Midterm Geriatric Healthcare Team PDF

MIDTERM GERIATRIC HEALTHCARE TEAM  FOUNDATIONS OF AGING EARLY HISTORY -The origins of gerontological nursing are rooted in England and began with Florence Nightingale as she accepted a position in the Institution for the Care of Sick Gentlewomen in Distressed Circumstances. -...

MIDTERM GERIATRIC HEALTHCARE TEAM  FOUNDATIONS OF AGING EARLY HISTORY -The origins of gerontological nursing are rooted in England and began with Florence Nightingale as she accepted a position in the Institution for the Care of Sick Gentlewomen in Distressed Circumstances. - Nightingale’s concern for the frail and sick elderly was continued by Agnes Jones, a wealthy Nightingale-trained nurse, who in 1864 was sent to Liver pool Infirmary, a large Poor Law institution. The care in the institution was poor, the diet meager, and the nurses often drunk. But Miss Jones, under the tutelage of Nightingale, improved the care dramatically, as well as reduced the costs. 2 In the united states, almshouses were the destination of destitute older people and were insuff erable places with “deplorable conditions, neglect, preventable suff ering, contagion, and death from lack of proper medical and nursing care” (crane, 1907, p. 873) in 1912 the american nurses association (ANA) board of directors appointed an almshouse committee to continue to oversee nursing in these institutions. World war I distracted them from attention to these needs. But in 1925, the ANA advanced the idea of a specialty in the nursing care of the aged. 3 With the passage of the social security act of 1935, federal monies were provided for old-age insurance and public assistance for needy older people not covered by insurance. Two nursing journals in the 1940s described centers of excellence for geriatric care: The Cuyahoga County Nursing Home In Ohio And The Hebrew Home For The Aged In New York. The fi rst textbook on nursing care of the elderly was published by Newton and anderson in 1950, and the fi rst published nursing research on chronic disease and the elderly (mack, 1952) appeared in the premier issue of nursing research in 1952. 4 IN 1962 A FOCUS GROUP WAS FORMED TO DISCUSS GERIATRIC NURSING, AND IN 1966 A GERIATRIC PRACTICE GROUP WAS CONVENED. HOWEVER, IT WAS NOT UNTIL 1966 THAT THE ANA FORMED A DIVISION OF GERIATRIC NURSING. THE FIRST GERIATRIC STANDARDS WERE PUBLISHED BY THE ANA IN 1968, AND SOON AFTER, GERIATRIC NURSING CERTIFICATION WAS OFFERED. GERIATRIC NURSING WAS THE FIRST SPECIALTY TO ESTABLISH STANDARDS OF PRACTICE WITHIN THE ANA. 5 IN 1976 THE DIVISION OF GERIATRIC NURSING CHANGED ITS NAME TO THE GERONTOLOGICAL NURSING DIVISION TO REFLECT THE BROAD ROLE NURSES PLAY IN THE CARE OF OLDER PEOPLE. IN 1984 THE COUNCIL ON GERONTOLOGICAL NURSING WAS FORMED AND CERTIFICATION FOR GERIATRIC NURSE PRACTITIONERS (GNPS) AND GERONTOLOGICAL CLINICAL NURSE SPECIALISTS (GCNSS) BECAME AVAILABLE. 