NURS 1002 Week 2 Gerontologic Nursing Theory PDF

NURS 1002: Week 2 Key Gerontologic Nursing Theory: Person Centered Care & Rela:onal Prac:ce Weekly Objectives 1.Explore the applica0on of person-centered care and autonomy. 2.Facilita0ng self-awareness for older adults 3.Facilita0ng Therapeu0c Communica0on within person-centered care 4.A...

NURS 1002: Week 2 Key Gerontologic Nursing Theory: Person Centered Care & Rela:onal Prac:ce Weekly Objectives 1.Explore the applica0on of person-centered care and autonomy. 2.Facilita0ng self-awareness for older adults 3.Facilita0ng Therapeu0c Communica0on within person-centered care 4.Apply assessment approaches to rela0onal prac0ce (Genogram and Ecomaps will be introduced) 5.Using a Rela0onal Prac0ce lens promote health and well-being of older adults Pa0ent  Person- Centered Nursing Framewor k Person- Centere d Care Autonomy Case Study Mrs. Adams is an 87-year-old widowed female. She is being admiNed to a rural long-term care (LTC) facility following hospitaliza0on for uncontrolled hypertension. Prior to hospitaliza0on, she had been living alone and it was determined she had not been taking her medica0ons for hypertension, osteoporosis, depression, and coronary artery disease. The nurse comple0ng her admission interview concludes by asking Mrs. Adams what 0me she usually eats, sta0ng the facility serves food cafeteria style between 0600 and 0800 hours for breakfast, 1100 and 1300 for lunch, and 1700 and 1900 hours for dinner. Residents are assisted to bed by 2200 hours. Her bath days would be Tuesday, Thursday, and Saturday mornings. The nurse gives Mrs. Adams an ac0vity schedule with the daily oXerings and states that if she did not like any of them, they would try to Ynd something else she enjoyed. “Every0me a nurse communicates with someone, their words and ac0ons aXect the rela0onship in posi0ve or nega0ve ways, depending on the nurse’s a]tudes and skills” (Wanko Keutchafo et al., 2020) What are some of the barriers and facilitators for communication with Older Adults? Barriers to Communica:on Facilitators of Communica:on Nurse-related barriers Authen0c and ac0ve listening Assess Hearing and use appropriate Hearing Impairment devices Vision Impairment Use Appropriate verbal and non-verbal communica0on skills Neurological Disorder U0lize alterna0ve or augmenta0ve Cogni0ve Impairment speech aid systems Language Use simple instruc0ons Use of reminiscence Literacy and Understanding Use of technology at the level that the Speech Impairment person is comfortable Environmental Limi0ng noise, poor ligh0ng and interrup0ons  Communica0on is the single most important capacity of human beings. Nurse Meaningful communica0on and ac0ve involvement in society contribute to healthy aging, and improve the older Related person’s chances of living longer, responding beNer to interven0ons, and maintaining op0mal func0oning. Barriers to Ageism: a term used to describe prejudice expressed Communicati toward older adults through a]tudes and behaviour, it is found cross culturally, but prevalent in the Western world. on Elderspeak: a form of ageism in which younger people alter their speech based on the assump0on that all older adults have difculty understanding and comprehending.  Communicating with Older Adults with Hearing Impairments Hearing Impairment: can interfere with communica0ons with others and interac0onal input Hearing loss is a prevalent, persistent condi0on in older Canadians and is the most common sensory impairment in Canadians over 60 years of age about 65% of adults aged 70 to 79 experiencing hearing loss Can diminish quality of life Hearing loss is oien overlooked in primary care se]ngs hearing loss. Lack of assessment and treatment of hearing loss in long-term care are even more of a concern since the majority of residents have a hearing impairment. 