N330: Nursing Care of the Aging Adult Credits: 3 Lecture Semesters Offered: F, S Prerequisites: N215, N228, N229 or RN Status MONTANA STATE UNIVERSITY COLLEGE OF NURSING Master Resource Outline Course Description: Analysis of the health and functional status of aging adults and the planning of nursing interventions. Emphasis is upon approaches for promoting functional ability and quality of life of the aging adult. Course Objectives: 1. Analyze the impact that values/beliefs about aging have on the quality of health care of aging adults 2. Discuss age-related changes based on an understanding of physiological, cultural, social, psychological, and spiritual functioning. 3. Develop a holistic gerontological nursing approach integrating theories of aging, normal aging changes, environmental influences, and the nursing process. 4. Contrast techniques and approaches of health assessment needed for aging adults with that of younger populations. 5. Analyze common health problems of aging adults using a framework of functional health patterns. 6. Plan interventions for alleviating selected health problems in aging adults. 7. Formulate strategies for promotion of health with aging adults. 8. Examine bioethical and legal issues facing aging adults, their families, and health care providers. 9. Analyze trends and issues as they impact health care services to aging adults. Approved by Faculty: 11/4/89; Reaffirmed 4/98 9/98:MRO.330 1
Recommended Content and Concepts: A. Theories of Aging Attitudes about aging Review of theories of aging and normal age changes Nursing approaches based on theories of aging, normal age changes and the nursing process B. Nursing Process Special techniques and considerations in the assessment of aging adults; functional assessment Functional health patterns and nursing diagnoses common in aging adults; planning for nursing interventions: 1. Health perception/health maintenance and management a. Health promotion/health screening (including tests recommended and frequencies, e.g., wellness exams, mammograms, colorectal, etc.) b. Health seeking behaviors c. Altered health maintenance d. Potential for infection and/or infection transmission e. Potential for injury (accident prevention) 2. Nutrition/metabolic a. Nutrition: More or less than body requirements b. Skin integrity c. Fluid volume deficit/excess 3. Elimination a. Altered bowel elimination: Constipation, diarrhea of incontinence b. Altered urinary elimination: Incontinence, stress incontinence, retention 4. Activity/exercise and sleep/rest a. Activity intolerance (fatigue) b. Physical mobility (including foot care) c. Sleep pattern disturbance d. Self-care deficits e. Self-help 5. Cognitive/perceptual/sensory a. Altered thought processes (situational confusion including relocation, visual and auditory disruptions) b. Sensory/perceptual alterations (including overload and deprivation) c. Chronic pain management 6. Self-perception/Self-concept 7. Role and role relationships a. Role changes b. Social isolation c. Impaired social interaction d. Caregiving roles (sandwich generation) e. Altered family processes 8. Sexuality/reproductive a. Sexuality b. Intimacy 9. Coping/stress tolerance a. Spirituality b. Losses 10. Values/beliefs a. Cultural variations C. Commonly encountered health issues Climacteric (male/female) Osteoporosis Polypharmacy, drug interactions, drug profile concept 2
D. Bioethical and legal issues associated with aging Right to die/live (Confirmed 420) Quality of life (N330, Aging) Right to spiritual care (N330) Right to privacy (N330) Right to self-determination (N330) Rationing of health care (Confirmed in 420 as resource allocation) Client's rights (living will) (Confirmed 420) Euthanasia (Confirmed 420) Power of attorney (N330) Guardianship (N330) DNR processes (Negotiate with 420) Elder abuse (N341, confirmed) E. Economics and politics of aging Percent of health care dollar used by older adults (Confirmed in N420) Sources of funding (private, state, federal) (Confirmed 420) Social security/ssi (Confirmed 420/479) Payment mechanisms (Medicare, Medicaid, DRGs) (Confirmed 420/479) Income changes of the older adult (N330) Legislative and governmental processes (N479 N420 - Confirmed) Federal, state, local aging agencies (AAA, State Division of Aging) (330) Resources & referral (Confirmed 420/479) F. Health care services available specifically for aging adults (reinforce as appropriate in N479) (All in N330) Social, political, economic aspects of long term care Long-term care policy issues Problems associated with changes in residence or care setting (relocation) Problems associated with activities of daily living in institutions Problems associated