6 NURSING WAS THE FIRST OF THE PROFESSIONS TO DEVELOP STANDARDS OF GERONTOLOGICAL CARE AND THE FIRST TO PRO VIDE A CERTIFICATION MECHANISM TO ENSURE SPECIFIC PROFESSIONAL EXPERTISE THROUGH CREDENTIALING (EBERSOLE & TOUHY, 2006). THE MOST RECENT EDITION OF SCOPE AND STANDARDS OF GERONTOLOGI CAL NURSING PRACTICE (ANA, 2010) PROVIDES A COMPREHENSIVE OVERVIEW OF THE SCOPE OF GERONTOLOGICAL NURSING AND IDENTIFIES LEVELS OF GERONTOLOGICAL NURSING PRACTICE (BASIC AND ADVANCED) AND STANDARDS OF CLINICAL GERONTOLOGICAL NURSING CARE AND GERONTOLOGICAL NURSING PERFORMANCE/ 7 EMERGENCE OF MODERN GERONTOLOGIC AND GERIATRIC NURSING 19TH CENTURY:INSTITUTIONALIZATION AND EARLY ADVANCES: >ESTABLISHMENT OF FORMAL HEALTHCARE INSTITUTIONS AND THE EMERGENCE OF NURSING AS A PROFESSION IN THE 19TH CENTURY. >CARE FOR OLDER INDIVIDUALS WAS OFTEN PROVIDED WITHIN ALMSHOUSES. THE 19TH CENTURY WITNESSED SIGNIFICANT SOCIETAL SHIFTS, INCLUDING INDUSTRIALIZATION AND URBANIZATION, WHICH DISRUPTED TRADITIONAL FAMILY STRUCTURES AND CAREGIVING ARRANGEMENTS. >1834 NEW POOR- LAW LED TO THE CONSTRUCTION OF MANY ADDITIONAL POORHOUSES THROUGHOUT THE VICTORIAN ERA. I 8  It was during this period that notable figures such as Florence Nightingale began advocating for improved care for the elderly. Nightingale’s work in nursing reform laid the groundwork for more systematic approaches to healthcare delivery, including the care of older adults. 20th century: professionalization and specialization: >emergence of formalized nursing education and professionalization efforts. Nurses began to receive specialized training in gerontologic care, recognizing the unique needs of older adults. >In the UK, pioneers such as Dame Cicely Saunders, known for her work in palliative care, contributed to shaping the field of geriatric nursing. 9 >the establishment of the National Health Service (NHS) in 1948 marked a milestone in healthcare provision, including services for the elderly. Late 20th Century: Focus on Quality of Life: The latter half of the 20th century witnessed a growing emphasis on improving the quality of life for older adults. This shift in focus led to advancements in gerontologic and geriatric nursing, with an increased emphasis on holistic care, dignity, and autonomy. Internationally, organizations such as the World Health Organization (WHO) began addressing the healthcare needs of aging populations, advocating for age-friendly policies and practices. In the UK, the promotion of active ageing and community-based care gained momentum, reflecting broader societal trends towards empowerment and independence for older adults. 10 GERONTOLOGICAL NURSING TEAM 1. GERONTOLOGIST/ GERIATRICS Geriatrician: is a primary care physician who specializes in treating conditions that affect older adult (Mauk, 2010). The approach tend to be holistic and involves multiciplinary team. The geriatrician concentrates on managing the medical conditions affecting the patient. 1. MAINTAINING A HIGH QUALITY OF LIFE FOR THE AGED POPULATION 2. GERONTOLOGISTS ARE RESPONSIBLE FOR EDUCATING OTHER HEALTH PROFESSIONALS, COMMUNITY PRACTITIONERS, AS WELL AS THE COMMUNITY AT LARGE ABOUT THE PROCESS OF AGING AND HOW TO AGE WELL BY GIVING INFORMATIVE PRESENTATIONS, PUBLISHING BOOKS AND ARTICLES ABOUT AGING AND HEALTH, AND PRODUCING RELEVANT FILMS AND TELEVISION PROGRAMS. GERIATRICIAN  A GERIATRICIAN IS A DOCTOR WHO SPECIALIZES IN CARE OF THE ELDERLY AND THE DISEASES THAT AFFECT THEM. THE APPROACH TENDS TO BE HOLISTIC AND INVOLVES A MULTIDISCIPLINARY TEAM.  ROLES O THE GERIATRICIAN CONCENTRATES ON MANAGING THE MEDICAL CONDITIONS AFFECTING THE PATIENT. NURSE GERONTOLOGIST  A GERONTOLOGY NURSE IS A NURSING SPECIALIST WHO WORKS DIRECTLY WITH OLDER ADULTS TO PROVIDE THEM WITH SPECIALIZED CARE AND A HIGH QUALITY OF LIFE.  