neuropsychologist can help determine how an injury affects
functions like reasoning or problem-solving skills.
• A neuropsychologist can help determine which of the many types of
learning disabilities someone has and develop a treatment plan.

24. ROLE OF OCCUPATIONAL THERAPIST
• Examining the condition of patients and analyzing their needs.
• Planning treatment and providing it to the respective patient.
• Keeping an eye on their medical condition.
• Reviewing progress and upgrading the prescribed treatment
as per the requirement.
• Educating the patients’ family and employer about their
needs and how to provide adequate medical care to them.
• Providing customized services as per different disabilities of
the patients.
• Examining the home and workplace of the patients. Making
potential changes as per the health requirement of their
client.

25. ROLE OF OCCUPATIONAL THERAPIST
• Installing the required equipment in the
classroom to help children with disabilities. Also,
providing guidance on how to use the special
equipment.
• Taking exercise sessions so that patients can get
relief from chronic pain
• Helping people to return to work.
• Program the aspirants of an occupational
therapist and supervising their work.
• Organizing rehabilitation groups for the clients
and carers.

26. ROLE OF OCCUPATIONAL THERAPIST
• Preparing reports and attending
multidisciplinary case meeting to decide and
review the continuing treatment.
• Help children participate in school activities.
• Taking sessions on time management, anxiety
management tricks and techniques.
• Perform administrative tasks like making
phone calls, maintaining records and case
notes.

27. ROLE OF SPEECH THERAPIST
• communication or eating and swallowing problems
following neurological impairments and degenerative
conditions, including stroke, head injury, Parkinson's
disease and dementia
• head, neck or throat cancer
• voice problems
• mental health issues
• learning difficulties
• physical disabilities
• stammering
• hearing impairment.

28. DIETITION

29. DIETITION
• A dietician is an expert in dietetics; that is, human nutrition
and the regulation of diet. A dietician alters their patient's
nutrition based upon their medical Condition and individual
needs.
• Dietician monitor, assess, and optimize nutrition status
based on the patient's current medical condition and/or
nutrition adequacy.
• They conform with physicians and other healthcare
professionals to coordinate medical and nutritional needs,
and they make recommendations for tube and intravenous
feedings and/or dietary supplements. Clinical dieticians
teach patients how to make nutritionally sound food
choices to speed the recovery process, prevent disease and
maintain a healthy lifestyle.

30. ROLE OF NURSE
• - Maintaining a safe environment;
• - Communicating;
• - Breathing;
• - Eating and drinking;
• - Eliminating;
• - Personal cleansing and dressing;
• -Controlling body temperature;
• - Mobilizing;
• - Working and playing;
• - Expressing sexuality;
• - Sleeping;
• -Mobilization

31. EFFECTS OF HOSPITALIZATION ON
PATIENT AND FAMILY
Hospitalization
Definition:
• Hospitalization is the act of placing a person in
a hospital as a patient.
OR
• The act of taking someone to hospital and
keeping them there for treatment.

32. PURPOSE
• For investigations
• Procedures
• Surgery
• Emergency medical treatment
• Administration of drug
• Or to stabilize or monitor an existing condition

33. RISKS OF HOSPITALIZATION
• Medication errors
• Hospital acquired infections
• Hospital acquired Pneumonia
• Deep vein thrombosis
• Bleeding after surgery
• Anaesthesia complications

34. IMPACT OF HOSPITALIZATION ON
DIFFERENT AGE GROUP
• Impact of hospitalization for children
Separation anxiety
Fear
Loss of control( restraint of movement, sleep,
feed)
Pain
 body image

35. CONTINUE...
• Stress response to hospitalization depends
upon
Pain
Intensity
Duration
Coping ability

36. THE IMPACT OF HOSPITALIZATION IS DIFFERENT IN
DIFFERENT AGE GROUPS OF CHILDREN
Reaction of neonates:
• Interrupt the mother and child relationship
And family integration
• Impairment of bonding and trusting
relationship
• Inability of the parent to love and care the
child
• Inability of the child to love the parents

37. CONTINUE...
Reaction of infant
– Separation anxiety disturbance in the
development of basic trust 4-8month – depression
and withdrawal
– Interference of growth and delayed development
– 8-12 month– limited tolerance to separation
Evidenced by excessive cry and over dependence
on mother
•

38. CONTINUE...
Reaction of toddler
• Protest: frequent crying, shaking crib, rejecting
nurses attention, urgent desire to find mother
showing sign of distrust with anger and tears.
• Despair: helpless, apathetic, anorectic, looks sad
cry continuously, use comfort measures like
thump sucking and tightly clenching the toys
• Denial: forget the absence of mother concentrate
on play and other

39. CONTINUE...
Reaction of preschool child
• Like toddler preschooler will react. They will use
defence mechanism like
• Regression,
• Repression
• Projection
• Displacement
• Aggression
• Denial
• withdrawal

40. CONTINUE...
Reaction of school age children
• Defence mechanism used is Regression
separation anxiety, negativism Depression,
Suppression denial, phobia- unrealistic fear

