9. The sixth vital sign
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
âĒ Functional status: The sixth vital sign
âĒ Optimizing functional status is a central tenet
of geriatric practice (editorials in JGIM)
10. āđāļāđ āļēāļŦāļĄāļēāļĒāļāļĩāđāļŠāļēāļāļąāļāđāļāļāļēāļĢāļāļđāđāļĨāļāļđāļŠāļđāļāļāļēāļĒāļļāđāļāđāļĢāļāļāļĒāļēāļāļēāļĨ
āđ
âĒ
âĒ Preserve functional
capacity of older
patients
âĒ Increase safety: falls;
pressure ulcer, acute
confusion state
âĒ Help increase comfort
âĒ
âĒ
âĒ
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
40.4% of patients developed
functional decline following
hospitalization ( Wu et al. 2006)
Before admissionâ advanced age,
Lower MMSE, IADL disabilities
Presence of pressure ulcer, ADL
disabilities, low social activities
(HARP study)
Hospitalization, Hypoalbuminaemia,
pressure ulcer, LOS, tendency to fall
(WU etal., 2006)
Bed rest, or acute inactivity
associated with hospitalization or
disease state, posed a potent threat
to muscle tissue and function
capacity (Covinsky et al., 2003:Brown
et al.2004; Janssen, 2006)
11. Nurses Improving Care for Health system Elders
(NICHE)
âĒ
Focus on the care needs
of the older patients
âĒ The NICHE nursing care
models
â Geriatric Resources
Nurse (GRN model)
âĒ
âĒ
âĒ
âĒ
âĒ
âĒ
âĒ
âĒ
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
Provide excellent bedside nursing to
hospitalized older adults
Develop a corps of nurses armed with the
clinical competencies to meet the needs
of older adult, and serve as a resources to
other staff
Develop incentives and improve moral for
nurses caring for the older adult
Provide a mechanism for professional
growth of nurses
Enhance the nurse/patient relationship
and patient satisfaction
Promote the effectiveness of the
interdisciplinary team
Increase implementation of evidencebased clinical practice
Facilitate safe and effective discharges
Promote continuity of care between the
hospital and other setting
12. Chula GRN model:
improving the care of older
patients in medicine unit
Lecture
- Small
talk
From the beginning
âĒAdvanced Practice
geriatric Nurse
âĒGRNs unit-based RNâs
volunteer with a
knowledge requirement
âĒNursing clinical round
âĒInternal medicine
physician provide
consultation
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
Evaluation
Having the staff
nurses routinely
monitor and
address common
geriatric
syndromes and
share their
knowledge with
other staff
Regularly
scheduled
-2 times
for wks
Clinical teaching
rounds with a
geriatric expert to
address specific
patient issues and
integrate new
geriatric
knowledge
13. During round
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
Chula SPICCES
Patient Name:
Date:
GRN present a brief synopsis of
âĒ The patientâs history
âĒ Course of hospitalization
âĒ Treatment and expected
outcome
âĒ Unresolved issues
âĒ Comprehensive
assessment of hospitalized
older patients
SPICCES EVIDENCE
YES
No
Sleep disorder
Problems with Eating or
Feeding
Incontinence
Caregivers preparedness
Evidence of falls
Skin breakdown
REMARK.............................................................
...........................................................................
...........................................................................
Adapted from a frameworks of six 'maker
conditions of Fulmer, T. (1991) The Geriatric
Nurse Specialist Role: A new Model. Nursing
Management, 22(3), 91-93
14. Best practices in Nursing Care to older adults
(The Hartford Institute for Geriatric Nursing)
âĒ
âĒ
âĒ
âĒ
âĒ
âĒ
âĒ
âĒ
Fall prevention program
Cognitive stimulation
Exercise
Delirium prevention
Nutrition
Caregiver preparedness
Pressure ulcers prevention
Incontinence management
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
15. âĒ Behavioral Methods for Urinary Incontinence
Bladder training, habit training, biofeedback, pelvic muscle
exercises, timed voiding and prompted voiding.
āļāđ āļēāļĒāļāļēāļĢāļāļĒāļēāļāļēāļĨ āđāļĢāļāļāļĒāļēāļāļēāļĨāļāļļāļŽāļēāļĨāļāļāļĢāļāđ
āļŠāļ āļēāļāļēāļāļēāļāđāļāļĒ
âĒ Guidelines and position stands outlining nutritional
standards of care for hospital patients; a high quality
protein with each meal and essential amino acid (EAA)
âĒDelirium prevention
Chula SPICCES
âĒCaregiver preparation
âĒ Resistance exercise and Walking program with
coordination with PT& OT
âĒMinimizing the use of sedative-hypnotic
âĒMedication drug reconcile
âĒUse environmental enhancement for eldercare
âĒMultidisciplinary team small talk
âĒFall prevention protocol
âĒEnsure assistive devices
âĒSkin care
âĒCognitive stimulation
Sleep disorder assessment
Problems with Eating or Feeding
assessment
Incontinence assessment
Caregivers preparedness
assessment
Evidence of falls assessment
Skin breakdown assessment