ROLE OF THE GERIATRIC NURSE -A SPECIALIST WHO WILL HELP ELDERLY PATIENTS RECOVER FROM ILLNESS OR INJURY BY PROVIDING PRACTICAL CARE AND DEVELOPING PATIENT CARE PLANS. -HELP WITH REHABILITATION AND CONDUCT CHECK- UPS IN SKILLED CARE FACILITIES OR HOSPICE FACILITIES. -ADMINISTER MEDICATION AND ASSIST WITH PAIN MANAGEMENT, -FOCUS ON PREVENTATIVE CARE SO THAT THEIR PATIENTS ARE ABLE TO AVOID INJURIES AND COMMON MEDICAL CONDITIONS THAT DEVELOP MOST COMMONLY LATER IN LIFE. OCCUPATIONAL THERAPIST >ARE HEALTH CARE PROFESSIONALS WHO UTILIZE EVIDENCE-BASED PRACTICE, RESEARCH, SCIENTIFIC EVIDENCE, AND A HOLISTIC PERSPECTIVE TO PROMOTE INDEPENDENCE, MEANINGFUL OCCUPATIONS, AND PATIENTS' FUNCTIONAL ABILITY TO FULFILL THEIR DAILY ROUTINES AND ROLES. >OCCUPATIONAL THERAPY IS A METHOD OF HELPING PEOPLE LEAD INDEPENDENT AND PRODUCTIVE LIVES BY ALLOWING THEM TO RECOVER OR DEVELOP SKILLS NEEDED TO COMPLETE DAILY TASKS. ROLES: >TO HELP IMPROVE THE ROLE PERFORMANCE OF THE ELDERLY. OCCUPATIONAL THERAPISTS WILL FIRST WORK TO UNDERSTAND AN INDIVIDUAL’S SPECIFIC NEEDS, BY TALKING WITH THE CLIENT, HIS OR HER FAMILY MEMBERS, FRIENDS, AND PRIMARY DOCTOR/PHYSICIAN. THEY ALSO TAKE INTO ACCOUNT MEDICAL HISTORY, EATING/SLEEPING PATTERNS, AND ANY OTHER BEHAVIORAL PATTERNS THAT CAN HELP FORM A THOROUGH ASSESSMENT. FROM THERE, THEY WILL DEVELOP A PLAN COMPRISED OF SPECIFIC RECOMMENDATIONS AND TECHNIQUES CONDUCIVE TO MEETING HIS OR HER GOALS. >TO HELP SENIORS LEARN TO MOVE AND FUNCTION AND OVERCOME PHYSICAL CHALLENGES, IN SPITE OF DIMINISHED RANGE-OF-MOTION AND MOBILITY. >OCCUPATIONAL THERAPY IS NOT LIMITED TO JUST IMPROVING PHYSICAL FUNCTIONALITY. THERAPISTS CAN USE A VARIETY OF TECHNIQUES TO HELP IMPROVE MEMORY AND COGNITIVE ABILITY, AS WELL. PHYSICAL THERAPIST >PHYSICAL THERAPISTS ARE HIGHLY TRAINED HEALTH CARE PROFESSIONALS, WITH AN EXPERTISE IN MOVEMENT AND EXERCISE. >GERIATRIC PHYSICAL THERAPY FOCUSSES ON THE UNIQUE MOVEMENT NEEDS OF OLDER ADULTS. THIS INCLUDES TREATMENT FOR CONDITIONS SUCH AS ARTHRITIS, CANCER, OSTEOPOROSIS, ALZHEIMER’S’ DISEASE, JOINT REPLACEMENT AND BALANCE DISORDERS. >THE GOAL OF THE GERIATRIC PHYSICAL THERAPY IS TO HELP RESTORE MOBILITY, REDUCE PAIN, ACCOMMODATE PHYSICAL LIMITATION AND INCREASE PHYSICAL FITNESS. COMPLEXITIES OF AGING. PHYSICAL THERAPY TRAINING INCLUDES ASSESSMENT, EXERCISE PRESCRIPTION, AND PROGRESSION, ALL WITH APPROPRIATE MONITORING. >ALL THESE SKILLS CAN BE UTILIZED FOR OLDER ADULTS BEFORE INJURY HAPPENS. AND IF USED MORE IN THIS WAY, PHYSICAL THERAPISTS CAN PLAY A KEY ROLE IN THE PREVENTION OF INJURY, FUNCTIONAL DECLINE, AND DISABILITY SPEECH THERAPIST  SPEECH LANGUAGE PATHOLOGISTS (SLPS) PROVIDE SPEECH THERAPY. THEY FOCUS ON AN INDIVIDUAL’S CAPACITY FOR LANGUAGE, SPEECH, AND COMPREHENSION.  THEY GENERALLY OFFER TREATMENT PLANS TO SHORE UP SENIORS’ COGNITION AND COMMUNICATION SKILLS.  THEY CAN ALSO ADDRESS ISSUES RELATING TO DIFFICULTIES WITH SPEECH CAUSED BY DEFICIENCIES IN NUTRITION AND HYDRATION. THESE ISSUES MAY BE OVERLOOKED BY SOME MEDICAL PROVIDERS.  SPEECH PATHOLOGISTS ARE ABLE TO PROMOTE A HEALTHY LIFESTYLE FOR SENIORS, EDUCATING THEM AND THEIR CARERS ON DEMENTIA-RELATED CONDITIONS AND HOW STROKES MAY BE PREVENTED. IT IS IMPORTANT TO ESTABLISH THAT SPEECH AND LANGUAGE ABNORMALITIES ARE NOT RELATED TO FACTORS SUCH AS MEDICATION, DEPRESSION, DEHYDRATION ETC  SPEECH THERAPY PREVENTS, DIAGNOSES, AND TREATS DISORDERS OF SWALLOWING, VOICE, COMMUNICATION, LANGUAGE, AND COGNITION INCLUDING MEMORY, ATTENTION, AND PROBLEM SOLVING. SOME DISEASES AND DISORDERS MORE COMMON IN THE