The helpful complete guide to an Aged Care Nursing Placement for students

Introduction

Make sure to sign up to The Nurse Break quickly before reading on. So we received a private email regarding a nursing student who is unsure what to expect on an Intensive Care Unit (ICU) placement. So we thought we would start a section on the website that goes into what to expect in all the different areas nursing students can be placed!

This is the Aged Care Nursing Placement Guide!

Some other articles you will enjoy

• For a comprehensive and systematic approach to assessment in ICU, read THIS POST
• For a guide to placement/grad year on a cardiac / cardiothoracics ward + free worksheet on cardiac pharmacology and main cardiac issues go HERE
• Cheat-sheet guide for your ICU nursing placement HERE
• Introduction to Cardiac Nursing Basics for nursing students
• The ultimate nursing guide to sepsis
• A cheat-sheet guide for your cardiac nursing placement
• The helpful complete guide to an Aged Care Nursing Placement for students
• 14 strategies for successful clinical placements
• Untangling nursing communication – “My patient can’t talk to me… Help!”
• Step-by-step explanation of nursing CPD
• Helpful list of proven graduate nurse tips!
• You MUST know about ACT-PINCHES (N) drugs

Also, go check out The Nurse Break’s Facebook Group for more tips and networking.

Before we get into the nursing placement specifics, it is important to understand the context of where you are going. This is a basic overview.

Context

The aged care system caters for older Australians who can no longer live without support in their own home. You may find aged care service’s provided in people’s homes, in the community and in residential aged care facilities (nursing homes) by a wide variety of providers both public and private. You may be placed in any of these environments for your nursing placement.

Legislative Framework

The Australian Government Department of Health (DoH) is responsible for the operation of the Aged Care Act 1997 (the Act). While the associated Aged Care Principles set out the legislative framework for the funding and regulation of aged care.

Types of Care

• Home Support: Through the Commonwealth Home Support Programme (CHSP), Home Help may be given to older persons. Respite services may be offered to relieve carers. This can include nursing care, home maintenance, social support and much more.
• Home care packages: There are different levels of home care packages from basic level 1 through to higher-level support. This involves health care professionals (HCP’s) going to people’s home to provide personal and support and clinical services.
• Residential Care: You may be most familiar with Residential Aged Care as this is where the majority of students are allocated for a nursing placement. Residential Care is subsidized by the Australian Government and the majority of funding is calculated using the Aged Care Funding Instrument (ACFI), which Aged Care nurses need to be very familiar with.

Care Needs

Check out this link from the Australian Institute of Health and Welfare! 87% of people in permanent residential care had at least one diagnosed mental health or behavioural condition. 49% are diagnosed with depression. 54% are diagnosed with dementia. 31% had high care needs!

What this demonstrates is a need to understand the whole patient. Older persons in Aged Care facilities have a multitude of care needs. Some low level and some high level. But knowing how to provide nursing care, also includes an ability to assess and recognise the differences between the 3 Ds. Dementia, Delirium and Depression. Learn about the Differential diagnosis of depression, delirium and dementia

Some definitions

Dementia – an umbrella term for a variety of diseases that cause a decline in multiple areas of cognition such as memory, judgment, communication and a decline in abilities to carry out activities of daily living.

Delirium – disturbance of consciousness with reduced ability to focus, sustain, or shift attention. Develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. There will often be evidence from the history, examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication, or medication side effect.

BPSD – behavioural and psychological symptoms of dementia.

Psychosis – a severe mental disorder in which thought and emotions are so impaired that contact is lost with reality.

Royal Commission

On 16 September 2018, the Australian Government announced a Royal Commission into the aged care sector. The Royal Commission is looking at the quality of residential and in-home aged care and will provide a final report by 26 February 2021.

For more go here

Aged Care Nursing Placement Tips!

Aged Care is Everyone’s Business

Just like Palliative Care is Everyone’s Business, Aged Care is also Everyone’s Business! Why? Because the majority of people in the healthcare system are older people and regardless of where you work, you will have to nurse older people! (Unless you spend 100% of your career in Paediatrics of course…). Check out our interview on Facebook about all things Palliative Care!

Get to know the residents, you’re in their home. The people are real, and so is the responsibility.

Get to know the residents, they love students! It’s so important to build rapport and good relationships with them. Bring with you to each shift a sense of humour. My challenge for you is to make one resident laugh or smile every day! Elderly residents have so many cool stories so ask and then listen!

Check out the amazing ‘Reflections of The Past’ which is an award-winning photo series.

Thier home (your placement) might be located in many different settings. Common ones include a low level or high level aged care facility both private or public, or even a locked/secure dementia unit. It could include other settings as well.

As a student, you will have time to “go that extra mile”, take time to help with feeding, do their hair, participate in activities. When providing help with feeding, toileting and hygiene, make sure to talk to them while you are doing it to break the awkward silence.

Treat every resident as if they were your grandparent or family member. With decency, kindness and respect. Always maintain their dignity. They are human, they have entire lives behind them, look past what you see in front of you. Always remember that you are in their home, quite possibly the last one they will live in. Treat them how you’d like to be treated in your own home. While this might just be a shift for you, they are letting you into their home.

They are trusting you to care for them. They are allowing themselves to be vulnerable in front of you. Just remind yourself of that when you come across a challenging patient or a draining shift.

