Gerontological Nursing Ch 1-3 – Flashcards
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Aging is determined by:
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Society and Culture
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- What age was considered "old" in 1935, when Social Security was created? - What age was considered "old" in 2000?
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- 65 - 70
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- Young old: - Middle old: - Old old:
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- Young old: 65 to 70 - Middle old: 75 to 84 - Old old: 85 and above
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The ratio of women to men is 50/50, up until what age?
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60
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Aging was devalued in what time period?
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Late 1800s
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Supercentenarian
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110+
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What are the four major factors of aging?
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1. Decade born. 2. Gender. 3. Ethnicity. 4. Health.
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Are disparities increasing or decreasing?
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Increasing
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What is essential to meet the needs of the rapidly growing, ethnically diverse elderly population?
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- Increasing numbers of health care providers from different cultures - Ensuring cultural competence of all providers
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Why are changes in global aging making it more challenging to meet the needs of the aging global community?
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The number of younger adults providing care and financial support are decreasing.
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By 2050, the number of people 60 years and older is likely to exceed the number of people...
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15 years and younger
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Health is influenced by:
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Culture and Age
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Wellness:
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One's whole being: physical, emotional, mental, and spiritual.
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Functional abilities:
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The ability to live independently, to enjoy family and life.
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Maslow's 5 levels of Needs:
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1. Self-Actualization: morality, creativity, acceptance, lack of prejudice. 2. Self-Esteem/Self-Efficacy: confidence, achievement, respect of others. 3. Belonging: friends, family, sexual intimacy. 4. Safety/Security: family, health, morality, employment. 5. Basic Needs: air, food, water, homeostasis, sleep.
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Which level is considered the highest level of wellness?
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Self-actualization; it is seen as people reaching out beyond themselves and finding meaning and a sense of fulfillment.
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Healthy People 2020:
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1. Achieve health equity, eliminate disparities, and improve health in all groups. 2. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages.
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4 Self-Care requirements:
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1. Maintaining sufficient intake of air, water, and food. 2. Maintaining satisfactory elimination function. 3. Maintaining a balance between activity and rest. 4. Maintaining a balance between solitude and social interaction.
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The 3 goals of the nurse:
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1. Always care and comfort. 2. Sometimes cure. 3. Prevent that which can be prevented.
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What do ageist attitudes and behaviors undermine?
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The self-esteem of the individual, and society's acknowledgment of the value of the contributions of older adults.
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MULTIPLE CHOICE 1. Identify the best statement about gerontological nursing. a. Nurses have only recently become involved in the care of the older adult. b. Gerontological care was the second specialty in which the American Nurses Association (ANA) offered a certification program. c. Purposes of gerontological nursing include the promotion of health and support for maximal independence. d. ANA certification is available only for gerontological nurses in research positions.
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ANS: C Promoting health and fostering independence are purposes of the practice, as reflected, for example, in the ANA Scope and Standards. Nurses have always cared for older patients. The ANA's gerontological nursing certification program was the organization's first and includes a variety of positions, such as nurse practitioners, clinical specialists, researchers, and administrators.
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2. Which gerontological nursing organization welcomes nurses from all educational backgrounds? a. The National Gerontological Nursing Association (NGNA) b. The National Conference of Gerontological Nurse Practitioners (NCGNP) c. The National Association of Directors of Nursing Administration in Long-Term Care (NADONA/LTC) d. The American Society on Aging (ASA)
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ANS: A The NGNA was formed specifically for all levels of nursing personnel: registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and certified nursing assistants (CNAs). The NCGNP is, as its name implies, limited to nurse practitioners. The NADONA/LTC is, as its name implies, limited to directors and assistant directors of nursing. The ASA is an interdisciplinary organization not limited to nurses.
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3. Which is an accurate statement regarding gerontological nursing education? a. Gerontological nursing content has long been integrated into the curriculum of the typical school of nursing. b. Undergraduate nursing programs extensively cover gerontological nursing in dedicated courses, comparable with the coverage of psychiatric nursing. c. When content is integrated throughout a curriculum, less than 25% is devoted to geriatric care. d. Accreditation of a nursing program guarantees that appropriate amounts of gerontological nursing content are included in the curriculum.
