October 25, 2022

Describe and discuss the nurses role in health promotion and disease prevention in older adults. Share an example from your personal experience as a RN. Name and elaborate on at least th

Nursing

After studying Module 2: Lecture Materials & Resources, discuss the following:

Describe and discuss the nurse’s role in health promotion and disease prevention in older adults. Share an example from your personal experience as a RN.
Name and elaborate on at least three screening/preventive procedure that must be done in older adults.
Define and discuss three common End-of-life documents that you as nurse must be familiar with to be able to educate older adults.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Chapter 6

Family Influences

Families play a significant role in the lives of most older persons.

85% of all senior citizens will need in-home assistance at some point in their lives.

78% of in-home care is provided by unpaid family members and friends.

Most of the care for the older adult is provided in the home environment.

Role and Function of Families

Demographic and Social Trends That Affect Family Support

Increasing aging population

Living arrangements

Disability and activity

Decrease in birth rate

Increase in employment of women

Mobility of families

Increase in number of blended families

Older adult providing as well as receiving support

State of the senior housing industry

Caregiver workplace issues

Common Late-life Family Issues and Decisions

Most common issues and difficult decisions families face include:

Changes in living arrangements

Nursing facility placement

Financial and legal concerns

End-of-life health care decisions

Vehicle driving issues

Family caregiving

Family members struggle with allowing a person to be as independent as possible and creating a more secure environment.

Older person views loss of independence as “being closer to the grave.”

As long as they have the mental capacity to make decisions, they cannot be forced to accept help.

If an older adult is resistant to accepting other living arrangements, nurses can help families ask crucial questions and use the answers to guide the older adult to accepting a safer alternative.

Changes in Living Arrangements

They are more options available than long-term care facilities including assisted living and continuing care retirement community.

The decision to move an older family member into any type of care facility is difficult.

Decision is filled with guilt, sadness, anxiety, doubt, and anger—even when the older person makes the decision.

Talk with family members about the potential benefits of a care facility.

Care Facility Placement

Paying for long-term care

Nurses should know about the community resources that are available and the eligibility requirements.

Financial and legal plans are necessary when the older adult has been diagnosed with Alzheimer’s disease or related disorders.

Durable power of attorney

Financial and Legal Concerns

A useful tool to help with end-of-life planning is “Five Wishes”:

The person I want to make health care decisions for me when I cannot

The kind of medical treatment I want or do not want

How comfortable I want to be

How I want people to treat me

What I want my loved ones to know

End-of-Life Health Care Decisions

Older drivers are more likely to get into accidents, receive traffic violations, and suffer serious injury or fatality.

Factors that contribute to increased risk are as follows: Loss of hearing acuity, loss of visual acuity, limited mobility and increased reaction time, medications, dementia, or mental impairment.

Families may need assistance assessing a person’s driving ability and following a recommendation that their relative should limit or discontinue driving.

Issue of Driving

Primarily provided by the adult children of the older adult (daughters and daughter-in-law)

Types of family caregiving: Routine care, backup care, circumscribed care, sporadic care, dissociation

More families are faced with long-distance caregiving.

Family member with Alzheimer’s disease will require increasing levels of support and assistance as the disease progresses.

Caregiver’s may feel a sense of failure when placement is necessary.

Caregiving is stressful.

Family Caregiving

Few families are prepared to cope with the physical, financial, and emotional costs of caregiving.

If the caregiver is employed, work relationships may be compromised.

Many caregivers express frustration regarding the inequality of the contributions of their siblings.

Caregiving can also be regarded as a beneficial opportunity where the caregiving situation demonstrates love and commitment.

Challenges and Opportunities of Caregiving

Caregivers may be unprepared for their new role so attending an educational program may help

Caregiver information needs

Understanding the family member’s medical condition

Improving coping skills

Dealing with family issues

Communicating effectively with older persons

Using community services

Long-term planning

Education to Support Family Caregivers

To provide caregivers with the confidence that they need to do a task or take an action

It is critical to give caregivers an opportunity to practice skills in a learning environment that is nonthreatening and psychologically safe.

Discuss the barriers caregivers may confront in the real world and ways to overcome these barriers.

Share printed information.

Goals of Caregiver Education

Allow caregivers planned time away from their caregiving role.

Benefits to the patient may include interactions with others in a similar situation; safe, supportive environment; and activities that will match their needs and abilities.

Care receivers benefit from caregivers being more refreshed after a break.

Nurses can educate on and encourage respite care.

Respite Programs

Lack of awareness

Apprehension

Caregiver attitudes

Timing

Finances

Care receiver resistance

Energy required to use the program

Program inflexibility and bureaucracy

Barriers to Access and Use of Respite Services

Caregivers get advice.

Gain knowledge about their older relatives’ medical conditions and problems.

Share experiences and feelings.

Develop new coping strategies.

