N4346Introwhyusecritthink.ppt

Preparing Nursing Students to Care for Older Adults

Introduction to N4346Gerontologic Nursing

Older Adults as Frail and in Need of Care

12/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development 2

What is Ageism?

Deep Societal Prejudice Against Older AdultsPersonal Revulsion/Distaste for Growing OldFear of Powerlessness, Uselessness, & DeathStereotyping and DiscriminationSeeing Elders as a Threat due to ↑ NumbersA “Cost Drain” to SocietySubtle Cease to Exist as “human beings”

Older Adults as Healthy and Active





Currently Much of All Health Care Is Devoted to Care of Older Adults

57% of all visits to generalist physicians 50% of hospital expenditures 80% of home care visits 90% of nursing home care


Older Adults in HospitalsOf all adult patients, people >65 make up:

• 47% of patients with anemia• 53% of patients receiving respiratory therapy• 64% of patients with heart disease• 66% of patients with urinary tract infections• 70% of patients with pneumonia• 78% of patients with CHF


Older Adults Are a Hospital’s CORE Business

Slow & progressive “aging” of who occupies hospital beds

Make up 52% of non-obstetric hospital days Long lengths of stay (7.8 vs. 5.4 days) High rates of re-admission within 30 days Documented functional declines & medical errors


Older Adults in Hospitals

60% of med-surg patients 46% of CCU patients 50% of ICU days 60% of all visits to cardiologists 63% of visits to oncologists In ERs, 26% of hospital admissions after trauma


Older Patients Experience Many Adverse Health Events

88% of older people have chronic conditions Common adverse events (IOM Report, 1999):

Pressure ulcers Medication errors Delirium Physical restraint use


Older Adults Most at Risk of Long LOS, Re-admission, & High ER Use

1. Dementia2. Physical and cognitive co-morbidities

LOS of older patients with dementia and CHF, CHD, diabetes, COPD is 3 times longer than for patients with physical illness alone

3. Complex diagnosis:10-30% of older patients4. Behavioral problems; 51% of older patients

(one study)



Dementia + Chronic Illness Compounds Complication Rate

Children as Core Business


Children as Core Business

dukechildrens.org“We’re all about kids”


University of Virginia Children’s Hospital

Web site and resources for children

1712/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development

Hospitals’ Response Given that Older Adults Are Their CORE Business Promotional materials and web site show pictures

of babies and children Little special programming and/or structure to

address needs of older adults, e.g.: Large print signage and written materials Bed height, chair configurations, mobility aids Strategies for patients with dementia, e.g.

protocols to minimize disruption of routines


Hospitals’ Response Given that Older Adults Are Their CORE Business

No national gerontological/geriatric certification requirements (>1% of RNs nationally ANCC certified in gerontological nursing vs 19% of nurses in children’s hospitals certified in pediatrics)

No national scopes and standards for care of older adults

No Magnet or JCAHO requirements for staff competence in care of older adults



Introduction• Caring for older adults is both complex and

challenging– Complex because of the array and number

of chronic illnesses facing older adults, only expected to increase with longevity

– Challenging because given the demand for skilled health care providers in geriatrics/gerontology, which far exceeds the capacity of current geriatric nurses and other health professionals


Average 75 yo experiencing at least three per person

90% over 65 yo have one or more chronic conditions

Introduction

• Caring for older adults is, and will continue to be, the “core business” of health care institutions

• As a result of consequences of an aging population with chronic illness, older adults are the predominate users of the health care system

2212/18/2006 9:45am eSlide - P3562 - AACN Hartford-sponsored Faculty Development

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Introduction

• Envisioning healthcare professionals in all health care settings, educators and new students entering nursing to question:


“Am I prepared to provide the very best geriatric care when called to do so?”

Introduction

• Want positive outcomes? Critical thinking is used especially when ~– certain evidence-based nursing assessments are made– certain evidence-based nursing management approaches

are followed – certain evidence-based system approaches are provided


Introduction

• This course uses a comprehensive approach • Touching key areas to form a core set of elements that nurses’

caring for older adults must think about and integrate into practice

• Key elements that frame 5 specific recommendations for nursing care of older adults of advanced old age with co-morbidities


Why Should Nurses Utilize Critical Thinking When Caring for Older Adults

with Chronicity/Complex Needs?

Five recommendations:1. Conduct advance health planning and make decisions • Assessment• diagnostic testing • treatments for chronic conditions – life expectancy– Functional– physical and cognitive status– quality of life – availability of social supports

2. Considered at increased risk to develop adverse response and complications related to mediations, treatment and geriatric syndromes




3. Viewed as an “at risk” population 4. Assessed for • Functional and cognitive status• Pain• Geriatric syndromes – Delirium– Fall risk– Presence of urinary incontinence– Pressure ulcers

• Irrespective of setting in the hospital – Emergency room– Oncology unit– Critical care




5. Access to hospital system-based models of care • Geriatric Resource Nurses• Acute Care of the Elderly Units (ACE)• Inter-disciplinary assessment• Volunteer programs (HELP)• Case management to implement strategies that prevent geriatric

syndromes • limited or no use of physical restraints• early and consistent walking and ambulation• removal from pharmaceutical formularies of medication known to

cause high adverse drug events• early treatment of functional decline and cognitive impairment due

to delirium, depression, and dementia


Our Partnership for Learning

• Tell Me and I Will Forget.• Show Me and I Will Remember.• Involve Me and I Will Understand.

David Kolb quoting Confucius

Documents

N4346Introwhyusecritthink.ppt