Contents
- 1 Nursing Care for Older People in Singapore
- 1.1 Case Study on Mr Tan Wei Ming, A 68 Year Old Civil Servant
- 1.2 Global and National Policies on Older People’s Health
- 1.3 Theories of Ageing and Disengagement Theory
- 1.4 Nursing Theories and Orem’s Self-Care Deficit Nursing Theory
- 1.5 Nursing Care Plan
- 1.6 Conclusion
- 1.7 Recently Solved Nursing Questions By Our Best Nursing Experts in Singapore
- 1.7.1 Whorlton Hall Inquiry | Ethical and Legal Healthcare Analysis
- 1.7.2 Chronic Condition Nursing Portfolio: Assessment & Care Guide
- 1.7.3 Care Transition Facility Analysis Report Singapore
- 1.7.4 Singapore Health Policy Brief: Structure & Requirements
- 1.7.5 Hip Fracture Case Study: Assessment, Surgery & Care Plan
- 1.7.6 Healthcare Access Inequalities: Thailand, US & Singapore
- 1.7.7 Health Promotion Case Study: Mr Ong & Age Well SG
- 1.7.8 Youth Mental Health — BPD Awareness Poster & Essay (SG)
- 1.7.9 Ethical Dilemmas in Nursing Practice: Case Study Analysis
- 1.7.10 Supporting a Colleague with ADHD & MH Continuum
Nursing Care for Older People in Singapore
The aging population presents a growing challenge for healthcare systems worldwide, necessitating positive and person-centred nursing care approaches that support older individuals in maintaining their independence, health, and quality of life (McCormack & McCance, 2017). In Singapore, where a significant proportion of older adults live alone or rely on minimal family support, holistic and integrated care models are crucial for ensuring their well-being (Lim et al., 2020). This essay will examine the theoretical and legislative perspectives that inform best practices in nursing care for older individuals, with a focus on how these approaches are applied in real-life contexts. The case study of Mr. Tan Wei Ming, a 68-year-old widower managing multiple chronic conditions while living alone, will serve as a framework for demonstrating the application of these principles in practice.
A positive approach to nursing care for older individuals incorporates person-centred care, holistic assessment, and multidisciplinary collaboration (Kitson et al., 2013). In Singapore, policies such as the Community Care and Silver Support Schemes play a pivotal role in ensuring that vulnerable older adults receive necessary financial and medical assistance (Ministry of Health Singapore, 2021). This essay will explore how these frameworks guide nursing interventions, emphasizing strategies to enhance Mr. Tan’s self-care, manage his chronic conditions, and address psychosocial factors like social isolation and frailty. By integrating evidence-based practice with policy considerations, this analysis aims to highlight the importance of compassionate, proactive nursing care in promoting the health and dignity of older individuals like Mr. Tan.
Case Study on Mr Tan Wei Ming, A 68 Year Old Civil Servant
Mr. Tan Wei Ming, a 68-year-old retired civil servant, lives alone in a 3-room HDB flat in Bukit Batok. A widower, he receives occasional visits from his two adult children who have families of their own but cannot provide daily care. Financially, Mr. Tan manages on his CPF retirement savings, a stipend from his children, and support from the Silver Support Scheme. While somewhat socially isolated, he maintains contact with neighbours and participates in occasional activities at the community centre and local temple. Mr. Tan has been living with type 2 diabetes for 15 years, as well as hypertension and early-stage kidney disease, both of which are managed with medication. Two weeks ago, he was hospitalized for pneumonia and, since being discharged, has been feeling weak and fatigued. He takes several medications, including metformin and amlodipine, and receives weekly home visits from a nurse for monitoring his health and managing a small foot ulcer. Mr. Tan has also noticed a decline in his ability to perform daily activities, struggles with shortness of breath, and is concerned about his increasing frailty, fear of falls, and progression of kidney disease. Despite his children’s support, he feels lonely after his wife’s passing and has difficulty maintaining a healthy routine on his own.
Global and National Policies on Older People’s Health
The World Health Organization (WHO) has developed comprehensive global strategies to enhance the health and well-being of older adults. The WHO’s Global Strategy and Action Plan on Ageing and Health (2016-2030) emphasizes the importance of healthy aging through integrated healthcare systems, age-friendly environments, and long-term care models (World Health Organization, 2016). This strategy aligns with the WHO’s concept of intrinsic capacity, which focuses on maintaining physical and cognitive abilities throughout the aging process. Additionally, WHO’s Decade of Healthy Ageing (2021-2030) advocates for collaborative efforts among governments, communities, and healthcare professionals to ensure older individuals receive adequate support and care (World Health Organization, 2020). Examples of successful implementation of WHO policies include Japan’s comprehensive eldercare system, which integrates healthcare, social support, and financial assistance for the elderly, and Sweden’s long-term care model, which provides extensive home and community-based services.
