GERONTOLOGICAL NURSING PRACTICE’s IN VARIOUS SETTINGS
-
Upload
vinayak-srinivasan -
Category
Documents
-
view
219 -
download
0
Transcript of GERONTOLOGICAL NURSING PRACTICE’s IN VARIOUS SETTINGS
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
1/39
GERONTOLOGICAL NURSING
PRACTICEs IN VARIOUS SETTINGS
HOSPITAL & COMMUNITY
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
2/39
CARE SETTINGS FOR OLDER ADULTS
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
3/39
HOSPITAL SETTING
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
4/39
ACUTE CARE FACILITIES
LONG TERM CARE FACILITIES
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
5/39
ACUTE CARE FACILITIES
Intensive Care Units
Emergency Departments
Rehabilitation
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
6/39
Long Term Care Facilities
Assissted Living
Intermediate Care facilities
Skilled Care Units Alzhiemers Units
Hospice
Rehabilitation Centres
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
7/39
Intensive-Care Unit (ICU)
An Intensive-Care Unit (ICU), Critical-Care Unit
(CCU), Intensive-Therapy Unit/Intensive-
Treatment Unit (ITU) is a specialized
department in a hospital that provides
intensive care medicine.
Geriatric intensive-care unit
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
8/39
Geriatric intensive-care unit
The most important effort in critical care
practice is maintaining physiological function
and restoring homeostasis
During a critical care episode, sleeping and
waking cycles are disturbed. Because of the
noise in an ICU.
Less sleep and more noise may trigger
delirium.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
9/39
Altered eating and feeding patterns arecommon in geriatric intensive care units.
Enteral tube feeding and total parenteralnutrition have many advantages and
disadvantages.
Foley catheters are regularly inserted inpatients in the intensive care unit to monitor
fluid balance, this should be changed. urinarycatheters are known to cause urinary tractinfections, which are potentially lethal
http://en.wikipedia.org/wiki/Eatinghttp://en.wikipedia.org/wiki/Feedinghttp://en.wikipedia.org/wiki/Enteralhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Foley_catheterhttp://en.wikipedia.org/wiki/Urinary_tract_infectionshttp://en.wikipedia.org/wiki/Urinary_tract_infectionshttp://en.wikipedia.org/wiki/Urinary_tract_infectionshttp://en.wikipedia.org/wiki/Urinary_tract_infectionshttp://en.wikipedia.org/wiki/Foley_catheterhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Total_parenteral_nutritionhttp://en.wikipedia.org/wiki/Enteralhttp://en.wikipedia.org/wiki/Feedinghttp://en.wikipedia.org/wiki/Eating -
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
10/39
Disorientation to time or place because ofoverstimulation, pain and metabolic
imbalances frequently results in cognitive
changes
baseline mental status on the older patient
upon admission and follow the changes
through the use of a standardized assessment
instrument such as a Mini-Mental StateExamination
http://en.wikipedia.org/wiki/Disorientationhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Mini-Mental_State_Examinationhttp://en.wikipedia.org/wiki/Mini-Mental_State_Examinationhttp://en.wikipedia.org/wiki/Mini-Mental_State_Examinationhttp://en.wikipedia.org/wiki/Mini-Mental_State_Examinationhttp://en.wikipedia.org/wiki/Mini-Mental_State_Examinationhttp://en.wikipedia.org/wiki/Mini-Mental_State_Examinationhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Disorientation -
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
11/39
Emergency Departments Four Step Care Process
Step 1
In order to properly care elderly patients, a
"triage" system is used. Every adult coming to theEmergency Department is triaged by a nurse. Thetriage nurse asks many questions to know as muchabout the problem as possible. Upon completion of thetriage process, the elderly patient is escorted to one of
the three treatment areas of the EmergencyDepartment: Non Urgent Care Center, Urgent CareCenter or Emergent Care Center.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
12/39
Step 2
Everyone seen in the Emergency
Department must be registered. A Registration
Clerk initiates the registration process at the
bedside. Proof of identification and insurance
information should be requested.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
13/39
Step 3
A nurse provides a thorough examination as perdoctors /physician assistants orders and perform teststo help treat the problems. The doctor makes adecisions to admit or send the patient home aftertreatment in the Emergency Department.
