nursing week
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Nursing WeekTRANSCRIPT
Foundations of Gerontological & Community
Based NursingWeek I
Fiona Chatfield, RN, MSN, MBA, CCRNAdrianne Maltese, R.N., MN, GCNS-BCLos Angeles Valley CollegeE-mail: [email protected]
What is “Old”?
Young Old: 65-74 years old Middle Old: 75-84 years old Old Old: those over 85 years of age Centenarians: >40,000 persons in
US over the age of 100. Projected that by the year 2020, there will be > 3 million.
Factors influencing aging
Health (cognitive & functional capacity)
History (historic events/cohort group) Gender (affects various aspects of
aging)
Goals—to function at the highest level one is capable of.
U.S. National Health Goals’79, ’90, 2000
Healthy People 2010 objectives Increase quality & years of life for
Americans Eliminate/reduce health disparities Increase # health professionals of
racial/ethnic minorities Increase awareness & achieve access to
preventative services for all Improved surveillance and data systems in
health care
Community Based Nursing
Care for individuals, families, and groups where they work, or go to school or as they move through the health care system
Movement out of traditional, structured acute-care roles for nursing
↑ opportunities for nurses Employment opportunities and trends
Your Personal Experiences
Parents & Grandparents Extended Family Members Neighbors Community/Church/Religious Groups Friends Fellow Employees Caregiver
Scope of Practice
National Gerontological Nursing Associations (NGNA) scope & standards of care: Emphasizes the need for competent care of
older adults so that professional nurses (RN’s) will be prepared to “meet the special needs of the increasing numbers of older adults, particularly those over 85 years of age, minorities, and those with decreased financial and social resources” (ANA, 2001, p. 7)
Recognizes that the professional nurse may be ADN, BSN, MSN/MN, or Ph D. prepared.
Roles of the Gerontological Nurse
Generalist or Specialist Generalist
Various settings: home, hospital, nursing homes Performs: planning, delivery, evaluation of care
Specialist Advanced preparation (MN or MSN)
Gerontological nurse practitioner (GNP) Gerontological nursing clinical nurse
specialists
Food for thought…….
What are your thoughts about gerontological nursing? Feelings? Impressions?
What do you think would increase interest in gerontological nursing?
How does Geriatric nursing differ from Gerontological nursing?
Financing Health Care & Medicare
Soc. Security Act-1965Part A→ (free to all who are
eligible)
Part B→ optional (eligible must
pay a premium)
Part C →(Medicare Advantage Plan)’may include PPO’s & MCP’ s [HMO]
Part D→ Optional-eligible pay premium (added in 2006 to offset cost of Rx drugs)
Long Term Care Insurance
Hospital, SNF’s,Home Health, Hospice &
blood transfusions
MD visits, med equip. OP services, home health &
med supplies
Capitation imposed on MCP’s
has led to abuse/denial of care,
↓cost to elder; PPO – copays
Monthly premium & decuctible~$250.00/yr. max up to $2250/yr.
Optional (costly premiums)
What is Medi-gap insurance?
Purchased to offset Rx drug costs between $2250.00/yr. and $5100/yr.(coverage gap or donut hole)
Medicare pays 95% of cost after out of pocket reaches $3850.00/yr.
Medicaid –Social Security Act-1965
Provides financial assistance –pays for health care for poor, blind, disabled, & families with dependent children
Eligibility, service coverage varies from state to state.
States are required to cover hospital care (inpt/outpt), SNF, home health, family planning, MD visits, periodic screenings, tx. for eligible children.