Learn about community resources and care alternatives.

Caregiver Support Groups

Beliefs about what is best often differ, creating family dissension so a meeting should be held early.

Everyone who is concerned/affected by decisions should be involved, including the older person.

Hold in a neutral setting.

Create a feeling of support and confidentiality.

Acknowledge everyone has a different relationship, and perspectives.

Family Meetings (1 of 2)

Give everyone the chance to express themselves and offer suggestions.

Keep the meeting focused on current concerns.

Focus on the positive things family members do, and encourage everyone to be honest about their limitations.

Prepare a written plan about decisions made, what each person will do, and when he or she will do it.

Family Meetings (2 of 2)

Quick Quiz!

Being a caregiver for an older adult is challenging. Name three things that nurses can do to help and support the caregiver in this role.

Answer to Quick Quiz

Possible answers:

Educate them in understanding the older adult's medical problem.

Give them a list of community services.

Inform them of respite care options and encourage their use.

Offer to hold a family meeting to help siblings express concerns and manage their roles.

Provide written materials.

Identify who is the patient and who are the family members.

Assess the family, relationships, and dynamics.

Roles, loyalties, and obligations

Dependence and independence

Caregiver stress

Working With Families of Older Adults: Considerations and Strategies

Help family members communicate their concerns honestly and positively.

Planning requires anticipating negative situations like dependency, disability, incapacity, and death, and exploring actions to be taken.

Critical time for discussion is when a family member shows signs of deterioration or has been diagnosed with a degenerative disease like Alzheimer’s.

Talk about “what ifs.”

Express good intentions and a willingness to listen.

Help family members communicate their concerns honestly.

Advanced Family Planning

A person who is excluded from decision making is more likely to become angry, demanding, helpless, or withdrawn.

Involvement in decision making provides greater assurance that a person will accept and adapt to a change, even if the change is not the person’s preferred choice.

Involve the Older Person in Decisions

Families experience many emotions when faced with difficult decisions and caregiving: Grief, frustration, anger, resentment, embarrassment, or guilt.

Family members may need to adjust their perception of the ill person.

Feelings, beliefs, and attitudes influence behavior, so address the belief systems and feelings of family members.

Deal with feelings of guilt since it reduces objectivity and the ability to make decisions that are best for everyone.

Nurses can discuss and reinforce the “goodness of intent” underlying their actions when the actual action taken may turn out not to be the best choice.

Consider Feelings

Take care of yourself.

Maintain contact with friends.

Caregiving to adults very stressful.

It is okay not to love the older person who needs care.

Asking for help is a sign of strength.

Caregivers have a right to set limits and to say no.

Taking regular breaks early in caregiving is not selfish.

Make caregiving decisions based on the needs of everyone involved.

Moving a family member into a care facility can be the most loving step to take.

Caregivers should focus on what they have done well―and forgive themselves.

Ten Important Things to Share With Caregivers

Recommend this six-step model to help families problem solve:

Gather information

Formulate options

Evaluate options

Create a plan

Implement the plan

Reassess

A Decision Making Model for Families

Chapter 5

Cultural Influences

It is projected that by 2044 those persons from groups that have long been counted as statistical minorities will become the emerging majority.

Immigrant population is growing at a faster rate than that of the native born.

Senior communities and health care facilities will need to advance their cultural competence.

It is likely that many of these older adults will not speak the same language as the nurse.

Diversity of the Older Adult Population in the United States

Nurses are challenged to gain new awareness, knowledge, and skills to provide culturally and linguistically appropriate care.

Culturally compassionate care reduces health disparities.

Culturally appropriate care begins with an increasing awareness of our own beliefs and attitudes.

Conduct a cultural self-assessment

Culturally Sensitive Gerontologic Nursing Care

Cultural Concepts

Culture

Enculturation

Values

Acculturation

Race

Ethnicity and ethnic identity

Ethnocentrism

Racism

Cultural conflict

Are grounded in culture and influenced by past experience

Magico-religious theory

Health, illness, and effectiveness of treatment are believed to be caused by the actions of a higher power.

Health is viewed as a blessing or a reward, and illness is viewed as a punishment.

Treatments may involve religious practices such as praying, meditating, fasting, wearing amulets, burning candles, or establishing family altars.

Beliefs About Health and Illness

The right amount of exercise, food, sleep, evacuation, interpersonal relationships, or geophysical and metaphysical forces in the universe

Disturbances balance results in disharmony and subsequent illness.

Interventions aim at restoring balance.

Yin/yang theory

Hot/cold theory

Balance and Harmony

The body is viewed as a functioning machine.

Health is a state of optimum functioning along with the absence of microorganisms such as bacteria or viruses.

Treatment is directed at repair or removal of the damaged part or administration of drugs to kill or retard the growth of the causative organism.

