Foundations of Gerontological &
Community Based Nursing
Week I
Fiona Chatfield, RN, MSN, MBA, CCRN
Adrianne Maltese, R.N.,...
What is “Old”?
 Young Old: 65-74 years old
 Middle Old: 75-84 years old
 Old Old: those over 85 years of age
 Centenar...
Factors influencing aging
 Health (cognitive & functional capacity)
 History (historic events/cohort group)
 Gender (af...
U.S. National Health Goals
’79, ’90, 2000
Healthy People 2010 objectives
 Increase quality & years of life for Americans
...
Community Based Nursing
 Care for individuals, families, and groups
where they work, or go to school or as
they move thro...
Your Personal Experiences
 Parents & Grandparents
 Extended Family Members
 Neighbors
 Community/Church/Religious Grou...
Scope of Practice
 National Gerontological Nursing Associations
(NGNA) scope & standards of care:
 Emphasizes the need f...
Roles of the Gerontological Nurse
 Generalist or Specialist
 Generalist
 Various settings: home, hospital, nursing home...
Food for thought…….
 What are your thoughts about
gerontological nursing? Feelings?
Impressions?
 What do you think woul...
Financing Health Care & Medicare
Soc. Security Act-1965
Part A→ (free to all who are
eligible)
Part B→ optional (eligible
...
What is Medi-gap insurance?
 Purchased to offset Rx drug costs between
$2250.00/yr. and $5100/yr.(coverage
gap or donut h...
Medicaid –Social Security Act-1965
 Provides financial assistance –pays for
health care for poor, blind, disabled, &
fami...
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 effective...
Legal Issues in Elder Care
 Competence and Capacity
ability to make decisions regarding
 Finances
 medical/health decis...
Power of Attorney
 Two types:
 General POA
 Durable POA
 Appointee- known as
the Attorney-in-fact
 Power to make
fina...
Guardians and Conservators
Guardianships & Conservatorships –
Elder is declared “incompetent” or to “lack
capacity” (eg. C...
Elder Abuse /Neglect
Types of Abuse:
 Physical
 Psychological/emotional
 Sexual
 Financial/material
 Medical (unwante...
Abuse & Neglect of elders
 Most abuse occurs in the home of elder
 Most abusers caregivers: spouses (58%)or
adult childr...
Risk factors /characteristics of Elder
Abuse victims
 Frail elder -dependent on caregiver
 Female > 80 + years of age
 ...
Characteristics of Abuser
 Middle aged male or adult child
 Caregiving spouse w/ history of previous
abuse/alcohol abuse...
When elder abuse is suspected
Nursing Interventions:
 Conduct assessment of elder
 Check for bruises (varying stages), w...
Characteristics:
Ageism & Elderspeak
 Beliefs/myths/
stereotypes of elders
 Prejudice through
attitudes & behaviors
 An...
Communicating with Elders
 Communication is especially important to
gerontological nurses
 Gerontological nurses need to...
Communicating with Elders
 Guide to Communication
 Ask how the patient would like to be addressed
 Do not yell or speak...
Communicating with Elders
 Active listening
 Use open-ended statement to encourage
the patient to talk
 Avoid misunders...
Communication Barriers
 Fear of one’s own aging
 Fear of showing emotion
 Feeling the need to write down every detail
...
Lewis Study Guide Case Study Question:
Chapter 5 #21 (pg 26)
 An 82 year old patient with multiple health
problems is hos...
Case Study cont’d
 The patient is too frail to complete
rehabilitation and it is D/C’d. Custodial care is
indicated. If t...
Discount! Discount! Discount!
 We are happy to announce our services at
discounted rate to during this nursing
week.
 Th...
Contact us:- 011-25464531, 9818569476
E-mail:- nursingnursing@yahoo.in
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Nursing Week

