1 Foundation of Nursing Practice

8/10/2019 1 Foundation of Nursing Practice

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Advantages of Learning Geriatric Nursing

Preparing for the future Recognizing the importance of

rehabilitation Being aware of the need to

undertake research.


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Classifications of Geriatrics Young Old

Ages 65 - 74

Middle Old Ages 75 - 84

Old Old (Very old,frail Elderly)

Ages 85 and up


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GerontologicalRehabilitation Nursing

Combines expertise in

gerontological nursingwith rehabilitationconcepts and practice

Branches of Gerontology


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Roles of the Gerontological Nurse Provider of Care Teacher Manager Advocate Research Consumer


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Continuum of Care

ACUTE CAREHOSPITAL

Inpatient rehabilitationunit

Home

Inpatient subacuteunit

Long-term care facility(Nursing home)

Long-term transitionalGeneralChronic

Transitional

OP Therapies

Home health care

Adult day care

Vocational rehabHospice

PTOTSpeech therapy

Social servicesNursing care

Ancillary services

Assisted livingResidential

Group homes

Hospice


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Demographics of Aging


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Projected Acceleration of Population

Aging


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Life Expectancy at an All Time High

Its substantial and pleasing riseresults from infectious diseasecontrol, public health initiatives,

and new surgical andrehabilitation techniques.


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A Skewed Sex Ratio

Its a Womans world

women characteristically

comprise the majority of theolder population in the majorityof countries throughout the

world.


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Aging Defies Definition

THE AGING PROCESS BEGINS WITH BIRTHAND ENDS WITH DEATH. Thus, human agingis:

universal everyone ages inevitable we cannot stop the

process irreversible we will never be

younger than we are today


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Theories of Aging


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Theories of Aging: Characteristics of a good gerontological

theory: Integrates knowledge Tells how and why phenomena are related Leads to prediction Provides process and understanding

Holistic Takes into account all that impacts on a

person throughout a lifetime of aging


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Theories of Aging: Psychosocial Theories of Agin

Sociological Theories: Activity Theory Disengagement Theory Subculture Theory Continuity Theory

Age Satisfaction Theory Person-Environment-Fit Theory Gerotranscendence Theory


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Theories of Aging

Biological Theories of Aging


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Theories of Aging Nursing Theories of Aging

FunctionalConsequences Theory

Theory of Thriving


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Psychosocial Theories of ging Psychological Theories

Personality

ego development Challenges

Sociological Theories

challenging roles relationships status


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Disengagement Theory By sociologists

Cumming and Henry(1961)

Aging is characterizedby gradual

disengagement fromsociety andrelationships


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Subculture Theory Postulated by Arnold Rose in 1965 Views adults as a unique subculture

within a society Older adults prefer to interact among

themselves

critical key determinants of socialstatus = Health and mobilityoccupation, education or income


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Individual differencesproduce varied responseto aging

Personality influencesroles and life satisfactionand remains consistentthroughout life.

CONTINUITY THEORY


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4 Personality Types: Integrated

Armored-defended Passive-Dependent Unintegrated


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AGE STRATIFICATION THEORY: Age cohorts are influenced by:

Historical context Shared similar experiences Beliefs Attitudes Expectations of life course transitions


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PERSON-ENVIRONMENT-FITTHEORY

Function is affected by: Ego Strength Mobility Health

Cognition Sensory perception Environment


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Human Needs Theory Postulated by Abraham Maslow in 1954

Five basic needs motivate human behaviorin a lifelong process toward need fulfillment

THEORY OF INDIVIDUALISM:


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THEORY OF INDIVIDUALISM: Jung (1960) (extroversion) (introversion) true self

It proposes that successfulaging includes: Ability to accept the past Adjust to losses as individualsexperience functional decline


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STAGES OF PERSONALITY DEVELOPMEN

THEORY (Erikson (1963)

- Ego Integrity vs.

Despair1. Final phase ofdevelopment

2. Evaluating lifesaccomplishmentsand meaning


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LIFE COURSE (LIFE SPAN

DEVELOPMENT) PARADIGM Buhler 1933 Life stages are predictable an

structured by roles, relationshvalues and goals

SELECTIVE OPTIMIZATION WITH


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SELECTIVE OPTIMIZATION WITHCOMPENSATION THEORYBaltes (1987)

Selection Optimization Compensation

Critical life points:

Morbidity Mortality Quality of life


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BIOLOGICAL THEORIES OF AGING

physiologic process On the molecular level in the cells,

tissues, and body systems How does the body-mind

interaction affect aging What biological processes impact

aging How to ones chromosomes impact

the overall aging process


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A. Stochastic Theory random cell damage

