N4346Introwhyusecritthink.ppt

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  • Nearly ninety percent of people over age 65 have one or more chronic conditions, with the average seventy-five year old experiencing at least three per person.
  • Older adults comprise 63 percent of patients with cancer, 60 percent of visit to cardiologists, 53 percent of visits to urologists, 52 percent of visits to ophthalmologists and 46 percent of patients in critical care .
  • We envision healthcare professionals in all health care settings, educators and new students entering nursing to question: “Am I prepared to provide the very best geriatric care when called to do so”?
  • We also know that, in order to impart quality health care to all older adults in all health care encounters; nurses must consistently draw upon a standard set of skills.
    This set of skills routinely requires critical thinking, applied at varying “dosages” depending on situational contexts and health care issues identified.
  • This module focuses on answering the, “how can I provide the very best geriatric care to older adults with complex illness”?
    Our approach and recommendations are drawn from national professional recommendations for geriatric assessment and existing gerontological nursing competencies.
  • We propose these 5 recommendations with evidenced-based rationales and supporting documentation as to the potential of the recommendation to yield positive outcomes, e.g. decreased mortality, morbidity and length of stay, and improved satisfaction:
  • N4346Introwhyusecritthink.ppt

    1. 1. Preparing Nursing Students to Care for Older Adults Introduction to N4346 Gerontologic Nursing
    2. 2. Older Adults as Frail and in Need of Care 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 2
    3. 3. What is Ageism? Deep Societal Prejudice Against Older Adults Personal Revulsion/Distaste for Growing Old Fear of Powerlessness, Uselessness, & Death Stereotyping and Discrimination Seeing Elders as a Threat due to ↑ Numbers A “Cost Drain” to Society Subtle Cease to Exist as “human beings”
    4. 4. Older Adults as Healthy and Active 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 4
    5. 5. 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 5
    6. 6. 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 6
    7. 7. 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 7
    8. 8. Currently Much of All Health Care Is Devoted to Care of Older Adults  57% of all visits to generalist physicians  50% of hospital expenditures  80% of home care visits  90% of nursing home care 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 8
    9. 9. Older Adults in Hospitals Of all adult patients, people >65 make up: • 47% of patients with anemia • 53% of patients receiving respiratory therapy • 64% of patients with heart disease • 66% of patients with urinary tract infections • 70% of patients with pneumonia • 78% of patients with CHF 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 9
    10. 10. Older Adults Are a Hospital’s CORE Business  Slow & progressive “aging” of who occupies hospital beds  Make up 52% of non-obstetric hospital days  Long lengths of stay (7.8 vs. 5.4 days)  High rates of re-admission within 30 days  Documented functional declines & medical errors 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 10
    11. 11. Older Adults in Hospitals  60% of med-surg patients  46% of CCU patients  50% of ICU days  60% of all visits to cardiologists  63% of visits to oncologists  In ERs, 26% of hospital admissions after trauma 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 11
    12. 12. Older Patients Experience Many Adverse Health Events  88% of older people have chronic conditions  Common adverse events (IOM Report, 1999):  Pressure ulcers  Medication errors  Delirium  Physical restraint use 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 12
    13. 13. Older Adults Most at Risk of Long LOS, Re-admission, & High ER Use 1. Dementia 2. Physical and cognitive co-morbidities  LOS of older patients with dementia and CHF, CHD, diabetes, COPD is 3 times longer than for patients with physical illness alone 1. Complex diagnosis:10-30% of older patients 2. Behavioral problems; 51% of older patients (one study) 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 13
    14. 14. 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 14 Dementia + Chronic Illness Compounds Complication Rate
    15. 15. Children as Core Business 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 15
    16. 16. Children as Core Business dukechildrens.org “We’re all about kids” 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 16
    17. 17. University of Virginia Children’s Hospital Web site and resources for children 1712/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development
    18. 18. Hospitals’ Response Given that Older Adults Are Their CORE Business  Promotional materials and web site show pictures of babies and children  Little special programming and/or structure to address needs of older adults, e.g.:  Large print signage and written materials  Bed height, chair configurations, mobility aids  Strategies for patients with dementia, e.g. protocols to minimize disruption of routines 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 18
    19. 19. Hospitals’ Response Given that Older Adults Are Their CORE Business  No national gerontological/geriatric certification requirements (>1% of RNs nationally ANCC certified in gerontological nursing vs 19% of nurses in children’s hospitals certified in pediatrics)  No national scopes and standards for care of older adults  No Magnet or JCAHO requirements for staff competence in care of older adults 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 19
    20. 20. 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 20
    21. 21. Introduction • Caring for older adults is both complex and challenging – Complex because of the array and number of chronic illnesses facing older adults, only expected to increase with longevity – Challenging because given the demand for skilled health care providers in geriatrics/gerontology, which far exceeds the capacity of current geriatric nurses and other health professionals 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 21 Average 75 yo experiencing at least three per person 90% over 65 yo have one or more chronic conditions
    22. 22. Introduction • Caring for older adults is, and will continue to be, the “core business” of health care institutions • As a result of consequences of an aging population with chronic illness, older adults are the predominate users of the health care system 2212/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 63% 60% 53% 52% 46% WithCancer VisitCardiologists VisitUrologists VisitOphthalmologists CriticalCare
    23. 23. Introduction • Envisioning healthcare professionals in all health care settings, educators and new students entering nursing to question: 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 23 “Am I prepared to provide the very best geriatric care when called to do so?”
    24. 24. Introduction • Want positive outcomes? Critical thinking is used especially when ~ – certain evidence-based nursing assessments are made – certain evidence-based nursing management approaches are followed – certain evidence-based system approaches are provided 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 24
    25. 25. Introduction • This course uses a comprehensive approach • Touching key areas to form a core set of elements that nurses’ caring for older adults must think about and integrate into practice • Key elements that frame 5 specific recommendations for nursing care of older adults of advanced old age with co- morbidities 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 25
    26. 26. Why Should Nurses Utilize Critical Thinking When Caring for Older Adults with Chronicity/Complex Needs? Five recommendations: 1. Conduct advance health planning and make decisions • Assessment • diagnostic testing • treatments for chronic conditions – life expectancy – Functional – physical and cognitive status – quality of life – availability of social supports 1. Considered at increased risk to develop adverse response and complications related to mediations, treatment and geriatric syndromes 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 26
    27. 27. Why Should Nurses Utilize Critical Thinking When Caring for Older Adults with Chronicity/Complex Needs? 3. Viewed as an “at risk” population 4. Assessed for • Functional and cognitive status • Pain • Geriatric syndromes – Delirium – Fall risk – Presence of urinary incontinence – Pressure ulcers • Irrespective of setting in the hospital – Emergency room – Oncology unit – Critical care 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 27
    28. 28. Why Should Nurses Utilize Critical Thinking When Caring for Older Adults with Chronicity/Complex Needs? 5. Access to hospital system-based models of care • Geriatric Resource Nurses • Acute Care of the Elderly Units (ACE) • Inter-disciplinary assessment • Volunteer programs (HELP) • Case management to implement strategies that prevent geriatric syndromes • limited or no use of physical restraints • early and consistent walking and ambulation • removal from pharmaceutical formularies of medication known to cause high adverse drug events • early treatment of functional decline and cognitive impairment due to delirium, depression, and dementia 12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 28
    29. 29. Our Partnership for Learning • Tell Me and I Will Forget. • Show Me and I Will Remember. • Involve Me and I Will Understand. David Kolb quoting Confucius

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