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  • Health care evolving from focus on illness/treatment in the hospital to a focus on health promotion and illness prevention and management in the community
    Nurses are ideally suited to meet these needs for providing care and education to the community
    Proportion of nurses working in non-hospital settings is growing.
  • Chapter 2 points out the increasing need for more gerontological nurses to keep pace with the growing population of older adults. It is estimated that the need for nurses to care for older adults will reach 1.1 million by 2030.
    Origins of gerontological nursing can be traced to Florence Nightingale, who laid the groundwork for a model of nursing care of older adults in her position as superintendent in an institution comparable to today’s nursing home. Gerontological nursing was eventually recognized as a specialty in its own right when the Division of Geriatric Nursing Practice was established within the ANA. This recognition gave care of the aged specialty status along with other recognized nursing specialties such as maternal/child health, medical-surgical nursing, and psychiatric nursing. Today, gerontological nursing has an established research-based body of knowledge with required core competencies.
    Standards of care for gerontological nursing, as well as a defined scope of practice and a certification program, identify specific knowledge and skills and bring credibility and evidence of professional competence to this growing specialty. A number of organizations exist that support different kinds of health care professionals and serve a variety of purposes in the field. Among the nursing organizations is the National Gerontological Nursing Association, whose purpose is multidimensional. Some of the goals of this organization are to provide a forum for gerontological nursing issues, conduct educational programs, and promote research, as well as advocate for legislation that enhances the care of older adults.
    Gerontological nurses may be generalists or have greater education and work as advanced practice gerontological nursing specialists or gerontological nurse practitioners.
    Because of the aging population, the need for gerontological nurses will continue to increase. Curriculum changes in schools of nursing incorporating gerontological content will also be needed to provide students with the core content to carry out this nursing role.
  • Medicare
    Health insurance program for almost all citizens older than 65 years of age
    Also, some ppl under age 65 with disabilities
    And people with ESRD requiring dialysis or a transplant
    Designed for acute illness care
    Reimbursement is based on daily documentation that indicates a pt is improving in function
    This nursing documentation is complex and crucial for adequate reimbursement.
    Medicare is:
    Composed of two parts:
    A, B and now DMedicare notes for next page
    Medicare A pays reasonable charges based on diagnosis, not LOS
    Skilled nursing facilities in the hospital or a LTC facility is paid if the stay results in an improved or rehabilitated condition.
    Number of days paid is limited. Cvg changes each year.
    Also covered under part A
    Home care if rehab or skilled nsg is required
    Hospice care
    Part B covers outpatient treatment and physician’s services
    Is voluntary and has a monthly premium and an annual deductible before payment begins
    PART D = drug reimbursement
    Medicare DOES NOT cover long-term nursing home care, custodial ADLs, dental care or dentures, preventive health care, routine foot care, hearing aids or eyeglasses.
    Non-covered costs plus the Medicare deductible account for the fact that most older adults pay for 50% of all acquired health care costs yearly.
  • Chapter 3—Ebersole
    Nonverbal communication includes body language such as position, eye contact, touch, tone of voice, and facial expression
  • Ask how the patient would like to be addressed
    avoid demeaning terms like sweetie, honey or dearie
    Do not yell or speak too loudly
    not all older ppl are HOH.
    if they are wearing a hearing aid, yelling can be disturbing
    Try to be at eye level with the patient
    Sit down if the pt is sitting or lying
    Try to minimize background noise as it can make it difficult for the pt to hear
    Monitor the patient’s reaction
    A puzzled look may mean that the pt cannot hear but is ashamed to interrupt
    Touch the patient if appropriate and acceptable
    many older pts report that they are hardly touched by their caregivers and they appreciate the human contact.
  • An important part of communication involves active listening.
    many healthcare providers try to anticipate what may be said and interrupt silent pauses.
    A careful listener will be rewarded with additional information
    Open ended statements will encourage the patient to talk
    Practice saying “tell me more about that……” or
    “how does this affect you?”
    Avoid misunderstandings
    by saying “I'm not sure what you mean”
    Nurses should not be afraid to acknowledge their feelings.
    nurses may feel sad when a pt is suffering and may even feel like crying.
    Older pts will not expect you to have all the answers or know exactly what to do in all circumstances
    many times just a caring response and careful listening will be of comfort to a patient.
    Encourage reminiscing.
    it gives comfort and reassurance to pts when they can talk about a time in their lives with circumstances were better
    it also allows the nurse to see the pt as an entire person with a life history and survival skills.
    if a patient cries, the nurse should offer a tissue, hold the pats hand if appropriate and wait a few minutes
  • Communication Barriers that can disrupt the communication process
  • Part A
    Daily documentation of improvement in function
    Only for a limited number of days and only if the patient improves in function
  • None
    Adult day care programs
  • Nursing Week

    1. 1. Foundations of Gerontological & Community Based Nursing Week I Fiona Chatfield, RN, MSN, MBA, CCRN Adrianne Maltese, R.N., MN, GCNS-BC Los Angeles Valley College E-mail: maltesam@lavc.edu
    2. 2. 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.
    3. 3. 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.
    4. 4. 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
    5. 5. 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
    6. 6. Your Personal Experiences  Parents & Grandparents  Extended Family Members  Neighbors  Community/Church/Religious Groups  Friends  Fellow Employees  Caregiver
    7. 7. 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.
    8. 8. 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
    9. 9. 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?
    10. 10. Financing Health Care & Medicare Soc. Security Act-1965 Part 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)
    11. 11. 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.
    12. 12. 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.
    13. 13. Community Health approach  Primary Health Care  Secondary Health Care  Tertiary Health Care
    14. 14. 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
    15. 15. Legal Issues in Elder Care  Competence and Capacity ability to make decisions regarding  Finances  medical/health decisions  Understands consequences of actions/choices  Informed consent
    16. 16. 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)
    17. 17. 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
    18. 18. 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
    19. 19. 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
    20. 20. 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
    21. 21. 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
    22. 22. 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)
    23. 23. 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
    24. 24. 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.
    25. 25. 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
    26. 26. 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?
    27. 27. 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
    28. 28. 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?
    29. 29. 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?
    30. 30. Discount! Discount! Discount!  We are happy to announce our services at discounted rate to during this nursing week.  The offer valid till 21st may 2014.
    31. 31. Contact us:- 011-25464531, 9818569476 E-mail:- nursingnursing@yahoo.in

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