Chapter 1: Introduction to Gerontological Nursing

1. Chapter 1: Introduction to Gerontological Nursing

2. Learning Objectives • Define important terms related to nursing and the aging process. • Outline significant landmarks that have influenced the development of gerontological nursing as a specialty. • Identify several subfields of gerontological nursing. • Develop the beginnings of a personal philosophy of aging. • Describe the unique roles of the gerontological nurse.

3. Learning Objectives (cont’d) • Discuss the scope and standards of gerontological nursing practice. • Examine core competencies in gerontological nursing practice. • Compare the nine essentials of baccalaureate nursing education with the core competencies in gerontological nursing. • Distinguish among the educational preparation, practice roles, and certification requirements of the various levels of gerontological nursing practice.

4. History of Gerontological Nursing • 1960s: ANA forms gerontological nursing specialty • 1970s: Veterans Administration (VA) funds Geriatric Research Education and Clinical Centers • 1980s: The National Gerontological Nursing Association (NGNA) established • 1990s: Hartford Foundation Institute for Geriatric Nursing established at NYU • 21st century: “baby boomers” begin turning 65; growing interest in gerontological care

5. Attitudes towards Aging • Television, Media, Newspapers, Film industry, Commercials in magazines and on TV, Greeting card/birthday cards • Observation of family members, friends, neighbors, and your own experience with older adults. • Examine myths and realities, separate fact from fiction. • Ageism: negative attitude toward aging or older adults.

6. Three major misconceptions about aging • Disease in old age is normal • Older adults have no future and therefore health promotion efforts are wasted • Damage to health from poor diet and inactivity is irreversible

7. Definitions of “old” • Chronological age • young-old: 65 - 74 • middle-old: 75 - 84 • old-old (frail elderly): 85+ • Biological age * Among individuals, vast differences exist between biological and chronological aging.

8. Youth is not a time of life; it is a state of mind; it is not a matter of rosy cheeks, red lips and supple knees; it is a matter of the will,….   Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul….. When the aerials are down, and your spirit is covered with snows of cynicism and the ice of pessimism, then you are grown old, even at twenty, but as long as your aerials are up, to catch the waves of optimism, there is hope you may die young at eighty.(Samuel Ullman “Youth”)

9. Definitions • Gerontology: study of aging and/or the aged. • Geriatrics: medical care of the aged. • Gerontological nursing: discipline of nursing practice includes all older adults from the time of “old age” until death. • Subfields of gerontology: geriatrics, social gerontology, geropsychology, geropharmacology, gerontological nursing, gerontological rehabilitation nursing.

10. Roles of the Gerontological Nurse • Direct-care provider • Teacher • Leader • Advocate • Evidence-based clinician

11. Certifications • Generalist Certification • Entry level • diploma in nursing, or an associate or bachelor of science degree in nursing • 2 years nursing experience • Advanced Practice Certification • Clinical specialist in gerontological nursing (GCNS-BC) • Gerontological nurse practitioner (GNP-BC)

12. Scope & Standards of Practice • Scope of nursing practice • defined by state regulation • influenced by the complex and multifaceted needs of the population being served • depends on the setting in which the nurse practices • Standards of nursing practice • developed by the nursing profession • These standards are divided into clinical care and the role of the professional nurse • There are six standards: assessment, diagnosis, outcome identification, planning, implementation, evaluation

13. AACN/Hartford Competencies • Gerocompetencies • 9 Essentials of Baccalaureate Education for Professional Nursing Practice: • Liberal Education for Baccalaureate Generalist Nursing Practice • Basic Organizational and Systems Leadership for Quality Care and Patient Safety • Scholarship for Evidence-Based Practice • Information Management and Application of Patient Care Technology • Healthcare Policy, Finance, and Regulatory Environment • Interprofessional Communication and Collaboration for Improving Patient Health Outcomes • Clinical Prevention and Population Health • Professionalism and Professional Values • Baccalaureate Generalist Nursing Practice

14. AACN/Hartford Competencies • Incorporate professional attitudes, values, and expectations about physical and mental aging in the provision of patient-centered care for older adults and their families. (Essential VIII) • Assess barriers for older adults in receiving, understanding, and giving of information. (Essentials IV & IX) • Use valid and reliable assessment tools to guide nursing practice for older adults. (Essential IX) • Assess the living environment as it relates to functional, physical, cognitive, psychological, and social needs of older adults. (Essential IX) • Intervene to assist older adults and their support network to achieve personal goals, based on the analysis of the living environment and availability of community resources. (Essential VII)

15. AACN/Hartford Competencies • Identify actual or potential mistreatment (physical, mental, or financial abuse, and/or self-neglect) in older adults and refer appropriately. (Essential V) • Implement strategies and use online guidelines to prevent and/or identify and manage geriatric syndromes. (Essentials IV & IX) • Recognize and respect the variations of care, the increased complexity, and the increased use of healthcare resources inherent in caring for older adults. (Essentials IV & IX) • Recognize the complex interaction of acute and chronic comorbid physical and mental conditions and associated treatments common to older adults. (Essential IX) • Compare models of care that promote safe, quality physical and mental health care for older adults such as PACE, NICHE, Guided Care, Culture Change, and Transitional Care Models. (Essential II)

16. AACN/Hartford Competencies • Facilitate ethical, noncoercive decision making by older adults and/or families/caregivers for maintaining everyday living, receiving treatment, initiating advance directives, and implementing end-of-life care. (Essential VIII) • Promote adherence to the evidence-based practice of providing restraint-free care (both physical and chemical restraints). (Essential II) • Integrate leadership and communication techniques that foster discussion and reflection on the extent to which diversity (among nurses, nurse assistive personnel, therapists, physicians, and patients) has the potential to impact the care of older adults. (Essential VI) • Facilitate safe and effective transitions across levels of care, including acute, community-based, and long-term care (e.g., home, assisted living, hospice, nursing homes) for older adults and their families. (Essentials IV & IX)

17. AACN/Hartford Competencies • Plan patient-centered care with consideration for mental and physical health and well-being of informal and formal caregivers of older adults. (Essential IX) • Advocate for timely and appropriate palliative and hospice care for older adults with physical and cognitive impairments. (Essential IX) • Implement and monitor strategies to prevent risk and promote quality and safety (e.g., falls, medication mismanagement, pressure ulcers) in the nursing care of older adults with physical and cognitive needs. (Essentials II & IV) • Utilize resources/programs to promote functional, physical, and mental wellness in older adults. (Essential VII) • Integrate relevant theories and concepts included in a liberal education into the delivery of patient-centered care for older adults. (Essential I)

18. Question Which of the following is NOT performed by gerontological nurses? • Maximize patient independence • Evaluate the effectiveness of their care • Identify the strengths and limitations of their patients • Prescribe medications for common conditions of aging

19. The AACN/John A. Hartford Foundation Competencies are helpful to nurses because they: A. offer suggestions about how to gain employment in geriatrics B. provide a guideline for the knowledge that is expected to provide quality care to older adults C. were designed to prepare nurses to pass the State Board Exam D. were written for nurses working on a graduate degree in gerontology

20. Summary • Gerontological nursing is a specialty practice focusing on the unique needs of older adults and their families. • Caring for older adults is influenced by many factors, including recognizing one’s own attitude about aging. • As the older population grows, more gerontological nurses will be needed.