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ANS: C When content is integrated throughout the curriculum, less than 25% of the content is devoted to geriatric care. Only recently has gerontological nursing content begun to appear in nursing school curricula. Most nursing schools still do not have such courses. At present, no minimum requirements exist for the coverage of care of older adults.
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4. Based on current demographic data, which of the following statements identifies a predictive trend regarding the health care needs of society? a. Most nurses will not need to care for older persons. b. More nursing services will be required to serve the needs of the population older than 85 years of age. c. Fewer nurses will be needed to care for older adults. d. Older adults expect their quality of life to be less than that of earlier generations at their ages.
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ANS: B Projections are that 20% of the American population will be older than 65 years of age by 2050, with those older than 85 years showing the greatest increase in numbers. Most nurses can expect to care for older people during the course of their careers. By 2050, the United Nations predicts that more Americans will be over the age of 60 years than those under the age of 15 years. Older people are better educated and more affluent and expect a higher quality of life than their elders had at their age.
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5. A case manager is likely to have how many years of nursing education? a. 1 to 1.5 b. 2 c. 4 to 6 d. 8 or more
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ANS: C A case manager typically has a bachelor's or master's degree. This amount of training is typical for an LPN, who typically practices at a nursing home or on a home nursing staff. This amount of training, resulting in an Associate's Degree in Nursing (ADN), is typical for an associate RN, who is typically found on hospital, home, and nursing home staffs. A nurse with 8 or more years of education, as well as a doctorate, is typically involved in research and teaching.
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6. Which was the first formal action the ANA took in relation to gerontological nursing? a. Established a national geriatric nursing group b. Defined educational standards for gerontology c. Created the ANA Division of Geriatric Nursing d. Formed the Council of Long Term Care Nurses
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ANS: A The first formal act of the ANA to promote gerontological nursing was to form a national geriatric nursing group in 1962. In 1973, the ANA defined educational standards for geriatric nursing. The ANA Division of Geriatric Nursing was begun in 1966. In 1979, the ANA formed the Council of Long Term Care Nurses.
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7. A older man is transferred to a hospice facility with end-stage disease. Which is a suitable nursing intervention for this older adult and his family according to the goals of long-term care? a. Decrease the analgesic dose to prevent sedation. b. Provide a basin and towels for morning self-care. c. Inform family members about strict visiting hours. d. Facilitate family rituals related to death and dying.
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ANS: D To promote comfort and dignity, the nurse facilitates the enactment of family wishes, rituals, or religious practices related to death and dying. To promote comfort, the gerontological nurse administers medications as prescribed and avoids restricting analgesic agents to patients, regardless of the setting or the nurse's personal views. Although fostering independence is within the scope of the gerontological nursing practice, the nurse should assess the older adult and family before assuming that he will want or be able to perform self-care. Although hospice can have regular visiting hours, the older adult may need his family at the bedside for comfort, strength, or companionship. Thus to provide comfort and promote dignity, the gerontological nurse adapts visiting hours to suit the older adult's needs.
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8. A nursing home executive interviews RNs to fill a full-time position for direct patient care to maintain the standards of elder care. Which nurse should the nursing home hire? a. Nurse from a certified college c. Nurse with 15 years of experience b. Certified gerontological nurse d. Gerontological nurse practitioner
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ANS: B A certified gerontological nurse receives education and training to care for older adults, assuring the nursing home and the public that the nurse has mastered the specialized skills and knowledge to care for older adults according to gerontological nursing standards. A nurse educated in a certified college does not necessarily have specialty education and training in gerontology. A nurse with 15-years experience might have no experience with gerontology and offers no proof of specialized knowledge or skills. Although a gerontological nurse practitioner receives specialized education and training in gerontology, these nurses provide primary care in a nursing home.
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9. Mezey and Fulmer (2002) justify gerontological nursing research and the work of gerontological advanced practice nurses by concluding the following: a. Other scientists devalue gerontological nursing research. b. The research influences outcomes from nursing care in a positive way. c. Gerontological care is expensive but required in long-term care. d. Gerontological nursing research is well known to practicing nurses.
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ANS: B The practices of advanced practice nurses, who base their practice on nursing research, have resulted in positive older adult outcomes and cost effectiveness. The scientific community widely accepts the research. Advanced practice nurses generate positive outcomes and are cost effective in many settings. Mezey and Fulmer believe the goal of gerontological nursing is to disseminate the knowledge from gerontological nursing research to all nurses and to have the knowledge applied to their practices.
