Assessment Of The Effect Of Community Health Workers Care Delivery Service On The Management Of Elderly Citizens

Project and Seminar Material for Public Health

Abstract

Ageing is often accompanied by chronic illnesses and continuous deterioration of mental and physical independence, which makes care giving more complex and challenging. With the increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. The study was aimed to assess the effect of community health workers care delivery service on the management of elderly citizens in University of Nigeria Teaching Hospital, Nsukka, Enugu State. The study adopted a descriptive cross sectional descriptive design. The population of the study was 205 health workers, which was made up of doctors, nurses and dentists. The instrument for data collection was a structured questionnaire. The study revealed that 95% of the health workers had good knowledge of care of the elderly patients. Majority of the health workers had positive attitude and moderately practiced care of the elderly patients. The factors that positively influenced health workers attitude to the care of the elderly were interest in taking care of the elderly patients, effective care of the elderly patient requires special training, lack of special ward for effective care of the elderly, unfavorable health care policy concerning care of the elderly difficult, difficulty in persuasion of elderly patients about their care, and lack of social support. There was significant association (P<0.05) between knowledge of care for elderly patients and involvement in care for elderly patients among health workers in University of Nigeria Teaching Hospital. Workers with less knowledge had negative attitude and low involvement, while those with more knowledge experience had positive attitude and high involvement, towards the care of the elderly patients. The study recommended the creation of special wards to enhance care of the elderly in the hospital and formulation and re-evaluation of health policies regarding health care for the elderly.

Table of Content

Chapter One

1.0 Introduction

1.1 Background to the Study
1.2 Statement of Problem
1.3 Objectives of the Study
1.4 Research Questions
1.5 Hypothesis
1.6 Significance of the Study
1.7 Scope of Study
1.8 Limitations of the Study
1.9 Operational Definition of Terms
1.10 Organisation of the Study

Chapter Two

2.0 Literature Review

2.1 Conceptual Framework
2.2 Concept of Healthcare Delivery Service
2.3 Health Worker’s Knowledge of Care Towards the Elderly
2.4 Theoretical Review

Chapter Three

3.0 Research Methodology

3.1 Research Design
3.2 Target Population
3.3 Sampling
3.4 Instruments for Data Collection
3.5 Validity of Instrument
3.6 Reliability of Instrument
3.7 Method of Data Collection
3.8 Method of Data Analysis

Chapter Four

4.0 Results and Discussion

4.1 Results
4.2 Discussion

Chapter Five

5.0 Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
Appendix

Chapter One

1.0 Introduction

1.1 Background to the Study

Ageing is often accompanied by chronic illnesses and continuous deterioration of mental and physical independence, which makes care giving more complex and challenging. Many older adults are frail and have co-existing disabilities and co-morbidities, conditions that can influence the clinical presentation and assessment of urinary continence, as well as patient’s responsiveness to interventions (Wagg, et al., 2015). An estimated 100,000 people worldwide die each day of age related causes (Aubrey de Grey, 2017). According to National Population Commission (NPC, 2006), persons who are old enough to receive pension who are between ages of 60-65 years are regarded as the elderly. The elderly are classified by age into young old for those aged 60-74years, middle old for those aged 75-84years, old for those aged 85-94 years and oldest old for those 95years and above (Barman, Snyder, Kozier & Erb , 2018). Many elderly patients do not have access to knowledge of evidence based medical therapy and their quality of life suffers because of the stigma inherent, this is where care giving plays a big role.

Care giving is the act of assisting with the care and wellbeing of another person. Care giving is a common phenomenon; health workers have the responsibility to assist older adults in performing activities and preventing elderly abuse. More generally, they play a role in the physical, emotional, psychosocial, and sometimes financial assistance of the elderly who cannot care for themselves. In present times, health workers take the attitude that some diseases are a natural consequence of ageing. So assessment and treatment is often overlooked (Resnick et al., 2016). There also seems to be lack of knowledge and compliance as to whether or not guidelines are followed appropriately by members of different levels of staff hierarchy (Lin, et al., 2012). There are several problems associated with deficit in understanding the impacts of disease conditions and problems peculiar older adults (Tuinissen, et al., 2016)

In most developing countries including Nigeria the population of the elderly is increasing rapidly but the government does not seem to be making any major commitments to elderly healthcare (Adio-Moses, 2011). The government is still assuming that families should take care of their elderly without recognizing that the extended family system is at the verge of collapse. Currently most families find it difficult to manage their own homes and face their challenges. This is gradually leading to neglect and abuse of the elderly (Gubrium, 2012). Care of the elderly requires adequate knowledge of the ageing process, nutrition and daily needs of the elderly. In Nigeria, marginalization of the elderly especially in their care is a common episode (Abdulraheem&Parakoyi, 2015). Those involved in the provision of health care have important roles to play in programmes relating to elderly care especially in screening and detecting abuse. A study of practitioners revealed weakness in commitment, time and knowledge, and raised awareness of the beliefs that comorbidity, low motivation and older person’s acceptance of the problem existence. Similar results emerged among registered nurses, where Urinary incontinence problems were seen as a symptom of aging that can be addressed using incontinence protection. However, as mentioned previously, nurses/health workers focus was on the choice of incontinence protection instead of the investigation of underlying causes (Dingwall & Mclafferty, 2016). These results are also supported by earlier research in which medical diagnosis were put before urinary incontinence problems.

