1. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. CHAPTER Gerontological Nursing, Second Edition Patricia A. Tabloski Gerontological Nursing Issues 2 Lecture Note PowerPoint Presentation

2. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 1 Discuss the nurse’s role in caring for older adults.

3. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Geriatrics Originated in 1925 Medical specialty focusing on the diagnosis and treatment of diseases in older adults

4. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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

5. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Standards of Gerontological Nursing Set by the ANA Establish standards and criteria for gerontological nursing

6. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Responsibilities of the Gerontological Nurse Direct care Management and development of nursing personnel Evaluation of care and services for the older adult

7. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski The Nurse’s Role in Caring for Older Adults Generalists –Direct care providers –Case managers –Nurse leaders –Educators –Patient advocates –Administrators

8. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski The Nurse’s 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

9. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 2 Identify appropriate educational preparation and certification requirements of the gerontological nurse generalist and specialist.

10. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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

11. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Basic Level Certification Associate, Diploma, or Baccalaureate degree in nursing Credentials appear as RNC (certified)

12. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Advanced Level Certification Clinical nurse specialist and nurse practitioners with Master’s degree Certified as gerontological specialists Credentials appear as RN or BC (board certified)

13. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 3 Identify components of the long-term-care system.

14. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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

15. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Employment Settings for Gerontological Nurses 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

16. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Employment Settings for Gerontological Nurses 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

17. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Employment Settings for Gerontological Nurses Residential care facilities –Previously called rest homes –Offer supervision and health monitoring

18. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Employment Settings for Gerontological Nurses 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

19. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Employment Settings for Gerontological Nurses 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

20. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Employment Settings for Gerontological Nurses Community nursing care –Visiting nurse service –Provides skilled care in the home –Services may include vital signs, education, wound care, and medication administration

21. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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

22. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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.

23. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 4 Discuss the ANA standards and scope of practice for gerontological nursing.

24. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski American Nurses Association (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 Gerontological Nursing Practice in 1976

25. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski American Nurses Association (ANA) Published A Statement on the Scope of Gerontological Nursing Practice in 1970 –Defines nature and scope of gerontological nursing –Purpose Health promotion Healthy maintenance Disease prevention

26. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski American Nurses Association (ANA) Self-care –Intended as a guide to current practice –Standards apply in all clinical practice settings

27. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski American Nurses Association (ANA) Standards of Clinical Gerontological Nursing Care –I. Assessment –II. Diagnosis –III. Outcome Identification –IV. Planning –V. Implementation –VI. Evaluation

28. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 5 Identify the use of functional health patterns in the formulation of a nursing diagnosis.

29. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Functional Health Patterns Developed by Gordon Interact and form the basis for the older person’s lifestyle Used to guide the nurse in obtaining information

30. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Functional Health Patterns Patterns include –Health perception–health management –Nutritional–metabolic –Elimination –Activity–exercise –Sleep–rest –Cognitive–perceptual –Self-perception–self-concept

31. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Functional Health Patterns Patterns include –Roles–relationships –Sexuality–reproductive –Coping–stress tolerance –Values–beliefs

32. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 6 Describe the uses and need for gerontological nursing research as support for evidence-based practice.

33. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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 evidence- based nursing interventions

34. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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)

35. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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

36. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski 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

37. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Focus of Nursing Research Noninvasive, cost-effective behavioral techniques Alternatives or supplements to the usual care

38. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Evidence-Based Practice Best method for delivery of care Based on clinical guidelines derived from research –Coding system indicates the strength of the research

39. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Agency for Healthcare Research and Quality (AHRQ) Three-level coding system –Strength of the available evidence

40. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Randomized, Controlled Clinical Trials Best for establishing causes and effects

41. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 7 Describe effective communication techniques appropriate for use with the older adult.

42. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Therapeutic Communication Ongoing, continuous, dynamic process Includes verbal and nonverbal signals

43. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nonverbal Communication 80% of communication process Body language Positioning Eye contact Touch Tone of voice Facial expressions

44. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Verbal Communication Guidelines Do not yell or speak too loudly Communicate at eye level Minimize background noise Monitor patient’s reaction Use touch as appropriate Supplement verbal instruction with written instructions

45. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Verbal Communication Guidelines Avoid long, complicated instructions Determine how patient would like to be addressed Use caring responses and caring listening Encourage reminiscing

46. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Barriers to Communication Fear of one’s own aging Fear of showing emotion Fear of missing something Fear of being called on to rectify every problem Lack of knowledge of patient’s culture, goals, and values

47. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Barriers to Communication Unresolved issues with aging relatives in own family Feelings that professional distance must be maintained Being overworked, or overscheduled