GERIATRIC POPULATION THAT CAN BE TREATED OR IMPROVED WITH SPEECH THERAPY INCLUDE PARKINSON’S, ALZHEIMER’S, DEMENTIA, DYSPHAGIA (DISORDER OF SWALLOWING), APHASIA, OR DYSARTHRIA, TO NAME A FEW. CASE MANAGER >A GERIATRIC CARE MANAGER, USUALLY A LICENSED NURSE OR SOCIAL WORKER WHO SPECIALIZES IN GERIATRICS, IS A SORT OF "PROFESSIONAL RELATIVE" WHO CAN HELP YOU AND YOUR FAMILY TO IDENTIFY NEEDS AND FIND WAYS TO MEET YOUR NEEDS. ROLES: O DISCUSS DIFFICULT TOPICS AND COMPLEX ISSUES O MAKE HOME VISITS AND SUGGEST NEEDED SERVICES O ADDRESS EMOTIONAL CONCERNS O MAKE SHORT- AND LONG-TERM PLANS O EVALUATE IN-HOME CARE NEEDS O SELECT CARE PERSONNEL O COORDINATE MEDICAL SERVICES O EVALUATE OTHER LIVING ARRANGEMENTS O PROVIDE CAREGIVER STRESS RELIEF AIM OF GERONTOLOGY SPECIALTY ROLES >Under the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (2008), APRNs must be educated, certified, and licensed to practice in a role and a population. >APRNs are educated in one of four roles; one of which is the adult-gerontology nurse practitioner. This population focus encompasses the young adult to the older adult, including the frail elder. >Titles of APRNs educated and certified across both areas of practice will include the following: Adult-Gerontology Acute Care Nurse Practi tioner (2013), Adult-Gerontology Primary Care Nurse Practitioner (2013), and Adult-Gerontology Clinical Nurse Specialist (2014) 29 One of the most important advanced practice nursing roles that emerged over the last 30 years is that of the gerontological nurse practitioner (GNP) and the gerontological clinical nurse specialist (GCNS) in skilled nursing facilities. The education and training programs arose from evident need, particularly in the long-term care setting. GENERALIST ROLES: 1. ACUTE CARE- describe themselves as geriatric nurses with subspecialities (geriatric vascular nurses, geriatric radiology nurses) and, along with geriatric nurse generalists, would populate hospital nursing services across the country. 30 2. Certified Nursing Assistants and Nurse Aides Although it is important to promote professional nursing care for all elders, certified nursing assistants (CNAs) provide the majority of direct care in nursing homes and significantly contribute to the quality of life for nursing home residents. 31 QUALIFICATION Two certifications are available at the professional nurse level from the American Nurses Credentialing Center (ANCC). The associate degree/diploma-level certification carries the credential RN, C (Registered Nurse, Certified) and the baccalaureate-level certification carries the credential RN, BC (Registered Nurse, Board Certified). Basic eligibility requirements for candidates include: 1) 2 years of fulltime practice as an RN in the United States or the equivalent thereof, 2) a minimum of 2,000 hours of clinical practice in gerontological nursing within the last 3 years, and 3) 30 or more continuing education contact hours in gerontological nursing within the last 3 years. 