Care givers showed lack of understanding of problems and failed to ask older adults about urinary incontinence (Norhein, and Guttormsenvinsnes, 2015). Care givers have different educational needs and require different levels of support depending on what level of urinary incontinence they have to deal with, whether mild, moderate, or catheter managed (Wagg A, et al., 2015). Earlier research about care givers revealed deficits in time and prioritization of tasks; staff did not take the older adults to lavatory in time. However, there was no expectation that urinary incontinence could be improved because urinary incontinence problems were seen as a normal consequence of ageing (Resnick et al., 2016).

Nursing staff who worked most closely with older adults exhibited weaknesses in recognizing some health problems like urinary incontinence sufficiently to undertake investigative measures (Davis, 2012). Care givers fail to understand that some disease conditions are not just caused by ageing but also certain factors such as infections etc. although it is mostly caused by ageing. Deficiencies in documentation where also found, whereby documentation of bladder and bowel movements was overlooked. Instead being described as incontinence occurring but with no investigation being conducted (Mangall et al., 2016). Incontinence in present times can be managed by instilling toilet habits based on the client’s need. This can be beneficial for maintaining health and well being (Orem D 2011). Also, involvement of hea;th workers in the care of the elderly patients will ensure that the elderly could be assisted to access health care services given the important social and psychological costs of health care. A review of research relating to the management of the elderly identified lack of qualitative research that sought the views of elderly people (Wyman et al., 2012). Incontinence is a pressing issue because it may result to elderly abuse, and can affect an individual’s physical, emotional, psychosocial, and sometimes financial wellbeing.

Promotion of health forms part of the remit of community nurses and they include health visitors for the elderly with training, support and clinic services provided by specialist nurses. In the past, an assessment of disease conditions was carried out in general practice annually as part of the over “15 years check”. However, following health policy changes, this health check is no longer a requirement for general practice and there is variation in the extent to which it is carried out by primary care staff. Recent initiatives have attempted to promote high standard of care and access to services for older people, including the promotion of best practices in healthcare services.

1.2 Statement of Problem

The population of the elderly in the world is increasing rapidly (United Nations, 2014) and the rate of increase is higher in developing countries including Nigeria. Currently, Nigeria has the highest number of the elderly people in Africa estimated to be about 5.6% of the Nigeria population (NPC, 2012). With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. Donatelle (2011) posited that in most curricula for health professionals, little or nothing is indicated about the care of the elderly showing absolute neglect in this area. Health care services are a major component towards providing quality living, however, it is a common problem that such services have posed a greater challenge on the health seeking behavior of the aged individuals in Enugu State. Health Care is a top social problem facing the aged today the lack of awareness of health care services has posed a threat on the health of the aged, inadequate and poor health care facility management are some of the factors affecting the seeking behavior of the aged towards practice and utilization particularly those residing in rural areas and poor implementation of National Health Policy. Majority of the aged persons had age associated illnesses such as blood pressure, cardiac problems, diabetes, joint pains, kidney infections, cancer and tuberculosis that take a long time to treat which particularly affect their health seeking behavior. Aged individuals are found to have patronized traditional healers, resorted to self-medication using local herbs or visit chemists‘ shops whenever they are sick. However, involvement of professionally trained health workers such as nurses, doctors, physicians among others will help to provide adequate healthcare services to them that will prove effective and increase their health outcome. Therefore, this study seeks to assess the effect of community health workers care delivery service on the management of elderly citizens.

1.3 Objectives of the Study

The main purpose of this study is the assessment of the effect of community health workers care delivery service on the management of elderly citizens. Specifically, the following objectives will guide the study;

To determine the level of knowledge of the care of the elderly among community health workers in University of Nigeria Teaching Hospital
To determine the attitude of the community health workers towards the care of the elderly in University of Nigeria Teaching Hospital
To determine the extent to which community health workers practice the provision of care for the elderly in University of Nigeria Teaching Hospital
To identify the factors that influence community health workers involvement in the care towards the elderly in University of Nigeria Teaching Hospital

1.4 Research Questions

The following questions were formulated to guide the study based on the research objectives;

What is the level of knowledge of the care of the elderly among community health workers in University of Nigeria Teaching Hospital?
What is the attitude of the community health workers towards the care of the elderly in University of Nigeria Teaching Hospital?
To what extent do community health workers practice the provision of care for the elderly in University of Nigeria Teaching Hospital??
What are the factors that influence community health workers involvement in the care towards the elderly in University of Nigeria Teaching Hospital?