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10. The gerontological nurse collaborates with the wound care team about an older patient who has an ulcer. How is this nurse demonstrating leadership in the care of older people? a. Assessing older adults effectively b. Facilitating access to elder care programs c. Coordinating members of the health care team d. Empowering older adults to manage chronic illness
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ANS: C The nurse demonstrates leadership in the care of older adults by initiating and coordinating collaboration with the wound care team to improve the health of an older adult. Screening and assessing are only indirectly related to collaboration. In this case, the nurse's collaborative efforts are unrelated to facilitating access to a program. Thus far, the nurse has not educated or trained this patient in wound care.
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11. Several organizations collaborated in 2001 to publish Scope and Standards of Gerontological Nursing Practice by the ANA. What is the significance of the collaborative effort to gerontological nurses? a. Changes the health care delivery to increasing numbers of older adults b. Mandates gerontological certification for nurses who care for older adults c. Standardizes gerontological nursing practice among various organizations d. Ensures minimum gerontological competencies for all graduating students
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ANS: C Various gerontological nursing organizations collaborated to define the criteria for gerontological nursing practice, demonstrating an agreement among the various organizations on these standards. The collaboration among multiple organizations potentially improves the quality of gerontological nursing care as the number of older adults grows. This document establishes the criteria for gerontological nursing practice. To improve the health care to older adults, all graduating students should master minimum competencies in gerontological nursing; however, many students continue to receive little specialty training and education in the care of older adults.
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12. Which had a major influence in shifting the care of older adults away from almshouses and public institutions and stimulated the growth of commercial nursing homes? a. Medicare b. Social Security Act c. Hartford Institute for Geriatric Nursing d. Health maintenance organizations (HMOs)
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ANS: B 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. To combat the fear of almshouse placement, Congress stipulated that the Social Security funds could not be used to pay for care in almshouses or other public institutions. This move is thought to have been the genesis of commercial nursing homes. During the next 10 years, many almshouses closed, and the number of private boarding homes providing care to older adults increased. Because retired and widowed nurses often converted their homes into such living quarters and gave care when their boarders became ill, they can be considered the first geriatric nurses and their homes to be the first nursing homes. The Hartford Institute has sponsored significant improvements in gerontological nursing practice, research, and education. HMOs have had a significant impact on the management of care but were virtually nonexistent in the 1930s and 1940s.
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13. Which gerontological organization had a significant influence on the care of older adults? a. American Association of Retired Persons (AARP) b. John Hartford Foundation c. Medicare d. Mutual of Omaha Insurance
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ANS: B The most significant influence in enhancing gerontological nursing has been the work of the Hartford Institute for Geriatric Nursing, funded by the John A. Hartford Foundation. The foundation seeks to shape the quality of the nation's health care for older Americans by promoting geriatric nursing excellence to both the nursing profession and the larger health care community. Initiatives in nursing education, nursing practice, nursing research, and nursing policy include enhancing geriatrics in nursing education programs through curricular reform and faculty development and the development of nine Centers of Geriatric Nursing Excellence. AARP is a foundation that helps struggling seniors by being a force for change on the most serious issues they face today. Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 years and older and younger people with disabilities. Mutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska.
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MULTIPLE RESPONSE 1. In which areas have advanced practice nurses demonstrated their skill in improving? (Select all that apply.) a. Health outcomes b. Length of stay c. Cost effectiveness d. Reimbursement measures e. Interprofessional communication
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ANS: A, C Advanced practice nurses have demonstrated their skill in improving health outcomes and cost effectiveness. Many of these advanced practice nurses have nursing facility practices managing complex care of frail older adults in collaboration with interprofessional teams. This role is well established, and positive outcomes include increased patient and family satisfaction, decreased costs, less frequent hospitalizations and emergency department visits, and improved quality of care. Reimbursement measures and interprofessional communication have not been identified as areas that advanced practice nurses have demonstrated their skill in improving.