Healthcare Policies for Older People Health!!
WHO Emphasises Integrated Healthcare Systems
Singapore Government Promotes Community Engagement
Silver Support Scheme for Low Income Elderly
In Singapore, national policies are designed to address the healthcare and social needs of the aging population. The Action Plan for Successful Ageing, introduced by the government, promotes active aging, community engagement, and improved healthcare services (Ministry of Health Singapore, 2021). The Community Networks for Seniors (CNS) initiative fosters social inclusion, while the Integrated Care Programme for Older Adults ensures coordinated healthcare support. The national Healthcare 2020 Masterplan also aims to enhance eldercare services, including home-based care and specialized geriatric facilities (Ministry of Health Singapore, 2020). Furthermore, Singapore’s Healthier SG initiative, launched in 2022, aims to shift the focus from hospital-based care to preventive care through community-based healthcare services, benefiting older adults by providing accessible chronic disease management and early intervention programs.
At the local level, the Silver Support Scheme provides financial assistance to low-income elderly individuals who lack family support. The Pioneer Generation Package and Merdeka Generation Package offer subsidies for medical expenses, including chronic disease management (Ministry of Health Singapore, 2021). Community initiatives, such as Active Ageing Centres and Senior Activity Centres, provide social engagement opportunities, reducing isolation and promoting mental well-being among older adults. Additionally, Singapore has implemented various smart healthcare technologies, such as telehealth services and wearable health monitoring devices, to facilitate remote healthcare access and enhance self-care among older individuals.
Applying these policies to Mr. Tan Wei Ming’s case highlights the significance of national and local strategies in addressing his healthcare and social challenges. His access to home nursing care aligns with Singapore’s commitment to integrated eldercare services. Financial support from the Silver Support Scheme and his children helps alleviate economic burdens, while community engagement at the local temple and community centre reflects the nation’s emphasis on social inclusion. However, gaps remain, such as his vulnerability to frailty and loneliness, indicating the need for enhanced home-based and psychosocial interventions. Expanding initiatives like volunteer-based home visit programs or integrating more social prescribing approaches could further support individuals like Mr. Tan in managing both their physical and emotional well-being.
In conclusion, global, national, and local policies play a crucial role in shaping nursing care strategies for older adults. By integrating WHO guidelines with Singapore’s structured eldercare initiatives, healthcare professionals can ensure holistic, person-centred care for individuals like Mr. Tan, enhancing their quality of life and overall well-being.
Theories of Ageing and Disengagement Theory
Theories of aging provide valuable insights into the biological, psychological, and social processes that individuals experience as they grow older. Various theories, such as activity theory, continuity theory, and disengagement theory, attempt to explain how aging impacts an individual’s behaviour, social roles, and interactions. While some theories advocate for maintaining engagement and social participation, others suggest that withdrawal from society is a natural part of aging.
Theories of Aging
Several theories attempt to explain the aging process and its effects on individuals, encompassing biological, psychological, and social dimensions. These theories provide valuable insight into how aging impacts behaviour, health, and social roles. Among the key aging theories are:
Activity Theory:
Proposed by Havighurst and Albrecht (1953), this theory suggests that staying physically, mentally, and socially active contributes to successful aging. It posits that older adults who remain engaged in activities and maintain social roles experience better well-being and life satisfaction.
Continuity Theory:
Developed by Atchley (1989), this theory states that older adults tend to maintain similar behaviours, relationships, and activities as they did earlier in life. It emphasizes the importance of past experiences and preferences in shaping aging experiences.
Disengagement Theory:
Proposed by Cumming and Henry (1961), this theory posits that aging individuals gradually withdraw from social roles and relationships as part of an adaptive process. According to this theory, this disengagement is mutually beneficial for both the individual and society, allowing for the transfer of roles to younger generations. The theory suggests that this withdrawal is inevitable and helps older adults prepare for the end of life.
Applying disengagement theory to Mr. Tan Wei Ming’s case, several aspects align with its principles. Mr. Tan, following the loss of his wife, experiences social isolation despite occasional visits from his children and participation in community activities. His concerns about frailty, declining health, and fear of falls contribute to his withdrawal from more active engagement in social and physical activities. His reliance on home nursing visits rather than seeking external social support further illustrates his gradual disengagement from broader societal interactions.
