Nursing Perspectives On Dual Diagnosis, Counselling, Legal Aspects, And Physical Triggers In Aged Care

Potential Impacts of Dual Diagnosis on Identification and Prioritisation of Older Person’s Needs

1. Dual diagnosis is a condition in which two severe mental health problem occurs at the same time such as an older patient might be affected with depression if he is indulged in substance abuse. The potential impacts of dual diagnosis includes severe illness, abusive behavior with social isolation, infection or different physical health issues, suicidal behavior and anti-social nature. Therefore prioritization of that older person needs are also affected due to such dual diagnoses. Nursing professionals face the dilemma of applying substantive changes or application of clinical intervention. This is because dual diagnoses changes the patient’s preference frequently that affects the application of integrated treatment for the patient (V et al. 2014).

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2. The major concerns of old age are under reconstruction as older adults nowadays are facing abuse, health and financial problems, substance abuse, ageism, discrimination and social exclusion. Therefore, counseling or support services provide them with mental and psychological support that helps to boost their self-esteem. Further, with these interventions, institutionalization in elderly patient is prevented (Lopez-Hartmann et al. 2012).

3. counselling is a process through which, people opens up about their pain and stress to a person who is carefully listening carefully to the concerns and finally provides meaningful solutions which drives self-esteem in the person going through the process. Therefore role of bereavement counsellor is to support the older adults in residential aged care facility, who are away from their home a psychological support so that they can share their feelings (Hall et al. 2012).

4. The primary role of Older Persons Mental Health Service (OPMHS) in South Australia is to provide support to the older adults so their mental health can be maximized. For this purpose, they work with communities, aged care centers, primary healthcare facilities so that the mental health condition of such adults can be maintained (Hnederson et al. 2014).

5. End of life care takes place at the final portion of the patient’s life and in this final months or weeks, the care process, clinical courses are being followed by the healthcare professionals. On the other hand, palliative care is inclusive of end of life care and some other aspects such as improvement of the quality of life. Further, it also includes the interventions that can reduce the pain of suffering and treats other aspects such as spiritual, physical and mental issues faced by the patient (Zimmermann et al. 2014).

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Purpose of Counselling in Aged Care Context

6. Physical Restraints: limitation and legal ramification of physical restrains includes increasing rates of injuries in the patient. The laws provide the healthcare facilities with the right to apply physical restraints on the patient for their benefit. However, when the applied restrain injures the patient or lead him to death, it becomes a ramification of the law (Kwok et al. 2012).

Chemical restraints: It is the type of restraint which is used to sedate a patient or limit his or her movements. The law provides the healthcare facilities with a right that includes ‘with-consent’ usage of chemical restraints. However, in care homes these are used unnecessarily that might affect the patients’ health negatively (Simpson et al., 2014).

Psychological restraints: this type of restrains are used by healthcare professions to prioritize the need of the patient despite the patient’s emotional or psychological breakdown. However in aged care facilities, these lawful restraints are used in negative aspect and the mental and psychological effect of the restraints are not assessed, that leads to the ramification of the law (Rost et al. 2012).

7. a. The Advanced Care Directive is a lawful form, which provides a person aged over 18 with the ability to write their wishes, end of life care, palliative care as well as other healthcare decisions so that during their old age, this can be provided as their consent. As well as it also appoints a person as a decision maker of the patient in future situation. In aged care facility it can be used as a patients need or consent depending on which interventions are applied on the patient (Houben et al. 2014). 

b. Aged Care Act 1997 has the objective of providing the aged care centers with funding s that they can achieve quality of care, refine their level and type of care as well as can ensure that the care provided by them is affordable and easy to access by the older adults of Australia. This helps the aged care centers to help the person who are in great need for such services.

c. Aged Care Funding Instrument (ACFI) us a resource allocation instrument and it focuses mainly on the care needs of the residents which are generally being used to discriminate those residents. Further this contains 12 questions about the need of the care and depending on the care ratings provided by the residents, the funding of the care homes are decided.

Role of Bereavement Counsellors in Aged Care Facility

d. Carers Recognition Act 2005 (South Australia) was developed to determine the roles and responsibilities of the carers in the community and determine their provision of care for the patient they are caring for. Therefore, in aged care settings it provides the carers with the same rights and responsibilities as healthcare facilities and provide them provision to live their freely without any professional obligations (Houben et al. 2014).

e. Aged care risk classification system divides the type of risks in several sections that has the capability to create a hazardous condition in aged care center (Blot et al. 2014). The five risk assessment tools which are applied in healthcare centers are

1. Conducting a workplace audit so that the number of hazards occurring every month in the settings can be identified.

2. Creating a client or patient profile so that the hazardous event with each patient can be identified.

3. Creating a patient moving and handling plan so that possible hazards while moving or handling can be prevented.

4. Further fall risk assessment to manage the falls in the setting and

5. Pre-movement risk assessment should also be carried out in the aged care facility.

f. The code of ethics for nurses in Australia is the set of guidelines for all kind of nursing professionals starting from registered nurse for clinical practice, aged care centers or research purposes. This codes provide them to guidelines to respect, protect and uphold the rights of the patients in ethical way. In aged care center this helps to provide a holistic care or approach that increases the quality of care (Nursing and Midwifery Board of Australia Council 2018).

