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Running head: MODULE 11 ASSIGNMENT- REFLECTION

Module 11 Assignment: Reflection Angela Moody Rasmussen College NUR2214: Nursing Care of the Older Adult Dr. Karen Thorton December 13, 2019

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MODULE 11 ASSIGNMENT- REFLECTION 

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Analyze the increased complexity of care among older adults.

Older adult care is highly complex compared to standard nursing. There are many accounts to take into consideration when addressing the care of the elderly. Nursing practice requires geriatric competency (such as knowledge, skills, and attitudes to safely manage and care for older adult clients with multiple chronic diseases including mental health conditions) of all nurses working with older adult clients across various care settings. Nurses must have effective communication, collaboration, and human relation skills to ensure safe care coordination as well as promote health and wellness, involving the clients and their families as active participants. There are current trends and important issues that relate to aging and older adults’ health. Some elements associated with their care is: o Social- As individuals grow older, the aging process increases one’s risk of illness, poor health, and functional abilities. This leads to an increase in acute health events and co-morbidities that require greater utilization of primary, acute, and long-term care, which leads the risk of polypharmacy. 

Health promotion/disease prevention

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Chronic disease management

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Functionality and independence

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Transitions of care

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Family dynamics

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Care coordination

o Demographics- Older adults are living longer with the help of greater access to medical care, technological advancements, and initiatives focused on health promotion and disease prevention.

MODULE 11 ASSIGNMENT- REFLECTION 

Age

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Gender

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Race

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Socioeconomic status

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o Economics- Millions of older adults live below the poverty level which significantly affects health and lifestyle behaviors. Gender, race, education, and literacy levels can significantly impact the older adult’s health behaviors and compliance with medical treatment. Care is also shifting away from acute care settings to community-based settings such as long-term facilities, home care, and ambulatory care. 

Housing

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Income

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Socioeconomic status

o Political- Shifts in health policy and funding have helped to shape geriatric nursing practice, such as Medicare and Medicaid. 

Medicare/Medicaid

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Affordable care

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Healthcare cost containment

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Value-based care

(Rasmussen College, 2019, Module 01) 

Compare care models for nursing practice specific to the older adult.

Geriatric care models are essential to the management and control of chronic diseases, healthcare costs, and high utilization of healthcare services of older adults. Various programs and

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care models have been implemented to save money on healthcare costs and monitor and promote health while improving overall health outcomes of the older adult client. o

Hospital-based Models of Care 

Acute Care for Elders (ACE) Model- designed to mitigate risks and improve healthcare outcomes from clients who experience disease exacerbations and various other illnesses and are admitted into the acute care setting.

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Improves health outcomes

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Improves costs

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Reduce hospital stay

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Improve medication reconciliation

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Minimize restraint use

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Interprofessional teams

Healthy Aging Brian Center (HABC)- Center-based memory care clinics that improve care coordination in clients prone for Sundowners. It was also designed for clients prone to dementia, post intensive care syndrome and delirium often experienced in the acute care setting. 

Sundowners

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Dementia

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Post-intensive care syndrome

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delirium

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Transition Care Model- Used to ensure the coordination and continuity of healthcare as patients transfer between different locations of different levels of care within the same location. 

IMPACT (Improving Post-Acute Care Transitions)- Initiated to ensure ideal transition in geriatric care.

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Project RED (Re-Engineered Discharge)- Initiated to transition a unique set of patients from the post-acute setting to the community

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Outpatient-based Models of Care 

GERI-PACT (Geriatric Patient-Aligned Care Teams) care model- Is a specialized patient care medical home model initiated by the Department of Veterans Affairs to provide high quality coordinated care to older adults over 65 with more risk of negative health and psychosocial outcomes similar to that of transition models.

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Outpatient geriatric evaluation

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Specialized medical home model

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Chronic disease

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Multidisciplinary team

Community Related Models of Care 

Patient-Centered Medical Home Model- Developed to provide more timely access, coordination, and patient-centered care in primary care settings. It is designed to focus on older adults with multiple chronic conditions.

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Home-based Primary Care Models- Used to promote value-based care for clients receiving primary and social care in the home to avoid emergency room visits, acute hospitalization, and institutionalizations. Provides quality, patient-centered care for people underserved where the patient must travel to the provider.

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Complex Care Model (C5-75) Case-Finding for Complex Chronic Conditions in Seniors over 75 Model- A model aimed at identifying frailty and commonly associated geriatric conditions among older adults and targeting interventions for identified conditions using a feasible systematic, evidence-informed multi-disciplinary approach.

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STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) Model- Associated with walking and musculoskeletal health. It is a walking program for hospitalized older adults focused on maintaining musculoskeletal strength and mobility.

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Telehealth Model- Used to improve access and quality of dementia care to patients and their caregivers in rural areas.

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Return to Community Initiative (RTCI) Model- Facilitates consumer choice in care setting and to achieve cost savings for the consumer and the medication program.

(Rasmussen College, 2019, Module 4) 

Design plans for care specific to the older adult.