However, disengagement theory has faced significant criticism for its generalized assumptions. One of its main weaknesses is that it does not account for individual differences in aging experiences. Many older adults actively seek social participation and maintain meaningful roles, contradicting the notion of inevitable withdrawal (Hochschild, 1975). Furthermore, disengagement theory does not consider external factors such as healthcare advancements and community support programs that encourage older individuals to remain engaged despite physical limitations. In the case of Mr. Tan, policies such as Singapore’s Community Networks for seniors and Active Ageing Centres provide opportunities for continued participation, challenging the notion that disengagement is a necessary or beneficial process.
Moreover, research has indicated that social participation plays a vital role in maintaining cognitive and emotional well-being in older adults (Cornwell & Waite, 2009). Studies suggest that disengagement can exacerbate mental health issues such as depression and anxiety, leading to a decline in overall quality of life (Rowe & Kahn, 1997). For Mr. Tan, his reduced social interactions and concerns about frailty may contribute to emotional distress, making it crucial to implement interventions that encourage his reintegration into community activities. Encouraging structured social participation and healthcare support, such as senior group exercises or peer support networks, could counteract the effects of disengagement.
Despite its limitations, disengagement theory offers a useful lens through which to understand some aspects of Mr. Tan’s experience, particularly his concerns about frailty and decreased independence. However, a more holistic approach that incorporates person-centred care and social support frameworks is necessary to ensure that Mr. Tan’s well-being is optimized. Encouraging continued engagement through structured community activities and enhanced healthcare services may help counteract some of the negative aspects of disengagement while respecting his individual preferences and needs.
Nursing Theories and Orem’s Self-Care Deficit Nursing Theory
Nursing theories provide essential frameworks that guide nursing practice and interventions, particularly in the care of older adults. Several theories have been instrumental in shaping gerontological nursing, including Peplau’s Theory of Interpersonal Relations, Watson’s Theory of Human Caring, and Orem’s Self-Care Deficit Nursing Theory. Several theories have been instrumental in shaping gerontological nursing, including:
Nursing Theories to Better Understand Patient!!
Nursing theories are crucial for nurses to understand their patients in a better way as they provide a structured framework by taking into consideration their physical, emotional, social and cultural needs.
Peplau’s Theory of Interpersonal Relations:
Developed by Hildegard Peplau (1952), this theory emphasizes the importance of the nurse-patient relationship in fostering health and well-being. It focuses on communication, trust, and mutual understanding, which can be beneficial when working with older adults experiencing social isolation and chronic illnesses.
Watson’s Theory of Human Caring:
Jean Watson’s (1979) theory centres on the importance of holistic, compassionate care. It emphasizes the emotional and spiritual dimensions of nursing, promoting dignity and respect in elder care. This theory is particularly useful when addressing the psychological well-being of older adults, such as Mr. Tan, who experiences loneliness following his wife’s passing.
Neuman’s Systems Model:
Betty Neuman’s (1982) model takes a holistic approach by considering physiological, psychological, sociocultural, developmental, and spiritual aspects of health. This theory is highly applicable to older adults, as it encourages comprehensive care strategies that address multiple dimensions of health and well-being.
Orem’s Self-Care Deficit Nursing Theory:
Dorothea Orem’s (2001) theory is particularly relevant to the care of older individuals, including Mr. Tan. Orem posits that nursing is required when an individual is unable to meet their self-care needs due to illness, disability, or other health-related limitations. The theory emphasizes the role of nurses in assessing self-care deficits and intervening to support patients in regaining or maintaining their self-care abilities.
Dorothea Orem’s Self-Care Deficit Nursing Theory (SCDNT) is particularly relevant to the care of older individuals, including Mr. Tan. Orem (2001) posits that nursing is required when an individual is unable to meet their self-care needs due to illness, disability, or other health-related limitations. The theory emphasizes the role of nurses in assessing self-care deficits and intervening to support patients in regaining or maintaining their self-care abilities.
Applying Orem’s theory to Mr. Tan’s case, it is evident that he experiences several self-care deficits due to his chronic conditions, frailty, and recent hospitalization. His type 2 diabetes, hypertension, and early-stage kidney disease require careful medication management, dietary regulation, and monitoring of symptoms, which he may struggle to manage independently. His recent pneumonia and ongoing fatigue further reduce his ability to perform daily activities, such as preparing meals, maintaining hygiene, and managing his foot ulcer.
