Ch02 Gerontological Nursing Issues

2
CHAPTER
LectureNotePowerPointPresentation
GerontologicalNursing
Issues
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright 2010 by Pearson Education, Inc.

Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 1
Discuss the nurses role in caring for older
adults.


Geriatrics
Originated in 1925
Medical specialty focusing on the
diagnosis and treatment of diseases in
older adults


American Nurses Association

Responsible for defining scope and
standards of nursing practice
Established the Division of Geriatric
Nursing Practice in 1966
Goal to create standards for quality nursing
care for the aged
Changed name to Division of

Gerontological Nursing Practice in 1976

Standards of Gerontological
Nursing
Set by the ANA
Establish standards and criteria for
gerontological nursing


Responsibilities of the
Gerontological Nurse
Direct care
Management and development of nursing
personnel
Evaluation of care and services for the
older adult


The Nurses Role in Caring for

Older Adults
Generalists
Direct care providers
Case managers
Nurse leaders
Educators
Patient advocates
Administrators


The Nurses Role in Caring for

Older Adults
Advanced practice gerontological nurses
Primary care providers focus on
Health promotion
Disease prevention
Long-term management of chronic conditions


LEARNING OUTCOME 2
Identify appropriate educational preparation
and certification requirements of the
gerontological nurse generalist and
specialist.


Gerontological Certification
Available from the ANA in 1973
Establishes competency in the area of
practice
Consists of a written examination
Criteria
Registered Nurse in the United States or one of
its territories
Practiced a minimum of 2,000 hours within the
last 3 years

Basic Level Certification

Associate, Diploma, or Baccalaureate
degree in nursing
Credentials appear as RNC (certified)


Advanced Level Certification

Clinical nurse specialist and nurse
practitioners with Masters degree
Certified as gerontological specialists
Credentials appear as RN or BC (board
certified)


LEARNING OUTCOME 3
Identify components of the long-term-care
system.


Employment Settings for

Gerontological Nurses
Skilled nursing facilities
Skilled care provided by nurses
May include both subacute and chronic
Helpful for the frail, older adult needing help
with activities of daily living



Retirement communities
Vary in size and scope
Offerings range from independent living to
nursing home care
May allow residents to move between levels of
care as condition changes mandate
Amenities vary



Adult day care
Provides daytime supervision and activities
May offer transportation
Typically fees are paid privately
Meal services normally included
Planned activities are included
Additional health service availability varies



Residential care facilities
Previously called rest homes
Offer supervision and health monitoring



Transitional care units
Established by acute care hospitals
Provide subacute care, rehabilitation, and
palliative healthcare services
Most patients are recuperating from surgery,
major illness, or injuries
Support services of the acute care facility are
provided



Rehabilitation hospitals or facilities
Specialized facilities provide subacute care to
patients with complex healthcare needs
Patients may have head injuries, be ventilator
dependent, or require rehabilitation after an
injury or surgery



Community nursing care
Visiting nurse service
Provides skilled care in the home
Services may include vital signs, education,
wound care, and medication administration


Approximately $207 billion spent on

long-term health care in 2005
Accounts for 12% of all healthcare
expenditures
70% of this figure covered by health
insurance
18% paid by patients and families


Figure 2-1
National spending for long-term care, by payer (2005).
Source: Harriet L. Komisar and Lee Shirey Thompson. National Spending for Long-Term Care. Fact Sheet.
Washington, DC: Georgetown University Long-Term Care Financing Project, February 2007.

LEARNING OUTCOME 4
Discuss the ANA standards and scope of
practice for gerontological nursing.



