Gerontologic Nursing Theory Quiz

Gerontologic Nursing Theory: Person-Centered Care & Relational Practice

• This week's focus is on key gerontological nursing theory, specifically person-centered care and relational practice
• Weekly Objectives:
  • Explore the application of person-centered care and autonomy for older adults
  • Facilitate self-awareness for older adults
  • Facilitate therapeutic communication within person-centered care
  • Apply assessment approaches to relational practice (Genograms and Ecomaps)
  • Promote the health and well-being of older adults using a relational practice lens

Person-Centered Nursing Framework

• The framework encompasses prerequisites, processes, and the care environment
• Prerequisites include knowing oneself, clarity of beliefs and values, and professional competence
• Care processes involve working with patient beliefs and values, providing holistic care, engagement, person-centered outcomes, and sympathetic presence and shared decision-making
• The care environment encompasses the totality of factors influencing care

Person-Centered Care

• Supports independence
• Improves quality of life
• Promotes positive well-being
• Honors choice
• Enhances dignity
• Empowers residents

Autonomy

• Older adults' rights to autonomy, independence, care, and palliative care are essential
• Older adults should be given the freedom to decide for themselves

Case Study

• Mrs. Adams, an 87-year-old widow, is admitted to a long-term care facility following hospitalization for hypertension.
• Key factors were reviewed about Mrs. Adams' needs: medication adherence, medical history, eating habits, daily routines, and preferred activities
• The nurse assessed Mrs. Adams' needs and preferences to tailor care
• The schedule was provided to match her routine

Communication with Older Adults

• Every time a nurse interacts with someone, words and actions affect their relationship in positive or negative ways.
• Attitudes and skills of nurses influence outcomes.
• Barriers to communication, such as nurse-related barriers, hearing impairment, vision impairment, neurological disorder, cognitive impairment, language, literacy and understanding, speech impairment, and environmental factors, should be considered
• Facilitators of communication include authentic and active listening, appropriate assistive devices, verbal and non-verbal communication skills, utilization of alternative communication strategies like speech aids, and simple instructions

Barriers and Facilitators for Communication

• Barriers: Nurse-related barriers, hearing impairment, vision impairment, neurological disorders, cognitive impairment, language, literacy, speech impairment, environmental issues
• Facilitators: Authentic and active listening, appropriate devices (assistive listening devices, hearing aids), communication skills, alternative communication methods, simple instructions, reminiscence, technology

Nurse Related Barriers to Communication

• Nurses may not understand how cognitive or physical status might be impacting the ability of the patient to communicate. Therefore better training is needed for nurses to communicate with older adults in a person-centered way, taking into account the older adult's circumstances.

Ageism and Elderspeak

• Ageism and elderspeak, a form of ageism where younger people alter their speech based on the assumption that older adults have difficulty understanding, are detrimental to meaningful communication,
• Older adults deserve to be respected and have their needs and perspectives considered

Communication with Older Adults with Hearing Impairments

• Hearing impairment is prevalent in older Canadians, impacting communication and interaction
• About 65% of adults aged 70-79 experience hearing loss
• Hearing loss can diminish quality of life
• Assessing and treating hearing loss in long-term care is crucial (not always done)

Assistive and Adaptive Devices

• Assistive hearing aids and cochlear implants are important technologies

Vision Impairment

• Major causes include cataracts, macular degeneration, glaucoma, and diabetic retinopathy

Communication with Older Adults Who Have Neurological Disorders

• Neurological disturbances can cause various communication impairments (Reception, Perception, Articulation)
• Specific difficulties include anomia (word retrieval), aphasia (communication disorder), and dysarthria (speech articulation impairment)
• Different types of aphasia (e.g., Wernicke's, Broca's) are important to understand

Communicating with Individuals Experiencing Aphasia and Dysarthria

• Accurate observation and recording of speech patterns are necessary
• Implementation of speech-language pathologist recommendations is vital in communication strategies
• Nurses need familiarity with appropriate technologies and communication strategies

Communication with Individuals Experiencing Cognitive Impairment

• Dementia affects memory, speech, and communication
• Simplification, facilitation, comprehension, and support strategies are crucial
• Care and communication (with respect and value) are key to effective interaction

The Life Story and Reminiscence Therapy

• The life story is an important aspect of communication, providing insight into the person's history
• Reminiscence involves recalling the past, cultivating security and personal development, and is a very accessible means of this.
• Reminiscence therapy improves continuity, extracts meaning, promotes identity, growth, integration of past experiences and assists in the acceptance of setbacks/regrets

Group Structure and Special Considerations for Groups of Older Adults

• The main goal of group work is education, establishing structure and restoring order for each person in the group
• Successful groups depend on organization, attention to detail, agency support, assessment, consideration of needs and skills, and leadership

Interpersonal and Intrapersonal Analysis for Patients

• Intrapersonal analysis focuses on self-awareness
• Interpersonal analysis involves understanding patient relationships and support systems
• Contextual analysis examines the broader factors impacting the patient, including broader societal contexts.

Case Study 1 (79 year-old male)

• A male patient, following a stroke, required communication strategies of simplified language, picture boards, and adequate lighting to facilitate understanding
• The gerontological nurse should utilize word boards and picture charts

Socio-environmental Understanding

• All people possess inherent strengths and a capacity for self-determination in their own needs
• People are positively diverse with a variety of factors relevant to their personal journeys, experiences and needs being taken correctly into account
• The importance of considering context, history, and societal influences in communication with older adults

Relational Nursing Practice

• Relational inquiry is defined as the interplay of human life, the world and nursing practice.
• Critiques existing norms to lead to knowledge development and challenges the existing status quo

Paper Due, March 6

• The paper is worth 30% of the grade (This is important to know, as it states the value of the assignment)
• The assignment is about the application of relational inquiry to care for older adults in long-term care settings

Moral Stance of "Unknowing" and Interprofessional Collaboration

• The importance of acknowledging the limitations of knowledge and questioning assumptions about older adults (and therefore their care) is a value needing consideration by nurses
• Interprofessional collaboration within geriatric assessments is necessary and expected in this module