Download - N143 Finals2
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Community Resources for Care of the
Older Adult
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Multipurpose Senior Centers community facilities that are primarily
used by relatively active and independent adults
Services:
health screeninghealth promotion and wellness programs
social, educational and recreational activities
congregate meals
information and referral services for older adults
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Adult Day Care Services: for older adults who are
physically frail, cognitively impaired, and require
assistance or supervision with ADLs.
Respite Care: provides short relief or time off for personsproviding home care to ill, disabled or frail older adult.
Homemaker Services: include such things as
housecleaning, laundry, food shopping, meal preparationand running errands.
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Nutrition Services: provide older adults with inexpensive,
nutritious meals at home or in group settings. Home
delivery programs such as Meals on Wheels and
Congregate meal sites.
Transportation Services: handled by volunteer drivers in
cars, bus, taxi or public van equipped to accommodate
wheelchairs.
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Telephone Monitoring and Friendly Visitors: provide
regular phone contact, check the safety and health of
older adults who live alone. Friendly Visitors make home
visits for the purpose of companionship, assistance with
correspondence, and needs assessment.
Personal Emergency Response Systems: are home
monitoring systems that allow older persons to obtain
immediate assistance in emergent situations such as
after a fall.
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Home Health Care
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Criteria:
Have a skilled care need
Be homebound
Unable to perform the skilled care aloneand have no one at home to provide care
Require only intermittent care
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Appropriate for those:
with chronic medical conditions
with chronic mental illness
needs continued treatment after discharge
from hospital
have terminal illness and want to die with
dignity in the comforts of their own home
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Benefits:
Less expensive than hospitalization
Faster recovery
Nosocomial infections are minimized
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End of Life Care of the Older
Adult
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End of Life
The time period preceding an
individuals natural death from a
process that is unlikely to be arrested
by medical care.
Begins six months before death
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Models of Care at End
of Life
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Hospice Care
Interdisciplinary model of care thatsurrounds and supports the patient,
the family, and significant others
through the final phase of a life
threatening illness
Criteria for Hospice:
A prognosis of 6 months or less based
on the clinical judgment of two
physicians.
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Comfort Measures Only
(CMO)
Preferred choice when the
patient,family and staff are in
agreement that the best care
for the patient is not to
prolong the dying process but
to keep the patient as
comfortable as possible.
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Palliative Care
Care of individuals with life
threatening illness that is not
limited to the 6 month window
period.
Include potentially curative
treatments as well as supportiveinterventions of Hospice Care.
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Main Approach
Management of pain and distressingsymptoms like nausea, bowel
function, sleep and nutrition
Multi disciplinary Team approach
with MD, RN, Social workers,
Nutritionist, Pharmacists, Chaplains
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Stages of the Dying Process
Denial: They must have the wrongpatient or lab result.
Anger: I cant believe this, I always took
care of others and this is my reward?
Why not someone else instead of me?
Bargaining: Ok doctor, I will give
chemotherapy another try if you can
guarantee that I will live another year.
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Stages of the Dying Process
Depression: Why should I bother taking
my medicines? Im helpless to fight
cancer. Its stronger than me.
Acceptance: Ok Im going to die so Id
better get my act together.Id like to
leave a few pieces of jewelries to mydaughter and books to my son.
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Phases of Grief
First Phase (Numb Shock): stupor,
withdrawal, nausea, insomnia
Second Phase (Emotional Turmoil) : alarm
or panic type reaction
Third Phase (Full effect of widowhood sets
in): regret, self doubt, despair, lifes purpose
is confusing
Fourth Phase (Reorganization): coping
strategies and positive outlook emerges
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Ethical Considerations
Ethics is the reflective, deliberative
process of examining our values and
beliefs and choosing a course of action
that upholds those values.
Nursing Ethics is a systematic analysis of
ethical issues emanating from nursingpractice , education and research.
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Moral PrinciplesApplicable to Care of
Older Adults
h i h Q li l h Old
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The Right to Quality Health Care: Older
adults have a right to the same standards
of health care as those in any other age
group.