1.5 Hypothesis

HO1: There is no significant relationship between the knowledge and attitude of community health workers care delivery service on the management of elderly citizensin University of Nigeria Teaching Hospital
HA1: There is a significant relationship between the knowledge and attitude of community health workers care delivery service on the management of elderly citizensin University of Nigeria Teaching Hospital

1.6 Significance of the Study

The findings of this study will be of great use to the elderly, health care workers and the general public. To the elderly, this study will be of good use to the elderly people having health problems leading to adverse effects not only on their health but also on their psychosocial life. To the health care workers, it will also help to promote high standards of care for the elderly with training and support and promoting best practices in healthcare services. The findings of this study will also help improve the decision making in the health sector when it comes to care for the elderly. Also, to the public, the result obtained from this study will help the public prevent elderly abuse and also assist the elderly in seeking adequate health services. Finally, information gathered from this study will serve as a source of literature and guide for future research and as well serve as empirical reference for further studies.

1.7 Scope of Study

The study was conducted in University of Nigeria Teaching Hospital, Nsukka, Enugu State. The justification for the study was that there was high rate of neglect recorded in the care for the elderly, leading to poor health outcomes and high morbidity rate. Involvement of healthcare workers in the care for the elderly will eliminate the influence of quacks and poor health delivery as well as promote the quality of life among the elderly. The respondents used were the health workers in University of Nigeria Teaching Hospital which include nurses, dentists and doctors. The study variables covered were the level of knowledge of the care of the elderly among health workers, attitude of the health workers towards the care of the elderly, the extent to which health workers practice the provision of care for the elderly, and the factors that influence health workers involvement in the care towards the elderly.

1.8 Limitations of the Study

This study was limited in the scope, as it only focused on University of Nigeria Teaching Hospital of Enugu state. This implies that the findings and conclusions drawn from this study cannot be generalized to other health workers and health facilities in the area. Also, the researcher faced time constraints, financial constraints as well as issues related to access to relevant materials for this research.

1.9 Operational Definition of Terms

Health Workers:

Refers to the professionally trained health personnel that provide care for the elderly; they include nurses, doctors and pharmacists for the purpose of this study.

Elderly:

Are the individuals attending University of Nigeria Teaching Hospital who are 60 years and above

Care Delivery Service:

Is the act of assisting with the care and wellbeing of the elderly by the health workers.

1.10 Organisation of the Study

This research work is organized in five chapters, for easy understanding it is broken down as follows:

Chapter one kicks off with the introduction, which consists of the background of the study, statement of the problem, objectives of the study, research hypothesis, scope and significance of the study.
Chapter two begins with the conceptual framework on which the study is based, the theoretical literatures and also the empirical literature and thus the review of related literature.
Chapter three deals on the research design, the population of the state used as a case study, the sample size and the sampling techniques used, the data collected, data analysis and the limitations of the method used.
Chapter four concentrate on the data collection and analysis, interpretation and presentation of finding.
Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five

5.0 Summary, Conclusion and Recommendation

5.1 Summary

The study focused on the assessment of the effect of community health workers care delivery service on the management of elderly citizens in University of Nigeria Teaching Hospital, Nsukka, Enugu State. The study adopted a descriptive cross-sectional design. The population of the study was 205 health workers, made up of 55 Doctors, 145 Nurses, and 5 Dentists that provided direct care to elderly patients. The sample was calculated using Taro-Yamane simplified formula for finite population giving a sample of 136 health workers. The study revealed that 95% of the health workers had good knowledge of care of the elderly patients. Majority of the health workers had positive attitude and moderately practiced care of the elderly patients. The factors that positively influenced health workers attitude to the care of the elderly were interest in taking care of the elderly patients, effective care of the elderly patient requires special training, lack of special ward for effective care of the elderly, unfavorable health care policy concerning care of the elderly difficult, difficulty in persuasion of elderly patients about their care, and lack of social support. There was significant association (P<0.05) between knowledge of care for elderly patients and involvement in care for elderly patients among health workers in University of Nigeria Teaching Hospital.

5.2 Conclusion

From the study, workers with less knowledge had negative attitude and low involvement, while those with more knowledge experience had positive attitude and high involvement, towards the care of the elderly patients. In conclusion, health care professionals need to have the right skills to manage a more demanding role in the future. In order to offer effective services for the elderly patients, a skilled and well-motivated workforce of health professionals is therefore very necessary.

5.3 Recommendation

Based on the findings of this study, the following recommendations were made:

Creation of special wards to enhance care of the elderly in the hospital; this can be done with a well-trained and motivated workforce of health workers
There is need for formulation and re-evaluation of health policies regarding health care for the elderly. This will eliminate restrictions and barriers that reduce the involvement of health care workers in this specialized area of elderly care.
Also, there is need for the health authorities and stakeholders to develop a system of regular evaluation of the health workers in order to determine strategies of upgrading their knowledge and enhancing their involvement.

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