The Biomedical or Western Perspective

Time orientation

Past

Perceive present health and health problems as the result of past actions, from a past life, from earlier in this life, or from events and circumstances related to one’s ancestors

Present

Perceive a new health problem to need attention in the immediate present

Future

Holders of a future orientation accept that what we do now affects our future health.

Transcending Cultural Concepts

Autonomy and individual responsibility are paramount.

Identity and self-esteem are bound to the self rather than to a group.

Decisions should be made autonomously.

The Patient Self-Determination Act (PSDA)

The Health Insurance Portability and Accountability Act (HIPAA)

Individualist Orientation

An individual derives identity from affiliation with and participation in a social group such as a family or clan.

Needs of the group are more important than the individual, and decisions are made with consideration of the effect on the whole.

Collectivist Orientation

Theory that refers to the characteristics of relationships and behaviors toward others

High context (universalism)

A more personal relationship is expected.

Body language is more important than spoken words.

Low context (particularism)

Task oriented

Individual identity is not as important

Direct approach is expected.

Context

The effective nurse is careful to follow correct etiquette with his or her patients whenever possible

Handshake

Eye contact

Interpreters

Skills

Patients have the right to an interpreter.

The more complex the decision making, the more important it is to have an interpreter.

Use only those trained in medical interpretation.

Avoid using children of patients.

Speak to the patient, not the interpreter.

Interpreters

The nurse works in a large metropolitan hospital that provides care for older adults of many different cultures. Discuss the ways a nurse can provide culturally competent care.

Case Study

Answers will vary

Theory of cultural care diversity and universality—recommended for use with the older adult population

Theorizes three modes of action for the professional nurse to provide culturally congruent care

Cultural care preservation or maintenance

Cultural care accommodation or negotiation

Cultural care repatterning or restructuring

Leininger

Kleinman, Eisenberg & Good (1978)

Suggested that to provide culturally sensitive and competent care, the gerontologic nurse explores the meaning of the health problem from the patient’s perspective.

The Explanatory Model

L—Listen carefully to what the older person is saying, including the person’s perception of the situation, desired goals, and ideas for treatment

E—Explain your perception of the situation and the problem(s)

A—Acknowledge and discuss both the similarities and the differences between your perceptions and goals and those of the older person

The LEARN Model (1 of 2)

R—Recommend a plan of action that takes both perspectives into account

N—Negotiate a plan that is mutually acceptable

The LEARN Model (2 of 2)

E—Explanation

T—Treatment

H—Healers

N—Negotiate

I—Intervention

C—Collaboration

The Ethnic Model

Chapter 7

Socioeconomic and Environmental Influences

Social status, economic conditions, and environment influence our health and our response to illness.

One of the strongest and most consistent predictors of illness and death is socioeconomic status.

The environment influences safety and well-being.

Introduction

The GI Generation commonly called the “Greatest Generation”—born 1900 to 1924

The Silent Generation—born 1925 to 1945

The Baby Boomers—born 1946 to 1964

They shared certain experiences at similar stages of physical, psychological, and social development that influenced the way they perceive the world.

Age Cohorts

They are healthy and have resources to maintain their homes.

They have contributed to Social Security more than any other age group because of their higher earnings.

Older adults receive income from five sources: Social Security, assets, retirement, government pensions, and wages.

The age at which Social Security can be drawn is increasing from age 65 to 67; the retirement benefit can slightly increase for those who delay payment.

Supplemental Security Income (SSI) benefits are available for the aged, disabled, or slightly impaired and those with few assets and minimal income.

Income Sources

In peak earning years

Most married

Few have children younger than 18 still residing in the family home.

53% are still employed.

Have completely or nearly paid for homes

Average annual income is more than $49,608.

Cohort 55–64 Years

Median income before taxes is $22,887.

Expenses related to medical care increase.

Face funeral expenses.

Veterans’ benefits are important to this age group because of the increased risk of chronic disease and other acute health problems.

Cohort 65–74 Years

Women outnumber men.

Health problems increase with age as do expenses for prescriptions and assistive devices.

Quality of housing deteriorates.

Decreased strength and endurance reduce the ability to conduct household chores.

Cohort 75–84 Years

Fastest growing segment of our population

At risk for an increase in chronic disease

Decreased ability to perform activities of daily living (ADLs)

Increased expenses for assistance, assistive devices, and medication

Lowest annual income of all older Americans, and 10% live in poverty

Social Security is primary income source

Cohort 85 Years and Older

In 2015, 8.8% of those age 65 or older were classified as poor with income below the poverty level.

Affects the quality of life for older adults

Inadequate housing and diet

Delay seeking medical

Assistive aids are unaffordable luxuries.

Knowing the income level enables the nurse to direct the patient to agencies and services to help those with limited resources.

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Describe and discuss the nurses role in health promotion and disease prevention in older adults. Share an example from your personal experience as a RN. Name and elaborate on at least th

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