Step 4
If a decision is made to admit, the elderly istaken care by the Charge Nurse, Head Nurse, SocialWorker, Critical Care Technician, or PatientRepresentative.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
14/39
Discharge Instructions
All patients discharged from the
Emergency Department at Robert Wood
Johnson University Hospital are sent home
with verbal and written instructions regarding
the final diagnosis given, the medications
prescribed and the appropriate follow uprequired.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
15/39
Senior Emergency Department The senior emergency department is a recent hospital
innovation to build separate geriatric emergency roomsfor older adults akin to pediatric emergency rooms
designed for children. The trend comes in response tothe nation's rapidly growing population of older adultsand overcrowding of emergency departments.[1]Typically, geriatric emergency rooms are designed toreduce anxiety, confusion and the risk of falling. Thisincludes elder-friendly lighting, softer colors, noiseabatement features, handrails and non-reflectiveflooring to reduce missteps.[2] Experts have found thenoise, chaos and crowding of typical emergency roomshave a negative impact on older patients.
CURRENT ISSUE
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
16/39
REHABILITATION
Elder care and rehabilitation services are meant for theaged who live by themselves and are sick or handicapped,or cannot look after themselves properly.
Rehabilitation refers to the gradual process of regaininga person's lost physical and mental capabilities.
AIM:
The rehabilitation centers for the elderly mainly aimat improving the life of these old individuals.
Psychology has an important role to play in
rehabilitation programs.The caregivers in rehab centers adopt a
psychological approach in treating patients.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
17/39
GOAL:
The goal of every rehabilitation
program is to help the affected person lead a
normal and active life. Traditional
rehabilitation strategies combined with social
contacts can help increase the involvement of
patients in these programs
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
18/39
Old age characterized by weakness and ill-health,make the aged depend on other people even fordoing their daily activities. With proper elder careservices, we can help improve the life of our
elders. The caregivers for elder care should beselected after thorough screening, making surethey would give the necessary care for thepatients. Different rehabilitation services are
available for the aged people such as pulmonaryrehabilitation, cardiac rehabilitation and more.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
19/39
The elderly patients in the rehab centers,
away from their dear ones long for good
companionship and wish to discuss their joys
and sorrows. The caregiver should be one withthe ability to listen and interact with them
patiently
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
20/39
ASSISSTED LIVING
Assisted living residences or assisted living
facilities (ALFs) provide supervision or assistance
with activities of daily living (ADLs); coordination
of services by outside health care providers; andmonitoring of resident activities to help to ensure
their health, safety, and well-being.
Assistance may include the administration orsupervision of medication, or personal care
services provided by a trained staff person.
http://en.wikipedia.org/wiki/Activities_of_daily_livinghttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Activities_of_daily_living -
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
21/39
types
Typical resident
A typical assisted living facility resident
would usually be a senior citizen man or a
woman who does not need the intensive care
of a nursing home but prefers more
companionship and needs some assistance in
day-to-day living.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
22/39
Special needs
The residence may assist in arranging the
appropriate medical, health, and dental care
services for each resident. The resident
generally chooses his or her medical doctor
and dental services.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
23/39
Residents who have periods of temporaryincapacity due to illness, injury, or recuperationfrom surgery often are allowed to remain in the
residence or to return from a rehabilitationcenter, skilled nursing facility or hospital ifappropriate services can be provided by theassisted living residence.
It is important to remember that assistedliving residences are a bridge between living athome and living in a nursing home. Assisted living
residences do not typically provide the level ofcontinuous skilled nursing care found in nursinghomes and hospitals
The Different Roles of Assisted Living
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
24/39
The Different Roles of Assisted Living
Staff Assisted Living Administrator:
Responsible for everyday operations,directing and supervising the work of staff in providingfor the care and needs of the residents.