Nursing interventions based on Orem’s theory would involve assessing Mr. Tan’s self-care capabilities and providing necessary support where deficits exist. His home nursing visits align with this model, as they assist with wound care, medication management, and monitoring of his overall health status. Additionally, education on self-care techniques, such as proper foot care for diabetes and fall prevention strategies, can empower Mr. Tan to take greater control of his health while reducing his risk of complications (Taylor & Renpenning, 2011).
To further enhance the application of Orem’s theory, nurses can incorporate individualized care plans that account for Mr. Tan’s emotional and psychological well-being. Establishing a structured routine for self-care activities, utilizing reminders for medication adherence, and promoting social engagement through community-based support programs can strengthen his ability to manage his health effectively. Research suggests that integrating family support and peer-led educational initiatives can significantly improve adherence to self-care practices in older adults (Sousa & Marques-Vieira, 2019).
Despite the strengths of Orem’s theory in addressing self-care needs, some limitations must be acknowledged. The model assumes that individuals can learn and apply self-care behaviours when given appropriate guidance, but factors such as cognitive decline, mental health issues, and social isolation can hinder the effectiveness of self-care interventions (Denyes et al., 2001). In Mr. Tan’s case, his feelings of loneliness and reduced motivation following his wife’s passing may impact his adherence to self-care routines. Therefore, a holistic approach that integrates psychological and social support, such as participation in community activities and counselling services, may be necessary to complement the self-care interventions.
Overall, Orem’s Self-Care Deficit Nursing Theory provides a useful framework for understanding and addressing Mr. Tan’s healthcare needs. By recognizing his self-care deficits and implementing targeted nursing interventions, his quality of life can be improved. However, a comprehensive care approach that includes emotional and social support is essential to ensure sustainable health outcomes.
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Nursing Care Plan
Nursing Care Plan for Mr. Tan
Medical Diagnosis: Type 2 diabetes, hypertension, early-stage kidney disease, recent pneumonia, frailty, social isolation
| Assessment & Actual/ Potential Problem | Goals (Measurable Outcome) | Intervention | Rationale | Date & Frequency of Review[1] Daily/Weekly/Monthly | |
| Physical: Weakness and frailty, fear of falls | 1. Mr. Tan will demonstrate improved strength and mobility, reducing the risk of falls, within 8 weeks. | – Conduct a fall risk assessment and provide assistive devices (e.g., walker). – Refer to physiotherapy for strength and balance exercises. | – Identifying fall risks helps tailor interventions. – Physiotherapy strengthens muscles and improves confidence in mobility. – Reducing environmental hazards and improving mobility lowers fall risk (Gillespie et al., 2012) | Weekly | |
| 2. Mr. Tan will report feeling more confident in ambulating safely within 4 weeks. | – Teach fall prevention strategies and ensure his home environment is safe (e.g., remove tripping hazards, ensure adequate lighting). | – Education and environmental modifications reduce fall risks and improve safety. – Exercise and nutrition help combat fatigue and promote recovery (Mudge et al., 2018) | Weekly | ||
| Physical: Foot ulcer | 1. The foot ulcer will show signs of healing (e.g., reduced size, absence of infection) within 4 weeks. | – Clean and dress the wound during weekly nursing visits. – Monitor for signs of infection (redness, swelling, or pus). | – Proper wound care minimizes infection risk and promotes healing (Armstrong et al., 2017) | Weekly review, with daily wound assessment by home nurse | |
| 2. Mr. Tan will demonstrate knowledge of daily foot care to prevent further complications within 2 weeks. | – Provide education on foot hygiene and the importance of checking for new wounds. – Encourage wearing proper footwear. | – Empowering Mr. Tan to care for his feet minimizes risks of ulcer recurrence or progression. | Weekly review, with daily wound assessment by home nurse | ||
| Emotional: Loneliness and grief after wife’s passing | 1. Mr. Tan will participate in at least one community activity weekly to enhance social connections within 6 weeks. | – Encourage participation in community centre programs or temple activities. – Arrange for regular check-ins by a community social worker. | – Social connections improve mental health and reduce loneliness (Cattan et al., 2005) | Monthly review, with weekly check-ins by community, support worker | |
| 2. Mr. Tan will express reduced feelings of isolation during nursing visits within 6 weeks. | – Facilitate video calls with his children to enhance family connections. – Suggest joining a local support group for older widowers. | – Strengthening social and familial ties provides emotional support and reduces feelings of isolation. | Monthly review, with weekly check-ins by community support worker | ||