3-14 Assistive Listening and Adaptive Devices Hearing Aids: Cochlear Implants: Other devices/adapta0ons: A. Hearing loss 1. Diminished quality of life, social isola0on, suspicion/paranoia ____ Case study: B. Consequences of hearing loss 2. A se]ng within which concern regarding hearing loss is more signiYcant, as the majority of clients experience hearing Matching impairment ____ C. Hearing screening 3. Usually involves external and middle-ear Mrs. Nicholas is a par0cipant in day programming abnormali0es that reduce transmission of at her local community centre. The nurse aNends a sound to the middle ear ____ once-weekly session where the focus is on health teaching with a small group of older persons. The D. Long-term Care (LTC) 4. A prevalent, persistent condi0on, and the nurse has observed through previous weeks that most common sensory impairment in Mrs. Nicholas has begun si]ng in the front row but Canadians over 60 years of age. ____ has become progressively less engaged in the discussions during the sessions. The nurse has also E. Conduc:ve hearing 5. Hearing loss resul0ng from damage to any recently no0ced some disagreements Mrs. Nicholas loss part of the inner ear, or neural pathways to and her peer group. the brain ____ Match the following deEni:ons regarding hearing impairment to the appropriate term: F. Sensorineural hearing 6. Recommended as part of rou0ne primary loss care for older adults, yet rarely done ____ Vision Impairment Major causes of vision impairment and blindness among older adults: Cataracts Macular degenera0on Glaucoma Diabe0c re0nopathy 3-17  Communication with Older Adults Who Have Neurological Disorders Three major categories of impaired verbal communica0on arise from neurological disturbances: 1. Recep0on 2. Percep0on 3. Ar0cula0on SpeciYc difcul0es can include: Anomia: word retrieval difcul0es during spontaneous speech and naming tasks Aphasia: communica0on disorder that can aXect a person’s ability to use and understand spoken or wriNen words Dysarthria: impairment in the ability to ar0culate words as the result of damage to the central or peripheral nervous system that aXects the speech mechanism The Canadian Stroke Best Prac0ces (2018) categorizes two broad types of aphasia: expressive and recep0ve. Within these types, there are many subtypes: Wernicke’s Broca’s Anomic Global Verbal (apraxia) Alterna0ve and Augmenta0ve Speech Aids Alphabet or picture board, electronic boards, computers These may be voice ac0vated or speciYcally designed to be turned on with one Ynger 3-18  3-19 Accurately observing and recording the speech and word recogni0on paNerns of the pa0ent Communicati ng with Consistently implemen0ng the recommenda0ons of Individuals the speech-language pathologist Experiencing The nurse needs to be familiar with techniques that facilitate communica0on, as well as strategies that can Aphasia and be taught to the person to improve communica0on. Dysarthia It is important for the nurse to be aware of available equipment and resources.  SimpliYca0on strategies Demen0a: aXects memory, Communicati speech, and communica0on ng with Facilita0on strategies Individuals Communica0ng (see Box Experiencing 3.10): Cognitive Care and communica0on that demonstrate respect Comprehension strategies Impairment and value for each person will enhance communica0on and personhood. Suppor0ve strategies 3-20 Question A 79-year-old man is admiNed to a long-term care home aier a stroke that has lei him paralyzed on one side and unable to talk. A daughter who is visi0ng from out of town approaches the gerontological nurse and expresses concern about how to communicate with her father. 1. The gerontological nurse explains to the daughter that when communica:ng with her father, she should: A. Use word boards and picture charts. B. Face her father; speak loudly and clearly. C. Explain procedures in detail. D. Face her father with adequate light on her face. The Life Story An important component of communica0on Tells us a great deal about the person Constructed through reminiscing, life review, or autobiography Reminiscing: any recall about the past Cul0vates a sense of security Important to personal development Very accessible 3-22 Reminiscence as a Developmental and Therapeutic Strategy Maintain con0nuity Evolve iden0ty Extract meaning Provide insight and growth DeYne and develop personal Integrate and accept regrets philosophy and disappointments Iden0fy cycles and themes Recapitulate learning and growth Perceive universality Enhance self-worth and feeling of accomplishment 3-23 Group The major goal of group work is educa0on Structure and the restoring of order (or control) in and Special each person’s lifestyle. Successful group work depends on Consideratio organiza0on, aNen0on to detail, agency ns for support, assessment and considera0on of Groups of the older adult’s needs and status, and Older Adults caring, sensi0ve and skillful leadership. 