B. Non-stochastic Theory timed framework

CATEGORIES OF THE B IOL OGICA L THEORY


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Stochastic Theories

Free Radical Theory

Aging is due tooxid tivemet bolism ndthe effects of freeradicals


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FREE

RADICALS

Appears as singleunpairedelectrons


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causes:A. Extensive damage to DNA ->

malignancy and acceleratedaging

B. Lipid oxygenation -> damageto cell membrane -> affectmembrane permeability

C. DNA strand breaks and basemodifications -> genemodulation


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Aging happens dueto the cumulativechanges occurring incells age and

damage cellularmetabolism

Wear and Tear Theory

Inability ofsome cells toregenerate

Cells inabilityto repairdamaged DNA

Excessive wear andtear due tostrenuous activities

accelerate aging bycausing increasedfree radicalproduction


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Non-stochastic Theories Programmed Theory(Cells die after a number of cell

divisions (40-60 times)) Defense mechanism of

cells to protect itself fromreplication errors that can

cause mutations in DNA When it is too short, the

cell undergoes apoptosis

Gene/Biological Clock


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Compromising genetic

influences that predict physical condition,occurrence of disease, causeand age of death, and other

factors that contribute tolongevity

Gene/Biological ClockTheory


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IMMUNOLOGIC/


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IMMUNOLOGIC/AUTOIMMUNE THEORY

Aging is due to faulty

immunological functionwhich is linked togeneral well-being

N i Th i f A i


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Nursing Theories of Aging

FUNCTIONALCONSEQUENCES THEORY

nvironmentaland biopsychosocialconsequencesimpact functioning.

N i Th i f A i


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Nursing Theories of Aging

FUNCTIONAL CONSEQUENCES THEORY

Nursings role is riskreduction to minimize age

associated disability inorder to enhance

safety and quality of living.


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Considers theimpact ofenvironment as

people age

THEORY OF THRIVING


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Results from a discord between

the individual and his/herenvironment or relationships.

THEORY OF THRIVING

THEORY OF THRIVING


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Thriving is achieved when there isharmony among a person and his/herphysical environment and personalrelationships.

THEORY OF THRIVING


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Nurses identify

and modifyfactors that

contribute todisharmonyamong these

elements

THEORY OF THRIVING


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COMMUNICATION


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Communicationnegotiate adversity, and

convey or feelings.

express our needs andwishes of others

Sensory Modalities Involved in


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Sensory Modalities Involved inCommunication

Vision Hearing

Touch Olfaction Gustation Movement Speech Disability

Verbal and Nonverbal


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Verbal and Nonverbal

Communication


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Effective Communication

Interprets the

messages andresponds in an

appropriatemanner

CUTE

AKO..



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Necessitates listening and taking intoaccount the meaning of an idea, event,or experience described by the otherperson


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We can learn together and build acommon bond through our respect and

understanding for others


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ASSISTIVE TECHNOLOGY Augmentative and

Alternative Communication(AAC)

Speech LanguagePathologist andOccupational Therapistdetermines what type ofcommunication device willbe prescribed


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Transmits sound

waves to a microphoneworn by the individualto improve listening

experience

FOR HEARING


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For Hearing May be used with or without a

hearing aid Four major types

Personal frequency

modulation systems Infrared systems Induction loop systems One-to-one communicators


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COMMUNICATION ESSENCE OF NURSING TWO-WAY PROCESS

HEARING AIDS


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HEARING AIDS

BTEITEITC

CIC

GUIDELINES FOR


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GUIDELINES FORVERBAL

COMMUNICATION:

-Do not yell or

speak too loudly topatients.-Try to be at eye

level with thepatient.

GUIDELINES FOR VERBALCOMMUNICATION


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COMMUNICATION

- Try to minimize background noise as it can makeit difficult for the pt to hear.- Monitor the patients reaction.- Touch the patient if appropriate and acceptable.

Supplement verbali i i h i


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instructions with writteninstructions as needed.

Do not give long-windedspeeches or complicatedinstructions to persons withcognitive impairment,

anxiety or pain. Ask how the patient would

like to be addressed.

