L3 Philosophy of gerontological nursing and roles of nurses

Define what is Gerontological nursing

• It is an evidence-based nursing specialty that addresses the unique physiological, social, psychological, developmental, economic, cultural, spiritual, and advocacy needs of older adults.

• The nursing practice focuses on the process of aging

• Is delivered by nurses at all levels of academic preparation in a variety of practice settings : hospitals, institutional skilled nursing facilities, ambulatory care, the home, and community

What is the philosophy of gerontological nursing

“Gerontological Nursing is unique in the care of older adults: physical, psychological, social and spiritual needs

It aims to work in partnership with older people and their family through good communication on all perspective of health.

By promoting an approach to nursing that is human, sensitive and caring, it can support each person in reaching optimum independence and self care in daily living; and hence the ability to live a comfortable dignifies and respectful life is sustained”

Suggest the 4 key principles of Gerontological Nursing

1. Person-centered care (PCC): emphasizing the individuality and dignity of older adults, recognizing their preferences, needs, and values

2. Holistic approach: addressing the physical, emotional, social, and spiritual needs of older adults

3. Respect autonomy and advocacy for older adults' rights

4. Promoting healthy aging, maintaining independence and quality of life

What are the 5 core competencies a gerontology APN should have ?

• Competence area 1: Professional, Legal and Ethical Nursing Practice

• Competence area 2: Health Promotion and Health Education

• Competence area 3: Management and Leadership

• Competence area 4: Evidence-based Practice and Research

• Competence area 5: Personal and Professional Development

What are the 3 major role aspects of gerontology nurse ?

1. Interprofessional care

2. Residential care

3. Geriatric rehabilitation care

List the Nurses’ Role in Interprofessional Gerontological Care (5)

• Assessment and Care Planning

• Communication and Coordination

• Patient Advocacy

• Education and Support

• Implementing Evidence-Based Practice

One of the role of gerontology nurse is to Categorize the care need by matching older adult with appropriate subsidized community care services or residential care services

• Suggest how to categorize

• No impairment, Mild impairment: Community care services

• Moderate impairment, Severe impairment: Community care services ± Residential care services

What major idea does the following service plan refers to ?

1. Government provide subsidized community care services (CCS)

2. Enable older people to age at home as far as practicable

3. Provide Residential care services (RCS), be taken care of in RCHE

“Ageing in place as the core, institutional care as backup”

List the categories of NGO residential care facilities for older adults in HK

Subvented 獲得資助的

• Subsidized places 獲得補貼的

Contract

• Subsidized places

• Non-subsidized places

Self financing nonprofit making

• Non-subsidized places

List the categories of Private sectors residential care facilities for older adults in HK

Contract

• Subsidized places

• Non-subsidized places

Private

• Non-subsidized places

List 3 regulatory framework that governing the operation and management (in the residential care facilities for older adults in HK)

1. Licensed under Residential Care Homes (Elderly Persons) Ordinance (Cap. 459) since 1996

   • Statutory licensing requirements

   • Statutory minimum standards to operate RCHE

2. Subvented/ Contract/ RCHE in Enhanced Bought Place Scheme (EBPS)

   • Enhanced standards set out in the Funding and Service Agreement/ service contracts

3. Quality accreditation 認證 scheme is VOLUNTARY

   • No universally agreed or accepted accreditation scheme in HK

Describe the workforce triangle for RCS

Suggest the minimun staffing requirement for the working time in RCS period below:

• 11 hours within the specified period

• 1 health worker (on-site and on duty) for every 30 resident

  • For this purpose, 1 nurse (on-site and on duty) is considered equivalent to 2 health workers

OR

• 1 ancillary 輔助 worker (on duty) for every 40 residents

Suggest the minimun staffing requirement for the working time in RCS period below:

• 10 hours within the specified period

1 care work (on duty) for every 20 residents

Suggest the minimun staffing requirement for the working time in RCS period below:

• Any time other than the 10 hours mentioned earlier

1 care worker (on duty) for every 40 residents

Suggest the minimun staffing requirement for the working time in RCS period below:

• From 6 pm on a day to 7 am on the next day

2 staff members (on duty)

Suggest the minimun staffing requirement for the working time in RCS period below:

• Any time when a resident is in the care and attention home

1 staff member (on-site and on duty)

List 6 role of nurses in residential care

1. Health care (e.g. medication follow up, hospitalization care planning)

2. Physical care

3. Social care

4. Psycho-supportive care

5. Financial care

6. Personal possession care (purchasing goods, sotring procession)

Define what is Geriatric rehabilitation (3)

Defined as “A multidimensional approach of diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation in older people with disabling impairments" (Lubb et al., 2023).

This approach is essential for older adults who experience a decline in function due to various health conditions, such as fractures, strokes, or severe infections.

The goal of geriatric rehabilitation is to improve functional independence, prevent complications, and enhance quality of life for these individuals (Achterberg et al., 2023) .

Suggest examples of common geriatric condtions that require rehabilitation (3+ categories)

Chronic disease

• stroke, COPD, PD, Ischemic heart disease, pstrep[orosis with Hip fractures, OA

Geriatric syndromes

• Fall, cognitive impairment, incontinence, mobility impairment

Functional decline / deconditioning after an acute illness

• Pneumonia, PI, Nutritional deficiencies or decreased intake

List the roles of Geriatric Nurses (8)

1. Monitoring Health Status

2. Assistance with ADLs

3. Collaborate with therapist to provide rehabilitation support

4. Provide patient and family education, lifestyle modification

5. Emotional and psychological support

6. Interdisciplinary collaboration to ensure comprehensive care,

   • Prepare discharge planning by coordinating follow up care and community resources to support continued rehabilitation

7. Patient advocacy

8. Encourage Healthy aging: participation in community activities that promote social engagement and physical activity