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Influenza has become an annual epidemic, increasing in volatility, which can greatly affect the fragile and vulnerable, particularly the elderly. Within healthcare settings, such as aged-care facilities, outbreaks can be greatly detrimental to the health and wellbeing of the residents, impacting greatly on their ability to partake in their activities of daily living (ADL). This essay will discuss influenza, infection control precautions, assessment and nursing care as well as a further interdisciplinary approach to the case study. Influenza has the potential to have a profound impact on a patients health and wellbeing if the appropriate precautions, assessments and continuous care is not provided to them.
Annually, multiple strains of influenza arise and spread throughout the population, leading to a yearly epidemic and a greater health risk for the vulnerable. Influenza is a complex virus in the way that it has the unique ability to undergo frequent antigenic variations. These minor changes in the structure of surface glycoproteins, hemagglutinin and neuraminidase facilitate for these yearly epidemics and the potential for multiple active strains (Pop-Vicas & Graventrein, 2011). In 2018, more than 90% of all influenza-related deaths were in people aged 65 years and older (Sheridan, Patel, Macartney & Cheng, 2018). This can be attributed to the clear decline in immune competence associated with increasing age. The elderly populations risk is increased again if they live in nursing homes. This is due to the increased exposure risk through close living quarters, shared caregivers as well as frailty and nutritional deficiencies (Pop-Vicas & Graventrein, 2011). Influenza is transmitted primarily through airborne droplets and spread occurs in healthcare settings during aerosol-generating procedures such as changing sheets and close proximity to residents. Furthermore, the virus may be spread though droplets produced by coughing, sneezing and talking making residents extremely vulnerable to an influenza outbreak and widespread illness (Pop-Vicas & Graventrein, 2011). In the absence of treatment, viral shedding, which starts prior to the onset of symptoms, continues for approximately five days in healthy adults and can last significantly longer in the elderly (Pop-Vicas & Graventrein, 2011). Whilst vaccines offer some protection against the influenza through active immunity, poor vaccine responses in the elderly decrease the ability to control the virus (Pop-Vicas & Graventrein, 2011). This combination of easy infection and transmission, place the elderly residents of aged care facilities at a significant risk of contracting the virus. Therefore, it is important to have adequate infection control precautions to limit the likelihood of spread and help improve patient health and wellbeing.
To decrease the risk of an influenza outbreak in a care facility, appropriate infection control precautions must be undertaken by staff, residents and all visitors who enter the facility. Whilst it is impractical to completely prevent influenza, it is vital to recognise the importance of infection control precautions. Nursing home residents experience a major decline in physical functions following an influenza-like illness and has been associated with greater negative outcomes in older adults. Influenza immunizations may prevent hospitalizations and associated functional decline in the elderly (McElhaney, Andrew & McNeil, 2017). Currently, Australian recommendations determine an annual influenza immunization for all persons regardless of age, as vaccinations improve influenza immunogenicity and efficacy, specifically in older adults (Whitaker, von Itzein & Poland, 2018). Through wide-spread vaccination use, herd immunity has resulted in lower infection rates so healthcare facilities may have policies to reflect mandatory vaccination campaigns further limiting the risk of falling ill (Lang, Mendes, Socquet, Assir, Govind & Aspinall, 2012). Hoi (2019), also explained how continually using disinfectants on public surfaces including door handles and handrails, reduces the exposure to virus and limits continual spread from person to person. Furthermore, appropriate personal protective equipment (PPE) must be worn by all staff when coming into close contact with potentially ill residents. PPE includes physical measures to reduce influenza transmission through gloves, masks and continuous hand hygiene. This is further required when residents are allocated droplet precautions which are posted outside their rooms. Rainwater-Lovett, Chun and Lessler (2013), explain that social distancing, quarantining or cohorting and visitor and staff restrictions further control and limit the spread of the virus. Current data remains unclear as to whether visitor restrictions do contribute to a clear decline in influenza cases however, cases of influenza in residential care facilities are primarily driven by the burden of influenzas emergence within the community (Bischoff, Petraglia McLouth, Bischoff & Palavecino, 2019). The elderly have a weakened immune system which allows the virus to manifest and endure, thus it is imperative it provide adequate assessments and nursing care to ensure that influenza is contained and a residents health is upheld.