g. Code of Professional Conduct for Nurses are the policies and guidelines that helps to provide a boundary to the nursing and midwifery care facilities while caring for their patients. This guidelines are made up of three standards such as code of conduct, codes of ethics and standard for practice that constitutes the code of professional conduct. In aged care facility this helps the nursing professionals to respect and protect their patients’ rights by complying to this code of practice (Nursing and Midwifery Board of Australia Council 2018).

h. Residential care quality assessment (RESCAREQA) is the assessment tool for the assessment of risks in residential care facilities throughout Australia. In this assessment tool, 24 questions need to be filled by the healthcare facilities depending on which the risk of the residential care unit can be determined.

Role of Older Persons Mental Health Service in South Australia

8. Primary healthcare services are important for any community as this level of healthcare is the first that connects with them to identify their health concerns. For older adults, primary healthcare settings can help them by identifying their health concerns and suggesting them interventions that can help them to control or reduce such condition (Salive 2013).

9. Two healthcare facilities that provide primary healthcare, other than GP clinics are:

1. Community healthcare settings

2. Residential aged care centers (Domiciliary settings) (Salive 2013).

10. Untreated or chronic pain: This trigger may affect the patient’s tolerability level and they might become violent or abusive to the healthcare professionals. However, the others may not behave similarly because of their thought that pain is a part of their growing age. Therefore, the effect of this trigger will be mixed among several type of patients (Watson and Breedlove 2012).

Not wearing the prescribed hearing aids or not using alternative listening devices: This trigger will make them anxious and depressed as they will not be able to listen properly using some other hearing aids. Therefore, they might react with agitated or rude attitude. Therefore, this trigger will increase tension and anxiety in the patients (Watson and Breedlove 2012).

11. The most common type of cancer which can be observed in older adults are: colorectal cancer, Prostate cancer and Breast cancer (Ramsey et al. 2013).

12. The complementary therapies are unconventional medical treatments which are used alongside the primary healthcare interventions which is used to maintain and improve the quality of care and life pf the patient. Examples are: 1. acupuncture, 2. aromatherapy and 3. Herbal medicine (Herman et al. 2012).

13. While describing the application of distraction and behavioral modification the effect of changing behavior of the patient should also be mentioned. There are several aspects due to which the behavior of the patient is changed and hence, healthcare professionals apply this method. Using this method the conflicts and changes are negotiated using several physical interventions (Stokes 2017).


Blot, S., Koulenti, D., Dimopoulos, G., Martin, C., Komnos, A., Krueger, W.A., Spina, G., Armaganidis, A. and Rello, J., 2014. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Critical care medicine, 42(3), pp.601-609.

Hall, S., Goddard, C., Opio, D., Speck, P. and Higginson, I.J., 2012. Feasibility, acceptability and potential effectiveness of Dignity Therapy for older people in care homes: a phase II randomized controlled trial of a brief palliative care psychotherapy. Palliative medicine, 26(5), pp.703-712.

Herman, P.M., Poindexter, B.L., Witt, C.M. and Eisenberg, D.M., 2012. Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations. BMJ open, 2(5), p.e001046.

Houben, C.H., Spruit, M.A., Groenen, M.T., Wouters, E.F. and Janssen, D.J., 2014. Efficacy of advance care planning: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 15(7), pp.477-489.

Kwok, T., Bai, X., Chui, M.Y., Lai, C.K., Ho, D.W., Ho, F.K. and Woo, J., 2012. Effect of physical restraint reduction on older patients’ hospital length of stay. Journal of the American Medical Directors Association, 13(7), pp.645-650.

Lopez-Hartmann, M., Wens, J., Verhoeven, V. and Remmen, R., 2012. The effect of caregiver support interventions for informal caregivers of community-dwelling frail elderly: a systematic review. International journal of integrated care, 12.

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Nursing and Midwifery Board of Australia Council, M.A., 2018. National guidelines for the accreditation of nursing and midwifery programs leading to registration and endorsement in Australia.

Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., Hollingworth, W. and Overstreet, K., 2013. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health affairs, 32(6), pp.1143-1152.

Rost, A.D., Wilson, K., Buchanan, E., Hildebrandt, M.J. and Mutch, D., 2012. Improving psychological adjustment among late-stage ovarian cancer patients: examining the role of avoidance in treatment. Cognitive and Behavioral Practice, 19(4), pp.508-517.

Simpson, S.A., Joesch, J.M., West, I.I. and Pasic, J., 2014. Risk for physical restraint or seclusion in the psychiatric emergency service (PES). General hospital psychiatry, 36(1), pp.113-118.

Stokes, G., 2017. Challenging behaviour in dementia: a person-centred approach. Routledge.

Watson, N.V. and Breedlove, S.M., 2012. The mind’s machine: Foundations of brain and behavior. Sinauer Associates.

Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., Moore, M., Rydall, A., Rodin, G., Tannock, I. and Donner, A., 2014. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), pp.1721-1730.