Respect for the Individual Person:
Treating older adults with quality healthcare that is specifically designed to meet
their particular needs.
Autonomy or Self Determnination: Older
persons will be respected as decison
makers about their own care.
C fid i li Old d l b bl
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Confidentiality: Older adult must be able
to control his or her personal information.
Beneficence: Deciding with the patient
and the family what is most bebeficial
given the particular circumstances andfacilitating that action.
Distributive Justice: Equal satisfaction ofequal need, subject to the adequate
maintenance of useful functions.
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Common Ethical Dilemma in
Gerontological Nursing
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1. Decisional Capacity
Four Elements:Comprehension of information
presented
Understanding the options and their
possible consequence
Deliberating among the choices
consistent with own values and
beliefsCommunicating a choice
P i i l f D i M ki
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Principles of Decison Making
1. Substituted Judgment: family members
respect the patients wishes by makingdecisions in accordance with the patients
general values and past choices.
2. Best Interest:directs the surrogate to
decide what seems optimal for the
patients good when specific wishes are
unknown.
2 End of Life Issues
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2. End of Life Issues
A. Witholding or Withdrawing Treatment
Withdrawing life sustaining treatment hasbeen legally acceptable provided there is clear
and convincing evidence of the patients wishes to
avoid prolonging the dying process.
B. Assited Suicide
Oregon is the only state in which physician
assisted suicide is legal. The ANA has a position
statment recommending that nurses not
participate in assisted suicide.
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C. Euthanasia
An action taken to terminate someones lifeis currently considered legally and ethically
unacceptable.
Objections:
1. Termination of anothers life is homicide.
2. Deciding for others that their life is no longer of
value is difficult.
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3. Rationing of Services: Older adults are often not
offered the standard level of care because of
inherent bias.
4.Rights of Institutionalized Patients :Older adults
in LTC facilities experienced diminished choice,
control, dignity and privacy in institutionalized
setting.
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5. Cognitive Impairment :Persons with dementiahave a right to know their diagnosis
6. Research in Older Adults : Only research that
offers minimal risk or direct benefit should be
offered to the older adult specially those with
Cognitive Impairment.
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Specific Techniques to
Promote Ethical Decision
Making
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Values History
A form wherein the older adult identifies his values and
beliefs and then determine preferences about whether theywould want various health care procedures.
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Patient Self Determination Legislation (December 1991)
Encourage people to make and document their choices and decisions
about the type and extent of medical care they want to accept or
refuse should they become unable to make their wishes known.
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Advance Directives
Allows individuals to designate their wishes in writing so that they are
available in case they become unable to to express themselves ordveloped diminished decision making capacity.
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A. Durable Power of Attorney for Health Care
A document that is executed by competent individual s to describe their
desires regarding death delaying procedures . It also designates another
person as the individuals agent or designee to make health care
decisions for themselves (Health Care Proxy)
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B. Living Will
Oldest and most common form of advance directive
A document in which living individuals can stipulate what their wishes
are regarding life prolonging treatment or procedures if they develop
a terminal condition.
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C. Five Wishes
A unique document which provides information such as choosing a
health care agent but also asks questions to elicit the persons values
and wishes.
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C. Five Wishes
The person I want to make care deccisons for me when I cant
The kind of medical treatment I want or dont wantHow comfortable I want to be
How I want people to treat me
What I want my loved ones to know
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Ethics Committee
Mandated by JCAHO functions are generally education, policy
development, consultation or case review.
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Legal Issues
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Legal Guardianship: mechanism that allows a surrogate to exercise
individual rights for the older person who is no longer mentally
competent.
Payee Status: allows another to cash the older persons Social Security
Check.
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Elder Abuse: All states have mandatory reporting laws for suspected
abuse of the older persons in domestic and institutinal setting.
Restraint Use: Strategies for environmental modification and supervision
reduce the need for the use of restraints.
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thank you forlistening!