41. CONTINUE...
Reaction of adolescence
• Concerned with problem of privacy
• Separation from peers, family, and school,
• Interference with body image and independency or self
concept or sexuality
• Show anxiety an insecurity in strange environment
• Anger and uncooperative behaviour
• Defence mechanism used are denial or withdrawal
rejection and depression
•

42. CONTINUE....
REACTION OF OLDER ADULTS
• Hospitalization of older adults is often
followed by an irreversible decline in
functional status affecting their quality of life
and well being after discharge

43. GENERAL IMPACT OF HOSPITALISATION
1. Psychological
2. Physiological

44. PSYCHOLOGICAL EFFECT
• Anxiety – fear of unknown or depression
• Express anxiety – Patient may express his anxiety as
frustration or irritability or guilt
• Obsessed with her health problems
• Guilt may result from being unable to work and
support one self
• Patient who are depressed may have suicidal ideas
• Copying skill may be challenged
• Loss of self esteem, loss of statues within the family

45. CONTINUE...
• Loss of independence
• Feeling of rejection
• Feeling of helplessness
• Emotional out burst
• Emotional pain, soma to form disorders,
mental insufficiency, mental exhaustion
• Perceptual disturbance.

46. PHYSIOLOGICAL EFFECT OF
HOSPITALIZATION
• Stress response by brain after hospitalization
• Confusion
• Physical exhaustion
• Affects developmental milestones
• Sleep disruption
• Loss of appetite
• Socio cultural effects

47. IMPACT OF LONG TERM
HOSPITALIZATION ON FAMILY
• When serious illness or disability strikes a person, the family as a
whole is affected by the disease process and by the entire health
care experience.
• Patients and families have different needs for education and
counselling. Because each person in a family plays a specific role
that is part of the family’s everyday functioning, the illness of one
family member disrupts the whole family.
• When a family member becomes ill, other family members must
alter their lifestyle and take on some of the role functions of the ill
person, which in turn affects their own normal role functioning. If
the person who does most of the family’s cooking has surgery and
can’t shop or prepare meals for several weeks, other family
members must take on this responsibility in addition to the tasks
they already do.

48. CONTINUE....
• When a working parent is up most of the night trying
to console a child with an ear infection, the parent not
only loses sleep, but must either arrange for emergent
child care or take a day off from work.
• If a man who is the primary income producer in a
family has a heart attack, his wife may have to return
to work, increase working hours if she is already
employed, or become the family’s breadwinner. Middle
aged adults whose children have just left home may
need to alter their plans and goals to accommodate
care needs for aging parents.

49. CONTINUE...
• Illness may cause additional strain as the result of
economic problems and interruptions in career
development.
• If the patient is a young child, there may be
additional strain to the family if there are siblings
whose needs must also be met.
• Illness in the middle stage of family life, when
adolescents are trying to break away from family
ties and parents are going through their own mid-
life transitions, may put further strain on what is
already a time of potential family turmoil.

50. CONTINUE..
• Illness in later age may have an impact not
only on grown children but also on the older
couple who had anticipated a time of
enjoyment together and are less able to care
for each other because of their own physical
limitations associated with aging.

51. CONTINUE...
• The extent of family disruption depends on the seriousness
of the illness, the family’s level of functioning before the
illness, socioeconomic considerations, and the extent to
which other family members can absorb the role of the
person who is ill.
• In some instances, a major illness brings a family closer
together; in others, even a minor illness causes significant
strain.
• It is important to identify what the illness means, not only
to the individual but also to the family. Asking them what
they consider major problems and how they plan to handle
specific situations can help you assess the meaning of the
patient’s illness to the family

52. CONTINUE...
• To achieve effective patient teaching outcomes, you
should make the family part of your teaching plan. For
example, if your patient’s wife does all the cooking in
the home, it is vital to include her in diet teaching.
• Involving family members may be an important future
source of support for the patient as he or she works at
behavioural change.
• Obviously it will be difficult for a husband to be
supportive of his wife’s blood pressure treatment
program if he does not understand the reasons for the
recommendations and the consequences of not
carrying them out.

53. CONTINUE...
• Long-term illness, even in the most stable and supportive
families, brings changes in family relationships. Illness
produces disequilibrium in the family structure until
adjustments can occur.
• If the nurse does not recognize the change, what it might
mean to the patient and family, and how it might affect the
patient’s willingness and ability to carry out health care
recommendations, the goals of the teaching process will be
diminished.
• When teaching the patient and family, it is important to
identify patterns of relationships and to be alert to
attitudes of family members. You may be able to identify
resources within the group and help family members
mobilize their resources to help the patient..

54. CONTINUE...
• It’s also important to be alert to some of the factors in
family members that act as a barrier to education.
• Illness in a family member tends to raise the anxiety of
all those close to the patient. Anxiety may be
misinterpreted by the health professional as lack of
interest or as reluctance to provide the patient with
help and support.
• The more you are aware of these reactions and help
family members deal with their feelings, the better
able you will be to teach family members about the
patient’s condition and treatment and to mobilize their
support