Chapter 6 The Specialty of Gerontological Nursing

Terms to Know Competency: having skill, knowledge, and ability to do something according to a standard Evidence-based practice: using research and scientific information to guide actions Geriatric nursing: nursing care of sick older adults Gerontological nursing: nursing practice that promotes wellness and the highest quality of life for aging individuals Standard: desired, evidence-based expectations of care that serve as a model against which practice can be judged

Introduction Gerontological nursing: gaining respect and experiencing growth Nurses have opportunities to play significant roles in the care of older population and shape the future of this specialty

Development of Gerontological Nursing 1904: First article on care of older adults; published in American Journal of Nursing 1935: Federal Old Age Insurance Law known as Social Security 1961: ANA recommended specialty group for geriatric nurses 1966: Division of Geriatric Nursing—specialty of Gerontological Nursing 1969–1970: Standards for Geriatric Nursing Practice 1975: Certification for Geriatric Nursing

Question Which organization certifies nurses in gerontological nursing practice? American Nurses’ Credentialing Center State Board of Nursing Association for Accreditation of Nursing Hartford Institute for Geriatric Nursing

Answer A. American Nurses’ Credentialing Center Rationale: Thousands of nurses have been certified in various aspects of gerontological nursing practice from the American Nurses’ Credentialing Center.

Core Elements of Gerontological Nursing Practice Evidence-based practice: Nursing practice decision-making follows research Relies on synthesis and analysis of information Benchmarking: performance compared with best practices Standards for nursing practice: Guide and evaluate nursing practice State and federal regulations Joint Commission ANA Standards Principles are based on scientific data

Question Is the following statement true or false? State and federal regulations outline minimum standards of practice for various health care workers and agencies.

Answer True Rationale: Professional nursing practice is guided by standards that reflect the level and expectations of care that are desired and serve as a model against which practice can be judged.

Evidence-Based Practice Nursing follows systematic approach for clinical decision making: evidence-based practice Is among the ANA Standards of Professional Gerontological Nursing Performance Relies on synthesis and analysis of available information from research Benchmarking-Performance can be compared with best practices or industry averages

Standards Guide professional nursing practice Reflect level and expectations of care Nurses must evaluate practices against standards to ensure highest quality of care. Box 6-2 page 78

Competencies Competencies specific to gerontological nursing promote highest quality of care Basic competencies: Normal from abnormal findings—risks Assessment—empowerment Engage older adults in all care—preferences identified Education—assist older adults in care needs Individualized care—facilitate advanced directives

Principles Proven facts or theories that guide nursing actions Foundation of nursing practice Direct care delivery

Aging: A Natural Process Aging begins at conception Aging of all cells is constant Aging is not a pathological experience; is not a crippling disease Aging brings opportunity for usefulness, fulfillment, and joy Accurate understanding of aging process encourages positive attitude toward aging

The Aging Process Factors include heredity, nutrition, health status, life experiences, environment, activity, and stress Aging is individualized and unique to each person Nurses need to understand multitude of factors influencing aging process

The Nursing Process Framework Integrates scientific data related to normal aging and general knowledge of nursing Offers systematic approach to care Involves holistic approach

Common Needs Core needs: Physiological balance Connection Gratification Self-care practices promote independence

Optimal Health and Wholeness View aging as the process of realizing one’s humanness, wholeness, and unique identity Achieve sense of personhood directed to self- actualization Strengthen self-care capacity Promote maximum independence for positive outcomes

Question Which nursing action within the framework of the self- care theory will assist in promoting health and wholeness? Strengthening self-care capacity Maximizing self-care limitations Providing direct services to an independent individual Making decisions for older adults

Answer A. Strengthening self-care capacity Rationale: Strengthening self-care capacity will act to promote health and help people achieve wholeness as nurses promote maximum independence and allow older adults to do as much for themselves as possible.

Gerontological Nursing Roles Nurses function in various roles Healer: practice holistic nursing Caregiver: meet unique needs Educator: share knowledge and skills Advocate: speak up for older adults Innovator: “think outside the box”

Question Is the following statement true or false? Nurses can advocate for older adults as they facilitate a community’s or other group’s efforts to affect change and achieve benefits for older adults.

Answer True Rationale: The gerontological nurse can function as an advocate by aiding older adults in asserting their rights, obtaining required services, and facilitating change in the community that will achieve benefits for the older adult.

Advanced Practice Nursing Roles Preparation in unique principles and best practices for the older adult Broad knowledge base Capacity for independent practice Leadership Complex clinical problem-solving abilities Roles include geriatric nurse practitioners, geriatric nurse clinical specialists, and geropsychiatric nurse clinicians. Require the completion of a master’s degree at a minimum.

Future of Gerontological Nursing Lessons from the past: protect care of older adults and specialty of gerontology Challenges for the future: research by nurses, add gerontological nursing courses to nursing programs, and teach continuing education for nurse in geriatrics Advance research: no room for trial and error; network with other nurse researchers

Challenges for the Future Utilize evidence-based practices Advance research Promote integrative care Educate caregivers Develop new roles Balance quality care and health care costs

Question Which statement best describes a nurse’s effort to be involved in cost-containment efforts? Allowing insurance companies to dictate care Testing creative staffing patterns Utilize an all RN staff Providing care to a larger number of patients

Answer B. Testing creative staffing patterns Rationale: Testing creative staffing patterns to provide a high level of safe care can prevent burnout and contain costs while balancing quality services and budgetary concerns.