3-25 Reminiscence Group Intervention in Dementia Care TAKE 5: BREAK Relational inquiry as Nursing Practice Rela0onal inquiry challenges liberalism OXers lenses and prac0ce processes that are rela0onal Draw aNen0on to sociohistorical contextual factors and inequi0es that inouence lived experience Lead to the development of poli0cal knowledge Support cri0que and challenge of the status quo Rela:onal inquiry is deYned as “the complex interplay of human life, the world, and nursing prac0ce” (Doane & Varcoe, 2015, p. 3) Being situated – where am I in rela0on to the box or outside the box? My view/experience depends on where I stand. Being situated – I may not be aware of the view/experience of others from where I stand.  Purpose: To give learners the opportunity to apply the core processes of nurse-client rela0onship, Paper Due rela0onal inquiry, and person-centered rela0onal prac0ce with older adults as they explore the Mar 6 at resident’s rela0onal world and its inouence on their experience of 2100 worth 30% From the standpoint of a developing nurse, the purpose of this assignment is to develop insight into yourself and consider the resident for whom you have been paired in their context of living in long term care. How did intrapersonal, interpersonal, and contextual elements impact the person’s experiences shaping what is important to them?  Moral stance of “unknowing” Necessity of ques0oning what we ‘know’ 1. How was this knowledge created? 2. How does this knowledge aXect people? 3. How are diXerent people aXected diXerently? 4. Consider impact of economic, gender, racial diversity 5. How does the knowledge advantage some and disadvantage others? As a moral stance, it is wrong not to ask these ques:ons Not asking reinforces inequi:es & contributes to marginaliza:on Intrapersonal Analysis using Relational Practice approach Paying aNen0on to yourself through being, doing, feeling and thinking in the moment Expanding and deepening your understanding your pa0ent shaped by individual knowing It is being aware of how your inner dialogue and percep0on is reoected in your analysis of person-centered care for your pa0ent Relational Practice Provides a beNer understanding of What may be a pa0ent’s daily going on beneath life and how Analysis using the surface health and Interpersonal wellness is approach aXec0ng that It could include a It includes speciYc health rela0onships, issue, Ynancial what is helping or security, mental hindering, health, or self support system esteem analysis Relational Practice What is going on around people and Analysis using the situa0on Contextual It is the structures and forces that approach impact the person Can include COVID, Sociopoli0cal element, economic, cultural, historical and/or geographical  Socio-environmental understanding All people have strengths and are capable of determining their own needs, Ynding their own answers, and developing their own solu0ons if they have access to the resources to do so. Every person and family lives within a social-historical context that helps shape their iden0ty and social rela0onships. This context can lead to the restric0on of choices, limited resources, and a state of perceived powerlessness. Diversity (race, gender, age, sexual orienta0on) is posi0vely valued People with fewer privileges have as much capacity as those with more privileges to assess their own needs (people have expert knowledge about their own lives). Living and Living Hermeneu:c Phenomenological Lens Valuing lived and living experiences Experiences of People can only be understood from within their own Older Adults context Canadian Gerontological Nursing Association Standards of Practice and Competencies Standard I: Rela:onal care Gerontological Nurses address: 1. Rela0onships of older persons and their care partners to op0mize health and well- being 2. Preferences of older persons and their care partners to reoect unique experiences, cultural contexts, and social determinants of health 3. All aspects of care as part of an inter- professional collabora0ve team. Genogram Sketch of family structure, rela0onships, and boundaries Usually constructed as 3 genera0onal to examine paNerns and rela0onships of family events Used to uncover roots of signiYcant family challenges related to intergenera0onal health and social problems  Ecomap Representa0on of family’s connec0ons in rela0on to the larger community Assesses family strengths, resources, support system Assesses strains and conoicts in rela0onships Assesses for deYcits in resources and support system  NEXT WEEK: Interprofessional Collabora:on for a Comprehensive Geriatric Assessment