Chapter 2
Gerontological
Nursing Issues
Responsibilities of the
Gerontological Nurse
Direct care
Management and development of
nursing personnel
Evaluation of care and services for the
older adult
Nurses Role in Caring for Older
Adults
Generalists
Direct care providers
Case managers
Nurse leaders
Educators
Patient advocates
Administrators
Nurses Role in Caring for Older
Adults
Advanced practice gerontological
nurses
Primary care providers focus on
Health promotion
Disease prevention
Long-term management of chronic conditions
Certification Requirements at the
Basic Level
Associate, diploma, or baccalaureate degree
in nursing
Currently registered as a nurse in the United
States or one of its territories
Practiced the equivalent of 2 years full time
as an RN
Minimum of 2,000 hours of clinical practice
within the past 3 years
Indicate certification with the initials RNC
(certified)
Certification at the Advanced
Practice Level
Clinical nurse specialists and nurse
practitioners with Masters degree
Certified as gerontological specialists
Indicate certification with the credentials
RN, BC (board certified)
Skilled Nursing Facility
Care may be delivered by nurses and other health
professionals
Sub-acute care (Medicare reimbursed, short stay)
Chronic care (private pay or Medicaid) for frail,
elderly residents requiring help with the activities of
daily living
A 3-day qualifying stay in a hospital is required for
skilled care to receive Medicare reimbursement in a
long-term care facility
Periodic recertification that documents the continued need
for skilled care
Residents progress toward established goals
One hundred days of skilled care can be reimbursed per
year
Retirement Communities
Range in size and scope of service
Resident pays admission fee and then
monthly fee
Adult Day Care
An option for frail elders requiring
daytime supervision
Many services are optional to meet
needs
Caregiver schedule
Healthcare for elder
Medical insurance does not usually cover
charges
Residential Care Facilities
Residents provide most self-care
Additional assistance for laundry,
meals, and housekeeping
Supervision and health monitoring
provided
Transitional Care Units
For persons who no longer require
acute care
Subacute care
Rehabilitation
Palliative care
Diagnostics, complex monitoring, and
support services provided
Rehabilitation Hospitals or
Facilities
Provide subacute care for persons with
complex needs
Payment covered by private insurance
or Medicare
Community Nursing Care
Visiting nurse services for older persons
requiring skilled care in the home
Provided by personnel with a variety of
skill levels
Usually covered by Medicare when
need for service exists under the
direction of a physician
Major Sources Financing Long-
term Care Expenditures
ANCC Guidelines for the Scope of
Practice of the Gerontological Nurse
Specialize in care and the health needs
of older adults
Plan, manage, and implement healthcare
Evaluate effectiveness
Identify and use the strengths of older
adults
Assist in maximizing independence
Actively involve older adults and family in
decision making
The 11 Functional Health
Patterns Include
Health perceptionhealth management
Nutritionalmetabolic
Elimination
Activityexercise
Sleeprest
Cognitiveperceptual
Self-perceptionself-concept
Rolesrelationships
Sexualityreproductive
Copingstress tolerance
Valuesbeliefs
Gerontologic Nursing Roles in
Research
Interpret, apply, and evaluate research findings to
inform and improve gerontological nursing practice
Identify clinical problems appropriate for study
Gather data
Interpret findings to improve care
Research findings to provide evidence-based nursing
interventions
Participate in research teams
Collaborate with nursing colleagues with advanced
education and research training
Serve on an institutional review board (IRB)
Nursing Research
U.S. federal funding for nursing
research began in the 1950s.
In 1986, the NINR was established
within the NIH.
NINRs mission is to support the science
that advances the knowledge of nurses.
Nursing Research
Nursing research focuses on the
development of
Noninvasive, cost-efficient behavioral
techniques
Alternatives or supplements to the usual
care
Nursing research can lead to broad
scope policy and practice changes.
Evidence-Based Practice
Best method for delivery of care
Based on clinical guidelines derived
from research
Coding system indicating the strength of
the research
AHRQ
AHCPR, now called Agency for
Healthcare Research and Quality
(AHRQ)
Three-level coding system
Strength of the available evidence
Randomized Controlled
Clinical Trials
Best for establishing causes and effects
Nonverbal Communication
Nonverbal communication composes up
to 80% of information exchange
Body language
Position
Eye contact
Touch
Tone of voice
Facial expression
Verbal Communication
Guidelines
Do not yell or speak too loudly to patients
Yelling into a hearing aid can be disturbing and
painful
Try to be at eye level
Minimize background noise
Touch if appropriate and acceptable
Supplement with written instructions as
needed
Avoid complicated explanations
Verbal Communication
Guidelines
Ask how the patient would like to be
addressed
Avoid demeaning terms such as sweetie,
honey, or dearie
Use open-ended statements
Tell me more or How does this affect you?
Avoid misunderstandings by clarifying
Im not sure what you mean
Use caring responses and careful listening
Encourage reminiscing