Mr Holden would require further clinical assessments to ensure his health and wellbeing is adequately maintained. These assessments include pressure injury, fluid balance, nutritional and falls risk assessments. Pressure injury assessment is imperative to ensure adequate skin integrity and to significantly lower the risk of developing a pressure injury. As Mr Holden has unsteady mobility he is at greater risk of developing a pressure injury due to a lack of movement. Through increased friction between skin, clothing or other materials pressure injuries can occur which has the potential to further impact on Mr Holdens ability to mobilise (Campbell, Coyer & Osboune, 2014). Furthermore, fluid balance charts and nutritional assessments should be undertaken and kept continuously. Prolonged dehydration in the elderly can result in serious health and cognitive issues and will further exacerbate existing symptoms of influenza, again limiting quality of life and prolonging the impact of the virus (Miller, 2017). The elderly are vulnerable to malnutrition and interventions play an important role in the prevention of degenerative conditions (Agarwalla, Saika & Baruah, 2015). An adequate nutritional assessment would further decrease the impact on the virus. Additionally, a falls risk assessment should be undertaken especially considering Mr Holdens limited and unsteady mobility. It is suggested that due to a multitude of factors affecting gait and balance, multiple assessment tools should be utilised to maximize the advantages of predicting the occurrence of falls (Park, 2018). Furthermore, it is crucial to recognise the importance of the cultural aspects of care and becoming culturally competent. As Mr Holden identifies as an Aboriginal Elder, his cultural identity must be recognised in order to provide care that is culturally sensitive. Daly, Speedy and Jackson (2017), explain that in order to provide culturally safe care, nurses must be aware of themselves and their clients. In regards to the case study, healthcare workers must be aware of Mr Holdens cultural beliefs including the distrust created by historical and contemporary factors which can impede on his ongoing health. Workers must also understand that Mr Holden is an Elder whom is regarded as a respected individual and role model within the community and this must reflect on the way care is provided and the relationship he has with his family and community (Waterworth, Pesuc, Brahaam, Dimmock & Rosenberg, 2015). Additionally, staff will work with other healthcare professionals to ensure Mr Holdens health and wellbeing is adequately maintained into his future.
Additional healthcare professionals will be required to uphold Mr Holdens health and wellbeing. Lancaster, Kolakowsy-Haner, Kovacich and Greer-Williams (2015), explain that the coordination of various treatments and interventions provided is crucial in preventing errors and fragmented care. For this case study nurses will work in conjunction with physiotherapists and psychologists to ensure that Mr Holden has exceptional ongoing care. Physiotherapists can help maintain functional independence in daily life and encourage patients partake in tasks to improve the efficacy to perform ADLs (Pihl, Cider, Stromberg, Fridlung & Matensson, 2011). A psychologist has the potential to improve and maintain Mr Holdens mental health in the short and long term. This offers the potential to discuss the short-term impact influenza has on his ADLs as well as his approach to cultural disparities, his cultural identity and to discuss his beliefs on the social connections to family that is intensified by his cultural obligations (Waterworth et al., 2015). These professionals will be used to enhance and maintain Mr Holdens health and wellbeing as well as overall quality of life during and after his experience with influenza.
Influenza is an infectious virus that results in yearly outbreaks and high rates of morbidity and mortality in the elderly. It is crucial to adhere to appropriate infection control precautions in order to contain and limit the spread of the virus. It is also important to use appropriate assessment on an impacted resident to ensure well-maintained health and wellbeing. These assessments may include pressure injury, fluid balance, nutrition and falls risk assessments which will be used in conjunction with culturally safe care to ensure the resident is comfortable presently and into the future. Lastly, an interdisciplinary approach is used to ensure that the resident has exceptional care provided to them both during this virus and into the future.
References
- Agarwalla, A., Saika A. M., & Baruah, R. (2015). Assessment of nutritional status of the elderly and its correlates. Journal of Family and Community Medicine, 22(1), 39-43. https://dx.doi.org/10.4103/2230-8229.149588
- Bischoff, W., Petraglia, M., McLouth, C., Viviano, J., Bischoff, T., & Palavecino, E. (2019). Intermittent occurrence of health care onset influenza cases in a tertiary care facility during the 2017-2018 flu season. American Journal of Infection Control, 1, 1-4. https://dx.doi.org/10.1016/j.ajic.2019.06.020
- Campbell, J. L., Coyer, F. M., & Osborne, S. R. (2014). Incontinence-associate dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting.International Wound Journal, 13 (3), 14. https://dx.doi.org./10.111/iwj.12322
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