1. Chapter Four The Use of the Nursing Process and
Nursing Diagnosis in the
Care of Older Adults

2. Introduction LPNs work in a variety of care settings
Every practice area expects the nurse to be involved with the assessment, planning, implementation, and evaluation of older adults and the care they receive.
What is the priority setting for this chapter? Pg.61

3. Environments of Care Home care Hospital care Long-term care facilities
Work under supervision of RN
Changing dressings, monitoring blood glucose levels, administering medications, assessing the status of chronic disease processes in the older adult’s home
Hospital care
May be paired w/RN to form a care team
Assigned specific tasks: treatments, passing meds
Long-term care facilities
What is the difference in the level of care provided in skilled nursing facilities vs. assisted living facilities? Pg.61-62
What kind of responsibilities do nurses have in this type of setting? Pg.62

4. Nursing Process Problem-solving model that describes what nurses do
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation
Provides a structure for nurses to plan and give high-quality, individualized care
Can the nursing process be utilized with the example listed in your book? Pg.62

5. Nursing Process (cont’d)
Assessment
Usually the assessment starts with the call/written summary from the agency/dept that is transferring the older adult
What is some of the information you need before the patient is transferred? Pg.63
What did the enactment of the Omnibus Budget Reconciliation Act of 1987 and 1990 (OBRA 1987 & 1990) establish? Pg.63
In 2010 the Resident Assessment Instrument (RAI) was updated to 3.0 and includes the MDS 3.0; the RAPs has been replaced with Care Area Assessments (CAAs)
The MDS is a very important part of the assessment
What is the MDS & CAA? Pg. 64
Identify problem areas that must be assessed in the care plan

6. Nursing Process (cont’d)
*The 1987 OBRA Act: the federal government determined that persons living in a long-term care facility are to be referred to as residents. They are residents of the facility.

7. Nursing Process (cont’d)
Nursing diagnosis
Developing nursing dx is a primary responsibility of the RN
Involves diagnostic reasoning to reflect the older adult’s strengths, problems, and potential problems
What does the RN consider when selecting specific nursing diagnosis? Pg.64
NANDA has helped establish the national standard for nursing diagnoses; why is this important? Pg.65
What are some common nursing diagnosis for older adults? Pg.65

8. Nursing Process (cont’d)
Nursing Diagnosis and Medical Diagnosis
What is the major problem with planning care based only on medical diagnoses? Pg.67
Planning: Setting Priorities
What model can assist in setting priorities? Pg.67
Another consideration are the priorities of the resident, what example does the author give? Pg.67

9. Abraham Maslow’s Hierarchy of Needs
*Removing the lodged food so that the resident could breathe would be a higher priority than putting on the resident’s shoes!

10. Nursing Process (cont’d)
Planning: Goal Setting or Identifying Outcomes
After identifying the priorities for the resident’s care, the nurse identifies goals or outcomes for each of the nursing diagnosis
In order to direct care & describe outcomes, goals must be:
Measurable
Realistic
Specific
Timely
Attainable
In long-term care, how often will the goals be measured/reviewed? Pg.68
Let’s review the examples of goals listed on pg.68, what do you notice about them?

11. Nursing Process (cont’d)
Planning: Designing & Documenting the Plan of Care
After goals/outcomes are identified, the nurse along with other members of IDT begin to plan the activities to reach the goals
What are some examples of interventions in an interdisciplinary care plan? Pg.69
Planned interventions must complement the interventions of other therapies
Pt ambulated w/walker by physical therapist but encouraged to walk with a can by the nursing staff
A coordinated approach enhances effectiveness of the care given
Why is it important to develop nursing interventions with input from CNAs? Pg. 69

12. Nursing Process (cont’d)
Implementation
The part of the nursing process that nurses do best
Bedside care is one of the most rewarding aspects of nursing
Many of the interventions are assigned to who? Pg.70
*Note: RNs, LPNs/LVNs, & CNAs ALL perform nursing interventions
Documentation is an important part of implementation
The nurse is responsible for documenting that the intervention was done and what else? Pg.70
A simple model for documenting nursing interventions & resident responses: (pg.71)
Assessment
Action
Plan

13. Nursing Process (cont’d)
Final step in the nursing process
Purpose: to decide if the identified goals were met, partially met or remain unmet; to assess the outcomes of nursing care
The evaluation of goal achievement needs to be documented how often and where? Pg.71
Evaluation is ongoing & occurs daily, not just at mandatory reassessment intervals, example on pg.72
Making daily changes in the actual care given is common; translating the changes into the written plan of care is not
Very important to update the care plan to reflect the actual care you want the patient to receive; this will ensure consistency among all staff

14. Conclusion Responsibilities:
The management of care given by nursing assistants
Working with the IDT
Completing documents required by the federal government
Delivering excellent care to the frail and vulnerable people in your care
It is essential that you become highly skilled in the use of the nursing process in the care of older adults

15. Questions?