Objective 2 2023 PDF - Factors Influencing Care for Older Adults

Objective 2: Factors that Influence Caring for Older Adults Required Readings: Ch 2, 3 (pg. 26-27, 38-43), Ch 4 Potter & Perry Ch 6 (pg. 75-79) Care of seniors in hospitals in the 1900s had a custodial focus (problem based focus) Evolution of Gerontological Nursing Care of physical conditions wa...

Objective 2: Factors that Influence Caring for Older Adults Required Readings: Ch 2, 3 (pg. 26-27, 38-43), Ch 4 Potter & Perry Ch 6 (pg. 75-79) Care of seniors in hospitals in the 1900s had a custodial focus (problem based focus) Evolution of Gerontological Nursing Care of physical conditions was the priority Affluent would care for older adults at home and hire nurses Evolution of Gerontological Nursing • Vera McIver & Priory Method (1967-68) • She believed that the approach to nursing care encouraged dependence, restricted movement, & contributed to death of the human spirit • Pioneered the restorative care model of care coined the ‘Priory Method’ • Nursing care for older persons should be based on current findings in research and many research opportunities exist with this population Priory Method Attention to the whole person, not just disability Focused on wellness, identifying strengths & abilities More humanized approach to nursing care Encouraged independence and strengthening residents’ egos through carrying out own ADLs Evolution of Gerontological Nursing Moved from ‘illness’ to ‘holistic’ focused Many nurses in LTC identified the need for this specialized approached Multitude of nursing research has been completed in the area of gerontology 1976 term geriatric nursing was replaced with gerontological nursing 1974, 1st provincial Gerontological Nursing Associated in Ontario 1985 establishment of Canadian Gerontological Nursing Association of Canada (CGNA) 1987 CGNA adopted Ontario’s standards 1996 CDNA adopted own competencies and standards (updated in 2010) Box 2.4 Pg 15 Gerontology Organizations devoted to Gerontology Research & Practice in Canada • Canadian Associated of Gerontology (CAG) • Canadian Gerontological Nurses Associated (CGNA) • 6 Standards of care and competencies of practice (Box 2.4 in text) Six Standards • Relational Care • Ethical Care • Evidence-Informed Care • Aesthetic/Artful Care • Safe Care • Socio-politically Engaged Care Development of Gerontological Nursing • Gerontological Nursing Roles • Required in a variety of settings – hospital, home, acute, & long term care facilities, community, and rehabilitation care centers • Mission is to preserve function, enhance health, quality of life, & end of life care There are multiple dimensions related to caring for older adults to promote optimal health Caring: Holistic Focus Holistic approaches to care involve addressing the bio psychosocial and spiritual needs of the older adult Biopsychosocial and spiritual needs: • Bio: refers to physical health • Psycho: refers to psychological health • Social: refers to social health • Spiritual: refers to spiritual health Settings: Where is Gerontologic Nursing Provided? • Care is provided to the older adult in institutions and community settings: • RNs, LPNs, PCAs – Deliver direct care • Other healthcare disciplines: PT, OT, DR., SW, Pharmacists also provide care (interdisciplinary approach to care) • Settings: • Long term care • Acute care • Community care Long Term Care (LTC) About 7% of older Canadians live in LTC Long term care in community vs. long term care facilities Facilities include chronic care / rehabilitation hospitals (Miller Centre) LTC – nursing homes Most are older adults (not always) • Over 50% of residents are 85+ years old • 2/3 have cognitive impairment Residents have complex needs, multiple chronic illnesses and require a high level of care LTC: Nursing Roles Leadership Decision making Effective communication and collaboration reporting to RN, family and other team members Knowledgeable Delegation of tasks to PCAs , assessment and evaluation of the care that they are providing Acute Care • Older adults comprise a large number of patients in acute care settings • Reasons: exacerbations of chronic illnesses, other acute illnesses • Complications: functional decline, malnutrition, incontinence, drug interactions, delirium and falls • Nursing role : become knowledgeable about needs of older adults and the complexity of managing multiple conditions and needs • Prevention of complications need to be nursing focus in acute care • Early detection of potential complications will affect health outcomes Approximately 93% live in community settings CommunityBased Settings Community based care settings: home care, independent living complexes, retirement communities, adult daycare programs Seniors want to age and live at home Nursing role: Comprehensive assessment and care for persons with multiple needs • Health promotion focus to promote optimal health , function and safety for the individual and family Gerontological Nursing, Aging, & The Future • Who will care for an aging society? • Demand is critical for gerontological nurses and other health professionals to care for older people • Growing concern: adequate staffing, particularly professional nurses, in nursing homes • Ageism impacts on nurses working with older adults • Baby boomers • Informed and educated • Preparing early for “good” old age • Expect much higher quality of life as they age • Global Challenges • Policies need to be developed and refined to meet income, health, and long term care needs for men and women throughout world Recall of the past, life review Helps one remember their past, reframe their life, and extract meaning from it Useful in assessment, tells us a great deal about a person Value of reminiscence Important to help fulfill Erikson’s Developmental task ‘Ego Integrity vs. Despair’ Once seen as a sign of senility, now realized to be an important psychological task Pleasurable experience that can comfort and improve quality of life, socialization, and cognitive stimulation • Box 3.11: Therapeutic Implications of Reminiscence • Box 3.12: Suggestions for Encouraging Reminiscence Culture, Ethnicity & aging Attention to culture and health care is increasing •Gerontological Explosion – rapid increases in total number of older persons and immigration •Impact of Canadian policies of multiculturalism •Recognition of health disparities for members of ethnocultural minorities Canada is a multicultural society •Over 6 million are visible minorities, and 1.4 million are indigenous people •Approx.. 1/3 Canadian over 65 years old are immigrants Nurses are required to provide culturally competent care. This is especially important in gerontological nursing, because many older persons are immigrants to Canada. • Health disparities exist in Canada • Example: Indigenous people have higher rates of chronic illness, disability, death by injury, lower life expectancy, etc. Culture & aging: issues • Box 4.1: Residential school system • Socio-economic challenges for immigrants presenting barriers to accessing health care • Language barriers • Culture affects views on aging, health beliefs, roles in families, and communities Culturally competent care • Involves cultural awareness, knowledge, and skills • Cultural Awareness: Need for openness and self reflection. Being aware of ‘isms’. Nurses should pause and self reflect on their own personal biases/beliefs and how that may affect their care for each patient • Cultural Knowledge: Knowledge of different cultures (beliefs, ways of thinking, practices, etc). Caution not to stereotype • Cultural Skills: Ability to work with patient instead of on patient. Considering implications when communicating and providing care • Working with interpreters: Box 4.13 Indigenous Culture: Elders  Highly respected members - Indigenous culture  The crucial role of elders: https://www.youtube.com/watch?v=Ipvy8y VTVoQ Indigenous Culture: Elders • Roles: Teacher, counselor, ceremony conductor, healer in conflict resolver • Teach the ceremonies and knowledge of healing to the next generation • Help resolve conflicts incorporate cultural teachings • Committed to living what they teach • Respected in their communities • https://www.thecanadianencyclopedia.ca/en/article/indigenous-elders-in-canada Legal & Ethical Considerations: Older Adults Mental Capacity (Obj 9) Advanced Health Care Directives (Obj 14) Adult Protection Act (Obj 13) Evidence-Informed Practice (EIP) Based on research (multiple healthcare disciplines) Best available evidence is used in providing care and influencing good outcomes for clients Affects clinical decision making / judgments Hartford institute for geriatric nursing