Community Health approach
Primary Health Care Secondary Health Care Tertiary Health Care
Examples of Wellness Diagnoses
Ability to perform ADL’s Seeks out services when appropriate Manages stress effectively Maintains healthy lifestyle Plans and follows a healthful regimen Has a effective support network Able to cope appropriately Seeks health information Practices health maintenance
Legal Issues in Elder Care
Competence and Capacityability to make decisions regarding Finances medical/health decisions Understands consequences of
actions/choices Informed consent
Power of Attorney
Two types:
General POA
Durable POA
Appointee- known as the Attorney-in-fact
Power to make financial decisions& pay bills (no health care decisions)
Can make financial & health care decisions
(must be willing to uphold wishes on incapacitated person)
Guardians and Conservators
Guardianships & Conservatorships – Elder is declared “incompetent” or to
“lack capacity” (eg. Chronic mental illness, dementia, brain trauma)
Individuals or agencies Must be appointed by court/hearing Renewed yearly Powers decided by court- based on
extent of capacity of the elder
Elder Abuse /Neglect
Types of Abuse: Physical Psychological/emotional Sexual Financial/material Medical (unwanted tx/procedures or
withholding of tx) Neglect[withholds food,clothes,shelter,care
etc.] Abandonment by primary caregiver
Abuse & Neglect of elders
Most abuse occurs in the home of elder
Most abusers caregivers: spouses (58%)or adult children(23-30%)(Murray,2005)
84% white elders Incidences expected to increase Abuse is episodic & recurrent Multiple risk factors
Risk factors /characteristics of Elder Abuse victims
Frail elder -dependent on caregiver Female > 80 + years of age Lives alone or with abuser Confusion/cognitive impairment Incontinent episodes Chronic Illness Mental disabilities
Characteristics of Abuser
Middle aged male or adult child Caregiving spouse w/ history of previous
abuse/alcohol abuse Previous history of violence/substance
abuse/mental health problems Financially dependent on abused Feels overwhelmed by burden of care Feels frustrated and resentful History of abuse and being abused Refuses to allow visitor to see elder alone
When elder abuse is suspected
Nursing Interventions: Conduct assessment of elder Check for bruises (varying stages), wounds,
fractures, signs of punishment/restraints Check labs Malnutrition/dehydration Sudden behavioral changes in elder File mandatory report to “Adult Protective
Services” (within required timeframe)
Characteristics: Ageism & Elderspeak
Beliefs/myths/stereotypes of elders Prejudice through
attitudes & behaviors
Any discrimination
A form of ageism Singsong voice Speaks in childlike
fashion Use of “pet names”
eg. “honey” “dear”“momma” “grandma”Using “we” in
questions/statements when “you” is meant
Communicating with Elders
Communication is especially important to gerontological nurses
Gerontological nurses need to communicate effectively with older pts with a variety of physical and cognitive impairments
Communication is dynamic process including verbal and non-verbal signals. Nonverbal communication is thought to
make up ~80% of communication.
Communicating with Elders
Guide to Communication Ask how the patient would like to be addressed Do not yell or speak too loudly Try to be at eye level with the patient Try to minimize background noise as it can make
it difficult for the pt to hear Monitor the patient’s reaction Touch the patient if appropriate and acceptable Provide written instructions (use large
print/contrast paper) Keep it simple when interacting with cognitively
impaired, anxious or client in pain or pain
Communicating with Elders
Active listening Use open-ended statement to
encourage the patient to talk Avoid misunderstandings Do not be afraid to acknowledge
your own feelings Encourage reminiscing & life review What if a patient starts to cry?
Communication Barriers
Fear of one’s own aging Fear of showing emotion Feeling the need to write down every
detail Lack of knowledge of the patient’s
culture, goals and values Unresolved issues with aging relatives “professional distance” Being overworked, overscheduled, or
lacking proper time to communicate with older patients
Lewis Study Guide Case Study Question: Chapter 5 #21 (pg 26)
An 82 year old patient with multiple health problems is hospitalized with a hip fracture. What Medicare coverage will apply to
treatment of the fractured hip? What criteria must be met for the patient to
receive Medicare benefits for hospitalization?
The patient is transferred to a skilled nursing facility for rehabilitation. Will Medicare continue to cover the expense of the skilled facility?
Case Study cont’d
The patient is too frail to complete rehabilitation and it is D/C’d. Custodial care is indicated. If the patient is placed in a nursing home or taken home to be cared for, what Medicare coverage is available for expenses?
The patient is taken to a daughter’s home for custodial care. The daughter and son-in-law are both employed. What community-based service might be appropriate to allow the family members to continue employment?
Discount! Discount! Discount!
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The offer valid till 21st may 2014.