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2. Identify future directions for gerontological nursing research as suggested by Wykle and Tappen. (Select all that apply.) a. Interdisciplinary practice models b. Intergenerational caregiving c. Health disparities d. Influence of culture on aging e. Long-term care initiatives
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ANS: A, B, C, D The following have been identified for future directions for gerontological nursing research according to Wykle and Tappen: interdisciplinary practice models, intergenerational caregiving, health disparities, and the influence of culture on aging. Long-term care initiatives have not been identified as a future direction for nursing research.
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Older adults are the largest consumers of health care services in _______ settings?
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All settings.
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A majority of older adults live in the _____ which include retirement communities, adult day health programs, primary care clinics, home care, etc.
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the community
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Nurses in the community provide:
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assessments, chronic wound care, IV therapy, tube feedings, and remote monitoring w/ increasingly complex technology.
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What is telehealth?
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is the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education public health and health administration. Uses remote-monitoring to use physical assessments, virtual visits, ICU monitoring.
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Why is telehealth useful?
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Nurses can practice in any setting in which onsite access to health care providers is limited. Particularly useful for use in rural patients.
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Smart Homes
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Sensors and monitors that can keep data on vital signs and other measure like gait, behavior, and sleep.
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Remote-Controlled Houses
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caregivers and family can perform virtual check-ins with older relatives. (can be expensive)
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Where will you mostly encounter older adults in the health care system?
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Acute care; comprises 60% of medical-surgical patients and 46% of critical care patients.
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What are the most frequent reasons for hospitalizations?
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Exacerbation of chronic illnesses and injuries
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Are hospitals safe places for the elderly?
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No; 34% experience functional decline and Iatrogenic complications occur between 29-38% of all older hospitalized patients.
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What will CMS do when it deems that hospitals are providing poor care to older adults?
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They will reduce reimbursements especially in the cases of CAUTIs, Pressure Ulcers, Falls, DVT, and C. Diff.
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What comprises LTC?
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A variety of services including medical and non-medical care, provided on an ongoing basis to people of all ages who have a chronic illness of physical, cognitive, or developmental disability.
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Who provides most of the care for people with LTC?
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They need to live in their own home with family, friends, and volunteers providing most of their care.
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Why is the number of older people needing LTC services dramatically increasing?
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The majority of baby boomers will need some form of LTC and 33% will spend at least 3 months in a nursing home.
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Which age group is most likely to need long term care?
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Those 80 years old or older; the number of people over 80 will increase 233% between 2008 and 2040.
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Nursing Homes; Cost of Care
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Averages $212/day or $90,000/year. Majority of cost is paid by Medicaid and then Medicare, and then pocket.
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If a patient only has medicare, how many days will a nursing home facility take them for?
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20 days.
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What is the predicted increase in the need for registered nurses in LTC?
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41%
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How many RN are required in a nursing facility at a time for 8 hours?
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Only 1 RN
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What are the main focuses of RN direct-care time per resident?
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Fewer pressure ulcers, fewer hospitalizations, fewer urinary tract infection, less weight loss, fewer caths, and less deterioration in the ability to perform ADLs.
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The main employees that provide the majority of direct care in nursing homes and contribute to the quality of life for residents are who?
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The CNAs and PCAs.
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True or False; Acute care and LTC require DIFFERENT nursing skills, judgment, and knowledge, but the nursing role is similarly demanding in both setting.
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True
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Omnibus Reconciliation Act 1986
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Elder abuse in olden times led to this act which increased staff training/ratios, eliminated use of medications and restraints for purpose of discipline or convenience, and provided quality assurance activities.
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Long-Term Ombudsman Program
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provides trained volunteers to investigate rights and quality complains or conflicts. Each facility is required to post name/contact info of each ombudsman assigned to the facility.
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Transitions are highly stressful and vulnerable to breakdowns in care because of which two main problems?
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1. Medication discrepancies 2. Pt./family are often under prepared and overwhelmed by discharge instructions/info
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How many transfers will be re-hospitalized within 30 days?
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1/4; most of these transfers can be avoided
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Gaps in care?
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Poor communication, incomplete transfer of communication, limited access to essential services.
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Who are the older adults most at risk for gaps of care?
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1. Isolated elders w/o family/friends 2. Non-English speakers, recent immigrants 3. Racially/ethnically diverse elders 4. Multiple medical conditions or depression
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What is the most frequent reason for re hospitalization in elders?
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HEART FAILURE.