It isn’t just ‘basic nursing care’. Change your mindset about your upcoming Aged Care Nursing Placement

You are not just doing an Assistant in Nursing (AIN) job or there as a freehand. Even if you feel like you are and are placed with staff that are not nurses some shifts. The carers are your best allies! They know the residents 6 million times better than the nurses will, they’ll identify signs of them being unwell way before nursing staff will.

Aged care is a complex environment and most residents have complex issues. Many students will need to change their mindset and realise there is so much you can learn in an aged care placement. While working within your scope of practice, you should be trying to practice at every occasion as much as you can.

You will learn and be exposed to SO MANY medications. Make sure you know what the medications are used for! Read this following article and ensure you have these 4 MUST HAVE drug calculation and pharmacology textbooks for nursing students!

You will learn and be exposed to SO MANY chronic medical conditions. Make sure to read the residents histories and learn about the pathophysiology of their conditions! Khan Academy on Youtube is free and provides great insights into common conditions the residents may have. Alternatively, just pick up your textbook!

Practice recognising all types of clinical deterioration and practising the primary survey and secondary survey, under the supervision of a nurse.

The sights, sounds, and smells in real life can’t be prepared for via textbooks. It is great preparation for the rest of your nursing career. You will be able to practice and learn about core nursing skills such as activities of daily living which may include lots of pad changes, showering, mobility, feeding, toileting, hoisting and other equipment, skin and nutritional assessments, wound management and risk assessments amongst many other things! These are things you will do in any area of nursing so get ready for it and take the time to learn these things and become great at recognising issues!

Promote independence wherever possible, but help when they struggle! And once again, ensure you maintain their dignity and privacy with the above tasks mentioned.

Learning to differentiate between dementia, delirium and depression (link above to a great resource). Learn to de-escalate challenging behaviours and refine your communication skills is very important also. Confusion and aggression are unfortunate realities in health care. Normally in dementia, there is a trigger such as pain, hunger, thirst, toileting or miscommunication. You will witness first-hand, delirium and dementia in all its forms. Make sure to remain safe at all times, and seek help if unsure.

For an absolutely amazing article on all things communication, we strongly suggest you read this article on The Nurse Break.

You will also learn about dealing with death and dying, learning about patient/family interactions, offering emotional support, learning about disease processes and comorbidities, adapting to different staff dynamics, adapting to different environments, policies and procedures, learning from poor practices you see, being involved in emergency situations and being exposed to deteriorating patients!

Time Management and Bad Practice during your Aged Care Nursing Placement

You may see some bad practice. This could be poor manual handling, abrupt communication and other things such as inappropriate short cuts. Understand that the people you will work with are tired, overworked, drastically underpaid and under-appreciated…so try not to judge to hard how they get their work done.

With that being said, you need to advocate for your patients and speak up tactfully when something really isn’t right. We advise speaking to your education provider point of contact on their advice and systems in place for this.

Also, check out this information here on Graded Assertiveness PACE acronym. An important concept to help prevent harm, promote teamwork and transparent communication.

Read this brief guide on Elder Abuse.

Time management is KEY in nursing and you will learn it along the way. Don’t be afraid to ask for help and don’t stress too much if you feel lost. Check out this article on how to prioritise your time as a nurse!

Time management skills will be developed when you prioritise how to structure your shift. It is often difficult in Aged Care due to the volume of residents to healthcare worker ratios, or lack of ratios…Ask lots of questions of the nurses and support workers (AIN/PCA’s). Understand that the staff are time-poor due to the number of residents they have to look after. Ask them how they manage and soak up all their advice.

Capacity and Consent

It is also very important in Aged Care to understand these concepts.

Check out this brief article on capacity and consent. The article has an ‘emergency nursing’ focus, but the concepts are transferable.

Other amazing placement tips for your Aged Care Nursing Placement

• You MUST read this article on Imposter Syndrome!
• You will need some very comfy, waterproof shoes! Check out our best shoe guide for nurses.
• 5 awesome ways to make the most out of your final nursing placement!
• 14 strategies for successful clinical placements!
• For all other student-related articles on The Nurse Break go here
• Listen to this TEDx Talk on compassion fatigue
• Wound care is also a big aspect of Aged Care nursing. Being able to differentiate between…is it a pressure injury or something else is vital! Check out some resources. Smith-Nephew, Go HERE to Ausmed and in search bar type ‘wounds’- lots of free articles, ACN has some good content, also Wounds Australia
• It’s ok to cry and it’s normal. It’s 100% encouraged to ask for help. At the end of the day, we are all there because we love to nurse and want to provide the best care to the patients/residents that we can. Keep your chin up…
• Put on the biggest smile you can muster every shift.
• LOOK AFTER YOUR BACK. Manual handling is tiring!
• Sit the patient upright when feeding and be cautious about aspiration and choking!!
• Be proactive, show initiative, don’t stand back – offer to help, use your therapeutic communication skills.
• Once again, residents have great stories to tell and they LOVE telling them. Take time for them.
• Once again, some residents with dementia might be a little aggressive, learn about their triggers, what they like/don’t like, walk with them at a safe distance, they are human too!
• Aged Care nursing is an incredibly special type of nursing. Don’t undervalue it or those who work there even if it’s not for you.
• One day you’ll probably end up having an aged care nurse look after YOU.

TIP JAR! Help keep The Nurse Break growing if you like our content.

Some other useful resources

My Aged Care

Aged Care Quality and Safety Commission

Australian Institute of Health and Welfare

Department of Health

Dementia Support Australia

Dementia Australia

Dementia Training Australia

Emergency Care Institute Article on Elder Abuse