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Chapter 2

GerontologicalNursing Issues

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Responsibilities of theGerontological Nurse

Direct care

Management and development ofnursing personnel

Evaluation of care and services for the

older adult

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Nurses Role in Caring for OlderAdults

Generalists

Direct care providers

Case managers Nurse leaders

Educators

Patient advocatesAdministrators

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Nurses Role in Caring for OlderAdults

Advanced practice gerontologicalnurses

Primary care providers focus on Health promotion

Disease prevention

Long-term management of chronic conditions

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Certification Requirements at theBasic Level

Associate, diploma, or baccalaureate degreein nursing

Currently registered as a nurse in the United

States or one of its territories Practiced the equivalent of 2 years full time

as an RN

Minimum of 2,000 hours of clinical practicewithin the past 3 years Indicate certification with the initials RNC

(certified)

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Certification at the AdvancedPractice Level

Clinical nurse specialists and nursepractitioners with Masters degree

Certified as gerontological specialists

Indicate certification with the credentialsRN, BC (board certified)

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Skilled Nursing Facility

Care may be delivered by nurses and other healthprofessionals

Sub-acute care (Medicare reimbursed, short stay) Chronic care (private pay or Medicaid) for frail,

elderly residents requiring help with the activities ofdaily living

A 3-day qualifying stay in a hospital is required forskilled care to receive Medicare reimbursement in along-term care facility Periodic recertification that documents the continued need

for skilled care Residents progress toward established goals One hundred days of skilled care can be reimbursed per

year

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Retirement Communities

Range in size and scope of service

Resident pays admission fee and then

monthly fee

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Adult Day Care

An option for frail elders requiringdaytime supervision

Many services are optional to meetneeds

Caregiver schedule

Healthcare for elder

Medical insurance does not usually covercharges

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Residential Care Facilities

Residents provide most self-care

Additional assistance for laundry,

meals, and housekeeping

Supervision and health monitoringprovided

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Transitional Care Units

For persons who no longer requireacute care

Subacute care

Rehabilitation

Palliative care

Diagnostics, complex monitoring, and

support services provided

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Rehabilitation Hospitals orFacilities

Provide subacute care for persons withcomplex needs

Payment covered by private insuranceor Medicare

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Community Nursing Care

Visiting nurse services for older personsrequiring skilled care in the home

Provided by personnel with a variety ofskill levels

Usually covered by Medicare whenneed for service exists under the

direction of a physician

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ANCC Guidelines for the Scope ofPractice of the Gerontological Nurse

Specialize in care and the health needsof older adults

Plan, manage, and implement healthcare

Evaluate effectiveness

Identify and use the strengths of olderadults

Assist in maximizing independence

Actively involve older adults and family indecision making

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The 11 Functional HealthPatterns Include

Health perceptionhealth management

Nutritionalmetabolic

Elimination

Activityexercise Sleeprest

Cognitiveperceptual

Self-perceptionself-concept

Rolesrelationships Sexualityreproductive

Copingstress tolerance

Valuesbeliefs

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Gerontologic Nursing Roles inResearch

Interpret, apply, and evaluate research findings toinform and improve gerontological nursing practice

Identify clinical problems appropriate for study

Gather data

Interpret findings to improve care

Research findings to provide evidence-based nursinginterventions

Participate in research teams

Collaborate with nursing colleagues with advancededucation and research training

Serve on an institutional review board (IRB)

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Nursing Research

U.S. federal funding for nursingresearch began in the 1950s.

In 1986, the NINR was establishedwithin the NIH.

NINRs mission is to support the sciencethat advances the knowledge of nurses.

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Nursing Research

Nursing research focuses on thedevelopment of

Noninvasive, cost-efficient behavioral

techniques

Alternatives or supplements to the usualcare

Nursing research can lead to broadscope policy and practice changes.

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Evidence-Based Practice

Best method for delivery of care

Based on clinical guidelines derived

from research Coding system indicating the strength of

the research

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AHRQ

AHCPR, now called Agency forHealthcare Research and Quality(AHRQ)

Three-level coding system

Strength of the available evidence

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Randomized ControlledClinical Trials

Best for establishing causes and effects

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Nonverbal Communication

Nonverbal communication composes upto 80% of information exchange

Body language

Position

Eye contact

Touch

Tone of voice

Facial expression

Verbal Communication

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Verbal CommunicationGuidelines

Do not yell or speak too loudly to patients

Yelling into a hearing aid can be disturbing andpainful

Try to be at eye level Minimize background noise

Touch if appropriate and acceptable

Supplement with written instructions asneeded

Avoid complicated explanations

Verbal Communication

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Verbal CommunicationGuidelines

Ask how the patient would like to beaddressed

Avoid demeaning terms such as sweetie,honey, or dearie

Use open-ended statements Tell me more or How does this affect you?

Avoid misunderstandings by clarifying

Im not sure what you mean Use caring responses and careful listening

Encourage reminiscing