Tiêu đề NCM 114 PRELIMS ✅

NCM 112 BY TONS and MADS c MODULE 1 Concepts, Theories, and Principles in the Care of the Older Adult CHAPTER 1 ESSENTIALS Gerontology ● broad term used to define the study of aging and/or the aged. ● Includes biopsychosocial aspects of aging. ● Have several subfields: ○ Geriatrics ■ generic term relating to the aged, but specifically refers to medical care of the aged. ○ Social gerontology ■ concerned mainly with social aspects of aging versus the biological or psychological. ■ Social gerontologists not only draw on research from all social sciences —sociology,—sociologwy, psychology, economics, and political science—they also seek to understand how biological processes of aging influence the social aspects of aging” ○ Geropsychology ■ Branch of psychology concerned with helping older persons and their families maintain wellbeing, overcome problems, and achieve maximum potential during later life ○ Geropharmacology ■ study of pharmacology as it relates to older adults. ■ credential for a pharmacist certified in geropharmacology is CGP (certified geriatric pharmacist). ○ Financial gerontology ■ emerging subfield that combines knowledge of financial planning and services with a special expertise in the needs of older adults ■ the intellectual intersection of two fields, gerontology and finance, each of which has practitioner and academic components ○ Gerontological nursing ■ Falls within the discipline of nursing and scope of nursing practice. ■ Nurses advocating for the health of older persons at all levels of prevention. ■ Gerontological nurses work with healthy elderly persons in their communities, acutely ill elders requiring hospitalization and treatment, and chronically ill or disabled elders in long-term care facilities, skilled care, home care, and hospice. ■ The scope of practice: all older adults from the time of “old age” until death. ○ Gerontological rehabilitation nursing ■ combines expertise in gerontological nursing with rehabilitation concepts and practice ■ often care for older adults with chronic illnesses and long-term functional limitations such as stroke, head injury, multiple sclerosis, Parkinson’s disease, spinal cord injury, arthritis, joint replacements, and amputations. ■ Purpose: assist older adults to regain and maintain highest level of function and independence possible while preventing complications and enhancing quality of life ROLES OF THE GERONTOLOGICAL NURSE 1. Provider of Care (Caregiver) a. gives direct, hands-on care to older adults in a variety of settings. b. educated about disease processes and syndromes commonly seen in older population 2. Teacher a. Focus teaching on modifiable risk factors and health promotion: lifestyle modifications, healthy diet, smoking cessation, appropriate weight maintenance, increased physical activity, and stress management. b. Educate the older adult population about ways to decrease the risk of certain disorders: heart disease, cancer, and stroke modifications (healthy diet, smoking cessation, appropriate weight maintenance, increased physical activity, and stress management); these are the leading causes of death for this group. 3. Manager a. Balance the concerns of the patient, family, nursing, and the rest of interdisciplinary team. b. Must be skilled in leadership, time management, building relationships, communication, and managing change. c. Supervise other nursing personnel: licensed practical nurses (LPNs), certified nursing assistants (CNAs), technicians, nursing students, and other unlicensed assistive personnel (UAP). 4. Advocate a. Acts on behalf of older adults to promote their best interests and strengthen their autonomy and decision making. b. May take many forms: active involvement at the political level or helping to explain c. medical or nursing procedures to family members on a unit level; helping family members choose the best nursing home d. Does not mean making decisions for older adults, but empowering them to remain independent and retain dignity 5. Research Consumer a. Remain abreast of current research literature, reading and putting into practice the results of reliable and valid studies. b. Using evidence-based practice: improve the quality of patient care in all settings. c. Read professional journals specific to specialty and continue education by attending seminars & workshops, participating in professional organizations, pursuing additional formal education degrees, and obtaining certification. 6. Expanded roles: counselor, case manager, coordinator of services, collaborator and geriatric care manager 1
NCM 112 BY TONS and MADS c Settings for Care 1. Acute Care Hospital a. often the point of entry into the health care system for older adults. b. About half of all patients in this setting are 65 years of age or older. c. Gerontological nurses focus on nursing care of acute problems: exacerbations of cardiopulmonary conditions, cancer treatment, and orthopedic problems. d. Goal of inpatient care: promote recovery and prevent complications. 2. Acute Rehabilitation a. Found in various degrees in several settings: acute care hospital subacute care transitional care, and long-term care facilities (LTCFs). b. Accomplished through the work of an interdisciplinary team: nurses, therapists, physicians and other professional staff. c. Goals: maximize independence, promote maximal function, prevent complications, and promote quality of life d. Level of intensity of acute rehabilitation is greater than for subacute or long-term care. e. For older adults to qualify: able to tolerate at least 3 hours of therapy per day. f. Inpatient: beneficial to stroke, head trauma, neurological diseases, amputation, orthopedic surgery, and spinal cord injury. 3. Home Health Care a. Independent-living older adults requiring a longer period of observation or care b. Designed for homebound due to severity of illness or immobility. c. Visiting nurse associations (VNAs) provide home health care. d. For reimbursement, home health care services must be ordered by a physician e. People’s desire to be cared for in familiar surroundings by their families than institution f. Physical, occupational, and speech therapies, home health aide services g. The majority of home health care patients are elderly with a variety of nursing needs, such as wound care, intravenous therapy, management of newly diagnosed diabetes, and tube feedings. 