| 4 | Physical: Poor diabetes management and diet | 1. Mr. Tan’s blood glucose levels will remain within the target range (as per physician) within 3 months. | – Monitor blood glucose levels during weekly visits. – Provide nutritional counselling tailored to his diabetes and kidney health needs. | – Regular monitoring and dietary adjustments help maintain stable glucose levels and prevent complications. – Enhancing adherence improves disease management and prevents complications (Lindquist et al., 2019) | Weekly review, with daily self-monitoring of medication intake |
| 2. Mr. Tan will verbalize understanding of his dietary needs within 4 weeks. | – Collaborate with a dietitian to create a meal plan that aligns with his cultural preferences and health conditions. | – Personalized meal planning improves adherence and health outcomes. | Weekly review, with daily wound assessment by home nurse | ||
| 5 | Physical: Hypertension management | 1. Mr. Tan’s blood pressure will remain within the target range as prescribed by his doctor within 2 months. | – Monitor blood pressure weekly during visits. – Educate Mr. Tan on the importance of medication adherence and a low-sodium diet. | – Consistent monitoring and adherence to prescribed measures help control hypertension and prevent complications like stroke. | Monthly review, with bi-weekly physiotherapy sessions |
| 2. Mr. Tan will demonstrate proper medication-taking practices within 2 weeks. | – Review Mr. Tan’s medication regimen and address any questions or barriers to adherence (e.g., pill organizers, reminders). | – Ensuring proper medication use prevents missed doses and optimizes treatment outcomes. | Monthly review, with bi-weekly physiotherapy sessions | ||
| 6. | Potential Problem: Progression of kidney disease | 1. Mr. Tan’s kidney function will remain stable (based on lab results) over the next 3 months. | – Coordinate with his physician for regular kidney function tests. – Reinforce adherence to medication and dietary restrictions for kidney health. | – Monitoring and preventive measures slow disease progression and reduce the risk of complications like kidney failure. | Bi-weekly review, with daily activity log tracking progress |
| 7. | Social: Reduced family interaction due to children’s busy lives | 1. Mr. Tan will report improved communication with his children within 6 weeks. | – Encourage setting a weekly family check-in schedule via video calls or in-person visits. – Facilitate discussion of shared caregiving roles among his family. | – Consistent communication strengthens family bonds and increases support for Mr. Tan’s overall well-being. | Monthly review, with weekly check-ins by community support worker |
| 2. Mr. Tan’s children will receive guidance on how to provide emotional and practical support during the monthly family meeting (as per nurse coordination). | – Provide education to the family on ways to support Mr. Tan, including managing his emotional needs and encouraging his participation in care decisions. | – Educating caregivers fosters a supportive environment that addresses both Mr. Tan’s physical and emotional needs. | Bi-weekly review, with daily activity log tracking progress |
This expanded care plan addresses Mr. Tan’s holistic needs, incorporating additional interventions for emotional support, family involvement, and preventive care for kidney health. Regular reviews ensure continuous assessment and adjustment to his changing needs.
Conclusion
In conclusion, ensuring quality nursing care for older individuals like Mr. Tan requires a holistic, evidence-based approach that addresses medical, psychological, and social aspects of health (McCormack & McCance, 2017). The implementation of structured nursing interventions, including infection control, medication adherence strategies, nutritional guidance, and social engagement initiatives, is vital in promoting his well-being (Armstrong et al., 2017; Lindquist et al., 2019). The integration of Orem’s Self-Care Deficit Nursing Theory in Mr. Tan’s care plan highlights the significance of empowering patients to regain self-care capabilities while providing essential nursing support where necessary (Taylor & Renpenning, 2011). Additionally, policies in Singapore, such as the Silver Support Scheme and Community Care Networks, play an essential role in providing the necessary assistance for older adults facing multiple chronic conditions and social isolation (Ministry of Health Singapore, 2021).
While Mr. Tan’s case reflects the challenges experienced by many older individuals, it also underscores the importance of proactive nursing interventions that can significantly enhance their quality of life (Cattan et al., 2005). Addressing issues such as frailty, fall risk, and social isolation through comprehensive care planning ensures that older adults receive the support they need to maintain independence and dignity (Gillespie et al., 2012). As the aging population continues to grow, the role of nurses in delivering compassionate, multidisciplinary care remains essential in fostering a healthier and more supportive aging society (Mudge et al., 2018).