GUIDELINES FOR VERBALCOMMUNICATION


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Instrumental or Tasked-focused Communication

gathering information that will helpin the diagnosis of the client (formal)

Affective Communication

Focuses on how the health careprovider is caring about the person(feelings or emotions)

More difficult

TYPES OF COMMUNICATION

5 Principles for Making Contact &


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5 Principles for Making Contact &Communicating with Others

Invite Arrange environment Maximize

communication

Maximize understanding Follow-through


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1.Inviting

Use open-endedquestions to invite peopleto engage

Extend your greeting andmake arrangements to

minimize distractionsduring the admissionsinterview

2. ARRANGING THEENVIRONMENT


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ENVIRONMENT Be face-to-face with

the client Remember to respect

personal space andterritory

Ask for permissionbefore sitting down orhandling any assistivedevices

Arrange the room tofacilitateindependence andprovide safety


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3. MAXIMIZING

COMMUNICATION

Maximize the patientsability to understand themessage

Health Literacy


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4. MAXIMIZING UNDERSTANDING


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Most important skill:LEARN TO LISTEN

Must be open-minded

and allow individualsto share thoughts

Focus your time on theperson

5. FOLLOW THROUGH


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Final principle Back up your words

with actions to gaintrust Trust and concern for

the welfare of others iscritical to optimalhealth outcomes

5. FOLLOW THROUGH

Challenges in Communicating with


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Challenges in Communicating withOlder Adults

Communicating with individuals with: Aphasia Dysarthria Visual Impairments Hearing Impairments

Deafness Ethical /L egalPr inciplesandI ssues


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Ethical /L egal Pr inciples and I ssues

Ethics principles that facilitate

decision making andguide our personalbehavior

Evolved from our beliefsand values Driven by moral

reasonin

eTHICS OF cARE FOR THE oLD


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eTHICS OF cARE FOR THE oLDcLIENTS

Compassion Equity Fairness Dignity

Confidentiality Autonomy

Ethi l M l P i i l


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Ethical Moral Principle Advocacy Autonomy Beneficence/Nonmal-eficence

Confidentiality Fidelity

Fiduciaryresponsibility

Justice Quality of life

Reciprocity Sanctity of life veracity

P A T I E N T RIGHTS


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P A T I E N T RIGHTS

Advanced Directives orLiving Wills

Durable Power of Attorney Competence Assisted Suicide


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END OF LIFE CARE


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END-OF-LIFE CARE

DEATH AND DYING


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DEATH AND DYING Nurses must take the lead in

integrating palliative care and

end-of-life care into their dailypractice, making it a corecompetency in caring for peoplewith actual or potentially life-limiting illness

THE FOCUS OF CARE SHOULD


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CENTER ON:- Living withterminal illness ratherthan prolongingsuffering or the dyingprocess- Addressing theirphysical, emotional,psychosocial, andspiritual needs

COMMUNICATION ABOUT END-OF-LIFE


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COMMUNICATION ABOUT END-OF-LIFE

Talking about death and dying ASK them

COMMUNICATING BAD NEWS


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Get started Find out what the patient

knows Find out how much the

patient knows Share information Respond to feelings Plan/Follow up

Six step approach:

Advanced Directives:


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Durable power of attorneyLiving will of declarationAppointment of health care

representativeDo not resuscitate (DNR)Life-prolonging procedures

declaration(Five wishes)Allow natural death (AND)

Advanced Directives:

Options for End-of-Life Care


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Options for End of Life Care

Curative/AcuteCare

Hospice Care Palliative Care

End-of-Life Hospice Care


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p

Conducted by a team: Doctor of Medicine or Osteopathy Registered Nurse Social Worker Pastoral or other counselor Volunteers Clergy/spiritual support Additional counseling

Complementary therapies

HOSPICE SHOULD INCLUDE BUT


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HOSPICE SHOULD INCLUDE, BUTNOT LIMITED TO:

Nursing services and coordination of care PT, OT, and speech-language pathology services Medical social services Home health aides and homemaker services Physician services/Medical director Counseling services (dietary, pastoral, & others) Short-term inpatient care Medical appliances and supplies Medications and biologicals

Focus on Symptoms


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Focus on Symptoms Physical, Nonpain Symptoms Physical, Pain Symptoms

Loss and Grief Psychosocial Issues Emotional Issues Spiritual/Cultural Issues

Components of Peaceful


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pDying

Instilling goodmemories Uniting with family

and medical staff Avoiding suffering

with relief of pain &symptoms

Saying good-bye

Maintainingalertness, control,privacy, dignity andsupport

Becoming spiritually

ready Dying quietly

POSTMORTEM CARE


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POSTMORTEM CARE Pronouncing Death

Identify the patient and note: General appearance of the body Lack of reaction to verbal or tactile stimulation Lack of pupillary light reflex (fixed and dilated) Absent breathing and lung sounds Absent carotid and apical responses

Physical care of the Body

Conclusion


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Aging continues to be explained from multipletheoretical perspectives

Using the knowledge learned, nurses can: Help people to use their genetic makeup to prevent

comorbidities Facilitate best practices for managing chronic

illnesses Maximize individuals strengths relative to

maintaining independence Facilitate creative ways to overcome individuals

challengesAssist in c lti ating and maintaining older ad lts

Documents

1 Foundation of Nursing Practice