32  ROLES OF THE ADVANCED PRACTICE NURSE (APN)-masters holder and certifi ed. Gerontological clinical nurse specialist- focuses on education of patients, families, and staff and often works in collaborative practice with physicians or hospitals. often an academic educator, consultant, or entrepreneur. In many states, geriatric clinical nurse specialists (CNSs) may obtain prescriptive authority and broaden the scope of practice. Geriatric nurse practitioner- expert clinicians in the field. As GNPs, clinical hours during master’s work or postmaster’s certification are done with older adults. Nurses in advanced practice will engage in education of patients, clients, staff, and other interdisciplinary team members. engages in advocating for the health of older adults. This may include mentoring other nurses; acting as an intermediary for patients, family members, and other team members; or being politically active by working to change laws to advance the care of the elderly. Nurses with advanced knowledge, education, and experience are in a special position to provide consulting services in many areas. This may include legal consulting, working with financial planners, or helping businesses with programming for the elderly. I 33 FUNCTIONS AND RESPONSIBILITIES OF GERONTOLOGY NURSE 1. PROVIDER OF CARE (CLINICIAN) Gives direct, hands-on care to older adults in a variety of settings as a nurse, we have to be educated/knowledgeable about: o the disease process that is happening to our patients esp. Older patients; o risk factors (why the pt is having this type of disability/illness in relation to the pt’s age/aging process); o signs & symptoms, (e.G., What s/s do we expect in elderly having osteoarthritis or rheumatoid arthritis); o usual medical treatment that patient might be receiving; o the type of rehabilitation methods/strategies we can provide in order for us to provide a quality life for our elderly 35 2. MANAGER gerontological nurses act as managers during everyday practice as they balance the concerns of the patient, family, nursing and t he rest of the interdisciplinary/health team plans and coordinate the care of the elderly develop skills in staff coordination, time management, assertiveness, communication and organization; leadership skills 36 3. TEACHER gerontological nurses focus their teaching in modifi able risk factors and health promotion organize and provides instructions on healthy aging, disease detection, treatment and rehabilitation to older patients and families focus: identifying modifi able factors of our elderly in order for them to have health promotion. many debilitating conditions of the elderly can be prevented through health teachings; e.g., lifestyle modifi cation (healthy diet, smoking cessation, appropriate weight maintenance/management), stress management 37 4. ADVOCATE act on behalf of older adults to promote their best interests and strengthen their autonomy and decision making empowering pt; helping pt remain independent and retain dignity anger displacement; venting anger towards other things 38 5. RESEARCH CONSUMER (RESEARCHER) gerontological nurses must remain abreast(updated) of current research literature, reading and putting into practice results of reliable and valid studies read and put into practice the results of reliable and valid studies assists with data collection and identifi cation of appropriate research sites uses evidenced-based results 39 FINAL TIPS & TAKEAWAYS Practice makes perfect Continue improving Consistent rehearsal Seek feedback Strengthen your familiarity Reflect on performance Refine delivery style Explore new techniques Pacing, tone, and emphasis Set personal goals Timing and transitions Iterate and adapt Aim for seamless, professional delivery Practice audience Enlist colleagues to listen & provide feedback 40 THANK YOU 41