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GerontologicalNursing
Issues
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 1
Discuss the nurses role in caring for older
adults.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Geriatrics
Originated in 1925
Medical specialty focusing on the
diagnosis and treatment of diseases in
older adults

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

American Nurses Association


Responsible for defining scope and
standards of nursing practice
Established the Division of Geriatric
Nursing Practice in 1966
Goal to create standards for quality nursing
care for the aged

Changed name to Division of


Gerontological Nursing Practice in 1976
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Standards of Gerontological
Nursing
Set by the ANA
Establish standards and criteria for
gerontological nursing

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Responsibilities of the
Gerontological Nurse
Direct care
Management and development of nursing
personnel
Evaluation of care and services for the
older adult

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

The Nurses Role in Caring for


Older Adults
Generalists
Direct care providers
Case managers
Nurse leaders
Educators
Patient advocates
Administrators

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

The Nurses Role in Caring for


Older Adults
Advanced practice gerontological nurses
Primary care providers focus on
Health promotion
Disease prevention
Long-term management of chronic conditions

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 2
Identify appropriate educational preparation
and certification requirements of the
gerontological nurse generalist and
specialist.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Gerontological Certification
Available from the ANA in 1973
Establishes competency in the area of
practice
Consists of a written examination
Criteria
Registered Nurse in the United States or one of
its territories
Practiced a minimum of 2,000 hours within the
last 3 years
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Basic Level Certification


Associate, Diploma, or Baccalaureate
degree in nursing
Credentials appear as RNC (certified)

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Advanced Level Certification


Clinical nurse specialist and nurse
practitioners with Masters degree
Certified as gerontological specialists
Credentials appear as RN or BC (board
certified)

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 3
Identify components of the long-term-care
system.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Skilled nursing facilities
Skilled care provided by nurses
May include both subacute and chronic
Helpful for the frail, older adult needing help
with activities of daily living

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Retirement communities
Vary in size and scope
Offerings range from independent living to
nursing home care
May allow residents to move between levels of
care as condition changes mandate
Amenities vary

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Adult day care
Provides daytime supervision and activities
May offer transportation
Typically fees are paid privately
Meal services normally included
Planned activities are included
Additional health service availability varies

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Residential care facilities
Previously called rest homes
Offer supervision and health monitoring

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Transitional care units
Established by acute care hospitals
Provide subacute care, rehabilitation, and
palliative healthcare services
Most patients are recuperating from surgery,
major illness, or injuries
Support services of the acute care facility are
provided

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Rehabilitation hospitals or facilities
Specialized facilities provide subacute care to
patients with complex healthcare needs
Patients may have head injuries, be ventilator
dependent, or require rehabilitation after an
injury or surgery

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Employment Settings for


Gerontological Nurses
Community nursing care
Visiting nurse service
Provides skilled care in the home
Services may include vital signs, education,
wound care, and medication administration

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Approximately $207 billion spent on


long-term health care in 2005
Accounts for 12% of all healthcare
expenditures
70% of this figure covered by health
insurance
18% paid by patients and families

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Figure 2-1
National spending for long-term care, by payer (2005).
Source: Harriet L. Komisar and Lee Shirey Thompson. National Spending for Long-Term Care. Fact Sheet.
Washington, DC: Georgetown University Long-Term Care Financing Project, February 2007.
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 4
Discuss the ANA standards and scope of
practice for gerontological nursing.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

American Nurses Association


(ANA)
Responsible for defining scope and
standards of nursing practice
Established the Division of Geriatric
Nursing Practice in 1966
Mission to create standards for quality nursing
care for older adults in all settings
Division name changed to Division on
Gerontological Nursing Practice in 1976
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

American Nurses Association


(ANA)
Published A Statement on the Scope of
Gerontological Nursing Practice in 1970
Defines nature and scope of gerontological
nursing
Purpose

Health promotion
Healthy maintenance
Disease prevention
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

American Nurses Association


(ANA)
Self-care
Intended as a guide to current practice
Standards apply in all clinical practice settings

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

American Nurses Association


(ANA)
Standards of Clinical Gerontological
Nursing Care
I. Assessment
II. Diagnosis
III. Outcome Identification
IV. Planning
V. Implementation
VI. Evaluation
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 5
Identify the use of functional health patterns
in the formulation of a nursing diagnosis.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Functional Health Patterns


Developed by Gordon
Interact and form the basis for the older
persons lifestyle
Used to guide the nurse in obtaining
information

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Functional Health Patterns


Patterns include
Health perceptionhealth management
Nutritionalmetabolic
Elimination
Activityexercise
Sleeprest
Cognitiveperceptual
Self-perceptionself-concept
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Functional Health Patterns


Patterns include
Rolesrelationships
Sexualityreproductive
Copingstress tolerance
Valuesbeliefs

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 6
Describe the uses and need for
gerontological nursing research as support
for evidence-based practice.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Gerontological Nursing Roles in


Research
Interpret, apply, and evaluate research
findings
Identify clinical problems appropriate for
study
Gather data
Interpret findings to improve care
Research findings to provide evidencebased nursing interventions
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Gerontological Nursing Roles in


Research
Participate in research teams
Collaborate with nursing colleagues with
advanced education and research training
Serve on an institutional review board
(IRB)

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

1986 NINR Established Within NIH


Mission to support science that advances
nurses knowledge
Improve health of individuals, families,
communities, and populations
Support and conduct clinical and basic
research training on health and illness across
the life span

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

1986 NINR Established Within NIH


Mission to support science that advances
nurses knowledge
Extend nursing science by integrating the
biological and behavioral sciences
Employ new technologies to research
questions, improve methods, and develop
scientists of the future

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Focus of Nursing Research


Noninvasive, cost-effective behavioral
techniques
Alternatives or supplements to the usual
care

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Evidence-Based Practice
Best method for delivery of care
Based on clinical guidelines derived from
research
Coding system indicates the strength of the
research

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Agency for Healthcare Research


and Quality (AHRQ)
Three-level coding system
Strength of the available evidence

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Randomized, Controlled Clinical


Trials
Best for establishing causes and effects

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

LEARNING OUTCOME 7
Describe effective communication
techniques appropriate for use with the older
adult.

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Therapeutic Communication
Ongoing, continuous, dynamic process
Includes verbal and nonverbal signals

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Nonverbal Communication

80% of communication process


Body language
Positioning
Eye contact
Touch
Tone of voice
Facial expressions
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Verbal Communication Guidelines

Do not yell or speak too loudly


Communicate at eye level
Minimize background noise
Monitor patients reaction
Use touch as appropriate
Supplement verbal instruction with written
instructions
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Verbal Communication Guidelines


Avoid long, complicated instructions
Determine how patient would like to be
addressed
Use caring responses and caring listening
Encourage reminiscing

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Barriers to Communication

Fear of ones own aging


Fear of showing emotion
Fear of missing something
Fear of being called on to rectify every
problem
Lack of knowledge of patients culture,
goals, and values
Gerontological Nursing, Second Edition
Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Barriers to Communication
Unresolved issues with aging relatives in
own family
Feelings that professional distance must
be maintained
Being overworked, or overscheduled

Gerontological Nursing, Second Edition


Patricia A. Tabloski

Copyright 2010 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

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