4. Long-Term Care Facility (LTFCs) or Nursing home's s a. Provide support to persons of any age who have lost some or all of their capacity for self-care due to illness, disability, or dementia. b. Though not acutely ill, they require 24-hour nursing care. c. Provide care planning & oversight of numerous residents, directing coordinating care via licensed practical & certified nursing assistants or unlicensed assistive personnel (UAP). d. Challenged to maintain functional and nutritional status of residents, while preventing complications of impaired mobility such as pressure ulcers and falls. e. Dementia care f. Skilled Nursing Facilities (SNFs) or subacute or transitional care i. For those patients requiring more intensive nursing care than provided in long-term care ii. Usually found as specially designated units within long-term care facilities or occasionally within hospitals iii. Patients are often transferred from hospital to continue their recovery from an acute episode and often require continued therapy (physical, occupational, and/or speech). iv. Frequent patient assessments for a limited time period for stabilization or completion of a treatment regimen. v. Typically those needing assistance as a result of non-healing wounds, chronic ventilator dependence, renal problems, intravenous therapy, and coma management and those with complex medical and/or rehabilitative needs, including pediatrics, orthopedics, and neurological. These units are designed to promote optimum outcomes in the least expensive cost setting vi. Should have knowledge of transfer techniques, prevention and assessment of swallowing problems, bowel and bladder management, and nutrition, preventing the hazards of immobility such as pressure ulcers and contractures. g. Alzheimer’s Care i. care of persons with Alzheimer’s disease and other dementing illnesses. ii. High rate of Alzheimer’s with advanced age iii. Due to impaired judgment that may pose safety issues, during middle and late stage dementia the older adult cannot be left alone. As memory loss progresses, home caregivers often feel overwhelmed and unable to provide the required care. iv. Goal: preserve the functional status of the demented person via supportive care that fosters self-worth and socialization even within the context of diminishing cognitive capacity. 5. Hospice a. caring for dying persons and their families. b. Many patients are not elderly but the majority of the dying are older. c. Concept is centered on holistic, interdisciplinary care that helps the dying person “live until they die.” d. Specialize in thanatology and palliative care work together to provide quality care e. Pain management and comfort care are the standards upon which treatment is based. f. Nurses and physicians work closely with social workers, chaplains, psychologists, and other hospice 2
NCM 112 BY TONS and MADS c professionals to make death as comfortable and easy transition g. Requires a great deal of patience, expertise, understanding, interdisciplinary communication, and compassion 6. Respite Care a. Caregiving for a dependent older adult b. Can demanding and caregivers often need a break to relieve stress and prevent burnout. c. Provides time off for family members d. Can be provided in an adult daycare center, home, assisted living or long-term care facility. e. Basic objective: provide caregivers with temporary, intermittent, substitute care, allowing for relief from daily responsibilities of caregiving. f. Not covered by Medicaid or Medicare, but may be covered by long-term care insurance policies or by local social service agencies 7. Continuing Care Retirement Community (CCRC) or life care community a. Provides continuum of care from independent living to skilled care (provided by traditional nursing homes) b. Levels of care adjusted to individual needs. c. Older adults can move seamlessly among independent living, assisted living, skilled care, or long-term care as their conditions warrant. d. Some include independent and assisted living, but provide home health services within the facility instead of moving the resident to a skilled unit. e. Gerontological nurses help older adults maintain independence for as long as possible. 8. Assisted Living Facilities (ALFs) a. As persons age, common disorders associated with the aging process may interfere with their ability to care for themselves. b. Provide alternatives for those older adults who do not feel safe living alone, who wish to live in a community setting, or need some additional help with activities of daily living (ADLs). c. May be connected with a long-term facility or care network, or may be free-standing. i. Drawback of free-standing facility: older adults whose condition worsens and who need greater assistance may need to pay extra for that assistance, d. Typically has: private room or apartment (with a variety of designs available for different costs). All rooms will have some type of kitchen or kitchenette and private bathroom with shower. The rest of the space includes a bed or bedroom, living area, and closet space. e. Provide healthy meals, planned activities, places to walk and exercise, and pleasant surroundings where adults can socialize with others in a safe and protected environment, Walking paths, aviaries, workout rooms, beauty salons, community gathering rooms, chapels, game rooms. 9. Foster Care or Group Homes a. For those older adults who can do most of their ADLs, but may have safety issues & require supervision w/ some activities such as dressing or taking medications. b. Offer more personalized supervision in smaller, more family-like environment than traditional nursing home and may be licensed to provide such services. c. May have a small number of elders and others have purchased larger dwelling for this purpose. d. Provides alternative to nursing home care for some older persons. e. No requirement that a person have a health care background nor is there a requirement that a nurse’s services be available 10. Green House Concept (The Green House Model) a. Endorsed by Centers for Medicare & Medicaid Services as conceived by geriatrician Dr. William Thomas b. Popular alternative to traditional long-term care facilities. c. First Green Houses in Tupelo, Mississippi 2003. d. Thomas has teamed and Robert Wood Johnson Foundation replace >100 nursing homes nationwide with clusters of small, cozy houses, e. Primary purpose: serve as a place where elders can receive assistance & support w/ activities of daily living & clinical care w/o that assistance becoming the focus of their existence. f. Caregivers are empowered to provide individualized care to older adults who retain control over daily activities, creating an environment that is a home. 11. Adult Daycare or Day Services/Programs a. Provide avenue for older adults unable to remain at home during the day w/o supervision. b. Often used by family members caring but who may work during the day c. Excellent alternative to institutionalization. d. Community-based group programs designed to meet needs of functionally and/or cognitively impaired adults through individual plan of care in which it provides a variety of health, social, and other related support services in a protective setting any part of a day, but <24-hour care” e. May be sponsored by different organizations f. Provide socialization, planned outings, nutritional meals, and therapeutic activities g. Only during the day: 6 a.m. to 6 p.m. (or normal business hours) with an emphasis on recreation and some health promotion. CHAPTER 2 ESSENTIALS Why the Recent Increase in the Number of Older Adults? Due to two main causes: 1. Increased life expectancy a. 2. Fertility a. 3