Other Administrative Staff:
Employees such as the chief financial officer,human resources director, and public relations directorreport to the board or bond holders, but have little orno reason to be in direct contact with residents.
> Nurse Supervisor:This person is responsible for nursingservices. He or she coordinates nursing staff inproviding resident care, evaluates nursing services andensures quality care for residents.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
25/39
Nursing Staff (RN):
Carries out resident care plans andmay be responsible for help in administration of
medicines or other health care needs. Not allfacilities have an RN on staff around the clock.
Caregivers:
Offers resident assistance whenneeded with daily chores and activities such ascleaning, cooking and laundry.
Activity Director:
Plans physical and social activityprograms to encourage and stimulate residents.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
26/39
Food Service Coordinator:
Oversees dining services in and thecoordination of wait staff. While this person isgenerally responsible for meal planning, he or shemay not necessarily be a registered dietitian.
Office Manager:
Handles and records payments, andmakes sure that billing is adjusted according thelevel of service and amenities that have beenchosen.
Social Worker:
Provides assistance where needed tomake sure each residents physical, mental, andpsychosocial needs are being met. They may actas a liaison in helping residents deal with issues
that arise.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
27/39
INTERMEDIATE CARE FACILITIES
Intermediate Care Facilities are designed forindividuals with chronic conditions who are unable to liveindependently, but who do not need constant intensivecare.
Intermediate Care Facilities provide supportive careand nursing supervision under medical direction twenty-four hours per day, but do not provide continuous nursingcare.
They stress rehabilitation therapy that enablesindividuals to return to a home setting or regain or retain asmany functions of daily living as possible. A full range ofmedical, social, recreational and support services are alsoprovided. Intermediate Care Facilities are also known asRest Homes with Nursing Supervision
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
28/39
SKILLED CARE FACILITIES
Skilled nursing care to medically complex
patients who require 24/7 nursing care service
Many patients require 24-hour medical
attention in order to make a complete
recovery from illness or surgery. Skilled Care
Unit provides the ideal environment for
patients whose conditions have stabilized butwho still need an extra measure of care.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
29/39
The Skilled Care Unit offers a completepersonalized program. Planned by a registered
nurse, patient and the family, the program isdesigned to fulfill the social, psychological,spiritual, medical and dietary needs.
The Unit is staffed by physicians, nurses andspecialists in physical, occupational, andspeech therapies. A recreational therapistdirects a regular program of activities for
patients. Social services personnel areavailable to assist families with long-termplans.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
30/39
Hospice
Hospice is a type of care and a philosophy of
care that focuses on the palliation of a
terminally ill patient's symptoms. These
symptoms can be physical, emotional,spiritual or social in nature
http://en.wikipedia.org/wiki/Philosophyhttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Terminally_illhttp://en.wikipedia.org/wiki/Terminally_illhttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Philosophy -
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
31/39
COMMUNITY SETTING
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
32/39
Hospice
Home Health Care
Nurse run clinics
Adult -day care
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
33/39
HOSPICE
That focuses on the palliation of a terminally
ill patient's.
http://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Terminally_illhttp://en.wikipedia.org/wiki/Terminally_illhttp://en.wikipedia.org/wiki/Terminally_illhttp://en.wikipedia.org/wiki/Terminally_illhttp://en.wikipedia.org/wiki/Palliative_care -
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
34/39
HOME HEALTH CARE
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
35/39
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
36/39
Nurse run clinics
A clinic where the nurse has his or her own
patient caseload. This involves an increase in
the autonomy of the nursing role, with the
ability to admit and discharge patients fromthe clinic or to refer onto more appropriate
healthcare colleagues.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
37/39
This may include detailed physical assessment,clinical history taking, monitoring of ongoingconditions, managing medicines such as nurse
prescribing if legislation and professionaldevelopment allows this health promotion,education, and psychological support.
AIM
The aim of all nurse-led/nurse-run clinicsmust be to provide a measurably effectiveservice. Audit and evaluation are an importantpart of a developing service.
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
38/39
Adult -day care
-
8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS
39/39
THANK YOU