chpt2nur225
TRANSCRIPT
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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