Module 4

• Quality of Care


  The gerontological nurse systematically evaluates the quality of care and effectiveness of nursing practice
• Performance Appraisal


  The gerontological nurse evaluates his or her own nursing practice in relation to professional practice standards and relevant statues and regulation
• Education


  The gerontological nurse acquires and maintains current knowledge applicable to nursing practice
• Collegiality


  The gerontological nurse contributes to the professional development of peers, colleagues, and others
• Ethics


  The gerontological nurse's decisions and actions on behalf of older adult are determined in an ethical manner
• Collaboration


  The gerontological nurse collaborates with the older adult, the older adult's caregiver, and all members
• Research


  The gerontological nurse interprets, applies, and evaluates research findings to inform and improve gerontological nursing practice
• Resource Utilization


  The gerontological nurse considers factors related to safety, effectiveness, and cost in planning and delivering patient care
• Ethical Issues Commonly Addressed in Gerontological Nursing


  • Artificial hydration & nutrition
  • Care decisions during chronic illness
  • Language barriers when discussing advance directives
  • Culturally influenced patterns of decision making when discussing advance directives and end-of-life care
• Role of Nurses Regarding Legal & Ethical Issues


  Communicate with older adults about advance directives, inform other members of the health care team, and address barriers in implementation<|>Facilitate decision making about advance directives by providing information and care options to older adults and proxy decision makers
• Autonomy


  Most people believe strongly that they have the right to decide what happens to their own bodies, and medical professionals support this. However, it's common for geriatric patients to arrive in the ER, or the nursing home, no longer mentally capable of making those judgments. At this point, it becomes important to determine what their wishes are, or would have been.
• Beneficence & Non Maleficence


  The charge to do good, and to "first, do no harm," comes naturally. Elder care, however, can challenge these seemingly simple directives. When a patient in the final stages of dementia requires a feeding tube, for example, the person giving care might wonder if it is kinder to go through the insertion procedure and prolong life, or to simply let nature take its course. Maybe there are concerns over whether such a patient should be dialyzed, or receive radiation or chemotherapy. Elderly men and women who seem to function tolerably well at home can quickly deteriorate in a nursing home or other long-term care setting. The question is whether they should be allowed to stay at home if they have fallen or are often forgetful. For geriatric patients, the line between helping and harming can be thin.
• Justice


  This ethical principle, which deals with health care as a resource, sometimes seems like a subject for theoretical debate. Should medical care be made available to those whom it most benefits, or to those who need it most? Note that the two positions are not the same. In the first, "utilitarian" view, health care would be skewed toward those who are most likely to recover, whereas in the second, "idealistic" stance, it would go to those in dire need, regardless of whether or not it would save them.
• Nursing Interventions for Specific Problems of Older Persons - Nutrition Support

  1. Elderly prefer Familiar foods that looks appetizing and delicious

  2. To avoid any food playing offer one dish at a time

  3. Cut foods into smaller pieces

  4. Liquids may be easier to swallow if converted to gelatin

  5. Hot foods or beverages should be offered warm, and must be checked to prevent burns

  6. As deficits progress feeding might be necessary

  7. Forgetfulness, disinterest, dental problems and choking may all serve as a barrier
• Nursing Interventions for Specific Problems of Older Persons - Stress Management

  1. Despite profound cognitive losses, patients are sometimes aware of their diminishing abilities needing constant emotional support that reinforces positive self image

  2. Goals are adjusted to fit elders ability

  3. Environment should be kept familiar and noise free

  4. Becoming familiar with particular elder's predicted responses to certain stressors helps care givers avoid similar situation
• Nursing Interventions for Specific Problems of Older Persons - Activity & Exercise

  1. Caregivers must identify the needs to be able to assist well

  2. Adequate sleep and physical exercise are essential

  3. If sleep is interrupted or cannot sleep, music, warm milk, or a back rub may help the patient to relax

  4. During the day they should be encouraged to participate in exercise because a regular pattern of activity and rest enhances night time sleep

  5. Long periods of sleep are discouraged
• Nursing Interventions for Specific Problems of Older Persons - Respiratory Management

  1. Stop smoking, because it is the single most important preventable cause of disease

  2. Pneumonia & Influenza Vaccinations and prevention of environmental tobacco smoke and crowded places during flu season

  3. Prevent Respiratory infections by proper hygienic measures such as hand washing

  4. Techniques such as Deep Breathing, and HOB elevation are also management for respiratory difficulties or disorders
• Nursing Interventions for Specific Problems of Older Persons - Tissue Perfusion Management


  Specifics are addressed to risk factors such as hypertension, smoking, obesity and lipid disorders as well as preventive measures like stress reduction, healthy dietary pattern and most of the time medical or pharmacologic intervention
• Nursing Interventions for Specific Problems of Older Persons - Electrolyte & Acid – Base Balance Management


  1. Ensure adequate fluid intake or hydration at 1500-2500 mL per day in the absence of disorders like heart failure

  2. The fluid intake recommendation should be tailored for the elders and provides basic suggestion only

  3. Though it is not known why nocturia increases with old age, it has been suggested that GFR and clearance of electrolytes decreases with standing and is enhanced with horizontal positioning

  4. Nocturia and urinary incontinence may cause the elderly to voluntarily restrict their fluid intake. Holding fluids 2 hours before bedtime may help decrease the frequency of nocturia and nighttime incontinence.

