Foundations of Gerontological

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Foundations of Gerontological Community Based
NursingWeek I

• Fiona Chatfield, RN, MSN, MBA, CCRN
• Los Angeles Valley College

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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.

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What Is Healthy People 2010?

• Healthy People 2010 is a comprehensive set of
  disease prevention and health promotion
  objectives for the Nation to achieve over the
  first decade of the new century. Created by
  scientists both inside and outside of Government,
  it identifies a wide range of public health
  priorities and specific, measurable objectives.

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Overarching Goals 

• Increase quality and years of healthy life
• Eliminate health disparities

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Focus Areas 

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Key Concepts

• Nurses have a responsibility improve the quality
  of ones life and reduce health disparities.
• Gerontological nursing is an opportunity to make
  significant differences in the lives of older
  adults.
• Health, history, and gender are among the major
  factors influencing the aging experience.

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More Key Concepts

• Primary Health Care consists of preventative
  services, diagnosis and treatment of common acute
  illnesses
• Secondary Health Care serious or complicated
  care traditionally provided in hospitals
• Tertiary Health Care management of chronic,
  complicated, long-term health problems

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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

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Your Personal Experiences

• Parents Grandparents
• Extended Family Members
• Neighbors
• Community/Church/Religious Groups
• Friends
• Fellow Employees
• Caregiver

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Examples of Wellness Diagnoses

• Ability to perform ADLs
• 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

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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 (RNs) 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.

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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

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Food for thought.

• What are your thoughts about gerontological
  nursing? Feelings? Impressions?
• What do you think would increase interest in
  gerontological nursing?

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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.

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Communicating with Elders

• Verbal 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 patients reaction
• Touch the patient if appropriate and acceptable
• Supplement verbal instructions with written
  instructions as needed
• Do not give long-winded speeches or complicated
  instructions to persons with cognitive
  impairment, anxiety or pain

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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
• What if a patient starts to cry?

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Communication Barriers

• Fear of ones own aging
• Fear of showing emotion or being around emotional
  patients
• Fear of missing something and feeling the need to
  write down every detail
• Lack of knowledge of the patients culture, goals
  and values
• Unresolved issues with aging relatives in the
  nurses own family
• Feeling that a professional distance must be
  maintained
• Being overworked, overscheduled, or lacking
  proper time to communicate with older patients

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• Practice active listening
• Practice communication skills
• Practice makes perfect!

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Healthcare Financing

• Social Security
• Medicare
• Medicare Part A
• Medicare Part B
• Medicare Part D
• Medicaid
• Long term care insurance

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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 fro 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?

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Case Study contd

• The patient is too frail to complete
  rehabilitation and it is D/Cd. 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 daughters 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?

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• Are you concerned about health insurance?
• Should you be concerned?
• Personally
• Professionally?