gerontological nursing practice’s in various settings

8/2/2019 GERONTOLOGICAL NURSING PRACTICEs IN VARIOUS SETTINGS

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GERONTOLOGICAL NURSING

PRACTICEs IN VARIOUS SETTINGS

HOSPITAL & COMMUNITY


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CARE SETTINGS FOR OLDER ADULTS


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HOSPITAL SETTING


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ACUTE CARE FACILITIES

LONG TERM CARE FACILITIES


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ACUTE CARE FACILITIES

Intensive Care Units

Emergency Departments

Rehabilitation


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Long Term Care Facilities

Assissted Living

Intermediate Care facilities

Skilled Care Units Alzhiemers Units

Hospice

Rehabilitation Centres


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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


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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.


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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


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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


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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.


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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.


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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.


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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.


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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


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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.


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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


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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.


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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


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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


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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.


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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.


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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


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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.


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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.


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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.


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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


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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.


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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.


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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


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COMMUNITY SETTING


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Hospice

Home Health Care

Nurse run clinics

Adult -day care


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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


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HOME HEALTH CARE


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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.


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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.


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Adult -day care


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THANK YOU

gerontological nursing practice’s in various settings

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