with long-term care in non-institutional settings Examples of Learning Activities: Lecture Discussion/seminars Small group work Case studies/simulations Self-assessments Debates Scholarly papers: bioethical issues, legal issues, theories of aging Values clarification Analysis of appropriate standardized care plans Individual/small group design of nursing care plans Audio-visual materials Analysis of health promotion printed materials Role-playing Planning and presenting educational programs for aging consumers in the community Panel of active elders Panel of caregivers Attendance at support group meetings Analysis of screening services in the community Analysis of senior services in the community Preparation or revision of community resource booklets for the aged Assigned readings CAI Guest speakers (elderly clients/experts) Newspapers and magazines Simulations/demonstration of physical assessment 3
Scope of the Course This course provides the basic gerontological nursing framework upon which concurrent and subsequent courses will build. The developmental range includes middlescence through the frail elderly. Clinical/laboratory application is expected in the following courses: N341, Psychosocial Nursing Concepts N436, Psychiatric Nursing N358, Medical-Surgical Nursing I N458, Medical-Surgical Nursing II N479, Community Health Nursing N420, Legal-Ethical Nursing Concepts N340, Physiological Nursing Concepts Specific experiences to be integrated into other courses in the curriculum: A. Preparation and analysis of a drug profile on an aging adult (358, 458, or 479) B. Health screening participation (N479) C. The following concepts with nursing management in N358/458: decubitus ulcer (358, confirmed) impaired swallowing (358, confirmed) impaired communication (358, confirmed) chronic pain D. The following concepts in N436: dementia depression in the elderly delirium and confusion suicide E. Substance abuse in the elderly in N341 4
"It is hoped that the baccalaureate graduate will be prepared to function as a generalist gerontological nurse as described by this document." GERONTOLOGICAL NURSING PRACTICE* Gerontological nursing practice involves assessing the health and functional status of older adults, planning and providing appropriate nursing and other health care services, and evaluating the effectiveness of such care. Emphasis is placed on maximizing functional ability in the activities of daily living; promoting, maintaining, and restoring health, including mental health; preventing and minimizing the disabilities of acute and chronic illness; and maintaining life in dignity and comfort until death. Gerontological nursing may be practiced in any setting, for example, the nursing home, the hospital, the client's home, the clinic, and the community. Gerontological nursing focuses on the client and family (in this document, the term family refers to family members and significant others). Generalist Nursing Practice The professional nurse practicing gerontological nursing at the generalist level functions in a variety of institutions, the home, and other community settings. The responsibilities of the generalist include direct care, management and development of professional and other nursing personnel, and evaluation of care and services for older persons. All professional nurses practicing gerontological nursing possess the basic knowledge and skills to do the following: 1. Develop, implement, and evaluate the older person's plan of care. 2. Establish a therapeutic relationship with the older person and family to facilitate their collaboration with the nurse in developing, implementing, and evaluating the plan of care. 3. Recognize age-related changes based on an understanding of physiological, cultural, social, psychological, and spiritual functioning. 4. Collect data to determine health status and functional abilities in order to plan, implement, and evaluate care. 5. Participate as a member of the interdisciplinary team. 6. Participate with older persons, families, and other health professionals in ethical decision making that is clientcentered, empathetic, and humane. 7. Teach older persons and families about measures that promote, maintain, and restore health or promote comfort. 8. Refer the older person to other professionals or community resources for assistance as necessary. 9. Apply the existing body of knowledge in gerontology to nursing practice. 10. Exercise accountability to the older person by protecting that person's rights and autonomy. 11. Use the standards of gerontological nursing practice and the nursing process to increase the quality of care of the older person. *A.N.A. Gerontological Standards 9/98:MRO.330 5