Geriatric nurses must utilize the nursing process and perform a complete head-to-toe assessment on the older adult before designing a plan of care specific to their needs. They must

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gather both objective and subjective data to formulate problems and the plan of care. The health assessment will include the SPICES (Sleep disorders, Problems with eating and feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown) geriatric assessment and screening tool. It is a nurse’s duty to create appropriate nursing diagnosis and intervention related to assessment findings. (Rasmussen College, 2019, Module 5) 

Identify local, state, and national resources which facilitate safe and effective transitions of care for older adults.

Older adults often require various services and resources at the local, regional, and national levels because they may not have the skills, knowledge, and attitudes to improve their health or take preventive measures. The healthcare team must advocate for the client to ensure access to safe and quality care and quality and safe care. o

Local- The nurse is the case manager at the local level and recognizes the essential health needs of the client so that care can be individualized, and resources and interventions implemented.

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Regional- Nurses can influence change at the state department regarding policies specific to older adults. Having a voice at the state level through various legislature meetings and hearings is an ideal way to advocate for older adults.

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National- Actions are taken to change and better understand public policy. Nurses can collaborate and speak to various civic groups and furthermore advocate and lobby for older adult rights and best practices. 

Community and Home Health Services/Homemaker Services

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Senior Centers

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Adult Day Care Services

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Respite Care

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Nutritional Services

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Transportation Service

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Telephone monitoring and personal emergency service

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(Rasmussen College, 2019, Module 8) 

Incorporate professional values, attitudes, and expectations regarding ageism when caring for the older adult.

Nurses and other healthcare providers are in prime positions to advocate for older adults who are victims of age discrimination. Reshaping the perceptions about aging is a necessary improvement measure. Nurses and other healthcare providers must not assume that older adults do not have the ability to provide independence for themselves just because of their age. It is important to assess the patient initially to determine their abilities when providing care and treatment. It is also important for healthcare providers to provide effective communication about medical decisions during their treatment and allow the client to have autonomy for the type of care they receive. It is also important to not provide the same care for older adults as everyone else. Healthcare providers must uphold the oath to implement equal care for everyone regardless of their age, sex, nationality, religion, race, etc. (Rasmussen College, 2019, Module 9) 

Outline the importance of advocating for older adults in management of their care.

With aging, older adult’s health status often leads to changes in living arrangements both in homes and institutions. These changes affect not only the older adult, but also often their family and others who must see to their care and living needs. Without enacting appropriate

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interventions and resources, this can lead to neglect, deliberate abuse, or exploitation of older adults. As older adults’ abilities to manage their personal affairs are compromised, the necessity of turning the management of certain activities over to others may also lead to mistreatment. Nurses must be alert to recognize signs and symptoms of abuse and caregiver stress, which can be in many forms. They must be advocates for older adults who may not have a voice in the matter or are told they will be black mailed if they report abuse. Any indication of abuse in an institutional setting must be reported as soon as it is suspected so that appropriate action can be taken and the abusive person removed. (Meiner, n.d., p. 33) & (Rasmussen College, 2019, Module 10) Throughout the course of this quarter, I was able to achieve each of these competencies in multiple ways. I was able to take the information taught and learned in class and use utilize it in real-life scenarios during clinicals at Stratford Court while encountering the geriatric population. I also took the information provided during lecture and incorporated it into many papers, and additionally, a course project about depression in older adults. I gained new knowledge and was able to critically think during the lab simulations with case studies on specific scenarios for older adults. This course material will impact my nursing practice in a positive way to care for and treat older adults professionally and specifically to their individual needs. I will not show ageism towards older adults and respect them and care for them as equally as I would any other patient I encounter.

MODULE 11 ASSIGNMENT- REFLECTION References Meiner, S. E. Gerontologic Nursing, 6th Edition [VitalSource Bookshelf version]. Retrieved from vbk://9780323498111 Rasmussen College. (2019). Module 01: Trends and Issues. In NUR2214: Nursing Care of the Older Adult: Fall 2019 [Lesson]. Retrieved from http://rasmussen.learntoday.info/default.asp Rasmussen College. (2019). Module 04: Geriatric Care Models. In NUR2214: Nursing Care of the Older Adult: Fall 2019 [Lesson]. Retrieved from http://rasmussen.learntoday.info/default.asp Rasmussen College. (2019). Module 05: Geriatric Assessment and Screening. In NUR2214: Nursing Care of the Older Adult: Fall 2019 [Lesson]. Retrieved from http://rasmussen.learntoday.info/default.asp Rasmussen College. (2019). Module 08: Health Resources and Prevention Initiatives. In NUR2214: Nursing Care of the Older Adult: Fall 2019 [Lesson]. Retrieved from http://rasmussen.learntoday.info/default.asp Rasmussen College. (2019). Module 09: Values and Attitudes Regarding Aging. In NUR2214: Nursing Care of the Older Adult: Fall 2019 [Lesson]. Retrieved from http://rasmussen.learntoday.info/default.asp Rasmussen College. (2019). Module 10: Legal and Ethical Standards. In NUR2214: Nursing Care of the Older Adult: Fall 2019 [Lesson]. Retrieved from http://rasmussen.learntoday.info/default.asp

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