(ANA)
Responsible for defining scope and
standards of nursing practice
Established the Division of Geriatric
Nursing Practice in 1966
Mission to create standards for quality nursing
care for older adults in all settings
Division name changed to Division on


(ANA)
Published A Statement on the Scope of
Defines nature and scope of gerontological
nursing
Purpose
Health promotion
Healthy maintenance
Disease prevention


(ANA)
Self-care
Intended as a guide to current practice
Standards apply in all clinical practice settings



(ANA)
Standards of Clinical Gerontological
Nursing Care
I. Assessment
II. Diagnosis
III. Outcome Identification
IV. Planning
V. Implementation
VI. Evaluation

LEARNING OUTCOME 5
Identify the use of functional health patterns
in the formulation of a nursing diagnosis.


Functional Health Patterns

Developed by Gordon
Interact and form the basis for the older
persons lifestyle
Used to guide the nurse in obtaining
information



Patterns include
Health perceptionhealth management
Nutritionalmetabolic
Elimination
Activityexercise
Sleeprest
Cognitiveperceptual
Self-perceptionself-concept


Patterns include
Rolesrelationships
Sexualityreproductive
Copingstress tolerance
Valuesbeliefs


LEARNING OUTCOME 6
Describe the uses and need for
gerontological nursing research as support
for evidence-based practice.


Gerontological Nursing Roles in

Research
Interpret, apply, and evaluate research
findings
Identify clinical problems appropriate for
study
Gather data
Interpret findings to improve care
Research findings to provide evidencebased nursing interventions

Gerontological Nursing Roles in

Research
Participate in research teams
Collaborate with nursing colleagues with
advanced education and research training
Serve on an institutional review board
(IRB)


1986 NINR Established Within NIH

Mission to support science that advances
nurses knowledge
Improve health of individuals, families,
communities, and populations
Support and conduct clinical and basic
research training on health and illness across
the life span


1986 NINR Established Within NIH

Mission to support science that advances
nurses knowledge
Extend nursing science by integrating the
biological and behavioral sciences
Employ new technologies to research
questions, improve methods, and develop
scientists of the future


Focus of Nursing Research

Noninvasive, cost-effective behavioral
techniques
Alternatives or supplements to the usual
care


Evidence-Based Practice
Best method for delivery of care
Based on clinical guidelines derived from
research
Coding system indicates the strength of the
research


Agency for Healthcare Research

and Quality (AHRQ)
Three-level coding system
Strength of the available evidence


Randomized, Controlled Clinical

Trials
Best for establishing causes and effects


LEARNING OUTCOME 7
Describe effective communication
techniques appropriate for use with the older
adult.


Therapeutic Communication
Ongoing, continuous, dynamic process
Includes verbal and nonverbal signals


Nonverbal Communication
80% of communication process

Body language
Positioning
Eye contact
Touch
Tone of voice
Facial expressions

Verbal Communication Guidelines
Do not yell or speak too loudly

Communicate at eye level
Minimize background noise
Monitor patients reaction
Use touch as appropriate
Supplement verbal instruction with written
instructions

Verbal Communication Guidelines

Avoid long, complicated instructions
Determine how patient would like to be
addressed
Use caring responses and caring listening
Encourage reminiscing


Barriers to Communication
Fear of ones own aging

Fear of showing emotion
Fear of missing something
Fear of being called on to rectify every
problem
Lack of knowledge of patients culture,
goals, and values

Barriers to Communication
Unresolved issues with aging relatives in
own family
Feelings that professional distance must
be maintained
Being overworked, or overscheduled



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2

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

American Nurses Association

Changed name to Division of

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

The Nurses Role in Caring for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

The Nurses Role in Caring for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Copyright 2010 by Pearson Education, Inc.

Basic Level Certification

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Advanced Level Certification

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Employment Settings for

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Approximately $207 billion spent on

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

Copyright 2010 by Pearson Education, Inc.

Gerontological Nursing, Second Edition

Copyright 2010 by Pearson Education, Inc.

American Nurses Association

Copyright 2010 by Pearson Education, Inc.

American Nurses Association

Copyright 2010 by Pearson Education, Inc.

American Nurses Association

Gerontological Nursing, Second Edition