  5. Provide ventilation through fans, drape windows from direct sunlight, and use air conditioning to assist with controlling fluid loss from excessive room temperature.
• Nursing Interventions for Specific Problems of Older Persons - Skin & Wound Management

  1. Bathing: Skin should be cleaned with mild soap and warm water and gently patted dry. Or a no-rinse cleanser can be used.

  2. Protecting skin: Skin that is vulnerable to excess moisture can be protected with talcum powder. Dry skin should have lotion applied.

  3. Inspecting skin: Daily skin inspection is important for identifying vulnerable areas of skin or early signs of pressure sores.

  4. Managing incontinence: Urinary or bowel incontinence should be managed to prevent moisture and bacterial exposure to skin. Care may include frequently scheduled assistance with urinating, frequent diaper changes, protective lotions on healthy skin, urinary catheters or rectal tubes.

  5. Cleaning: It's essential to keep wounds clean to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores are cleaned with saline solution each time the dressing is changed.

  6. Dressings: A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings. A combination of dressings may be used. Your doctor selects an appropriate dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of application and removal.

  7. Pain management: Interventions that may reduce pain include the use of nonsteroidal anti-inflammatory drugs — such as ibuprofen (Mo
• Skin care


  1. Frequent assistance with urinating

  2. Frequent diaper changes

  3. Applying protective lotions

  4. Using urinary catheters or rectal tubes
• Cleaning wounds


  1. Gently washing stage I wounds with water and mild soap

  2. Cleaning open sores with saline solution each time the dressing is changed
• Dressings


  Promote healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry
• Types of dressings


  • Films
  • Gauzes
  • Gels
  • Foams
  • Various treated coverings
• Selecting dressings


  Based on size and severity of the wound, amount of discharge, and ease of application and removal
• Pain management


  1. Using nonsteroidal anti-inflammatory drugs before and after repositioning, debridement procedures and dressing changes

  2. Using topical pain medications like lidocaine and prilocaine during debridement and dressing changes
• Treating infected pressure sores

  Using topical or oral antibiotics
• Repositioning in a wheelchair


  1. As much as possible on their own every 15 minutes

  2. Assisted with every hour

  3. Using foam, gel, and water filled cushions to relieve pressure and ensure proper positioning
• Repositioning in bed


  1. At least every 2 hours

  2. Raising HOB to no more than 30°

  3. Protecting bony areas with proper cushioning rather than lying directly on a hip
• Coping assistance


  1. Assisting older persons to identify stressors and rate their levels of stress

  2. Educating about stress theory and the stress cycle

  3. Helping identify successful coping mechanisms used in the past

  4. Assisting to examine and alter current coping mechanisms

  5. Reinforcing and strengthening positive coping mechanisms

  6. Investigating community resources, support groups, stress-reduction clinics, and other stress relievers
• Patient education


  1. Enhancing self esteem by improving functioning, using verbal and non verbal communication

  2. Promoting sense of control by providing information, rephrasing events, addressing threats

  3. Involving them in decision making by challenging attitudes, facilitating communication

  4. Encouraging life review & reminiscence
• Spiritual care


  Communicating, caring and compassion, instilling hope, referring for spiritual care, encouraging participation in religious activities
• Risk reduction activities


  • Lifestyle interventions like weight management, optimal nutrition, adequate physical activity, sufficient sleep and stress relieving techniques
  • Using OTC medications, nutritional supplements, complementary and alternative therapies
  • Vaccinations
• Managing the environment


  Modifying the environment to decrease falls and injuries while considering familiarity for the older person
• The Expanded Senior Citizens Act of 2003 granted additional benefits and privileges to senior citizens
• The Expanded Senior Citizens Act of 2010 further amended the previous act, including provisions for the DOH to administer free vaccination against influenza and pneumococcal diseases for indigent senior citizens
• The Senior Citizens Center Act of the Philippines established senior citizens centers in all cities and municipalities
• The Centenarians Act of 2010 grants 50 percent discount and VAT exemption on goods and services for Filipino citizens who reach the age of 100 years and above
• Wellbeing/Quality of life for older people

  Feeling safe, listened to, valued and respected<|>Able to get the help they need, when they need it, in the way they want it<|>Living in a place which suits them and their lives<|>Able to do the things that matter to them
• Responses to care


  • Expressing satisfaction with improved cognitive abilities
  • Able to use cognitive skills in everyday activities
  • Positive self-perception
  • Involvement in Decision Making
  • Effective coping strategies
  • Expressed feelings of improved quality of life
  • Daily nutrient intake that corresponds to metabolic need
  • Achieving or maintaining body weight within 110% of ideal
  • Achieving or maintaining regular bowel elimination
  • Verbalization of correct information about risks
  • Reported participation in health promotion interventions
  • Indicators of cardiovascular function within normal range
  • Ease of breathing
  • Up-to-date status of pneumonia immunization
  • Influenza immunization per year
  • Smoking cessation project participation
  • Expressed feelings of being rested upon awakening
  • Improved score on sleep assessment tool
  • Observation of person sleeping at midnight