NCMB 314 (MIDTERMS)

Evidence-Based Practice

follows a systematic approach that uses existing research for clinical decision making-a process known as?

Meta-Analysis

is a process of analyzing and compiling the results of published research studies on a specific topic

American Nurses Association (ANA)

Published a Statement on the Scope of Gerontological Nursing Practice in 1970

Scope of Practice of Gerontological Nurse

They specialize in the nursing care and health needs of older adults, They plan, manage and implement health care to meet those needs & evaluate the effectiveness of such care

Roles of the Gerontological Nurse

Provider of care, Teacher/Educator, Manager, Advocate, Research Consumer

Core Competencies

Provide a foundation of added knowledge and skills necessary for the nurse to implement in daily practice.

Principles of Gerontological Nursing Practice

Aging is a natural process common to all living organisms. Various factors influence the aging process. Unique data and knowledge are used to the older population. Older adults share similar self-care and human needs in all other human beings. strives to help older adults achieve wholeness by reaching optimum levels of physical, psychological, social, and spiritual health.

Ethics of Care

include compassion, equity, fairness, dignity, confidentiality, and mindfulness of a person's autonomy within the realm of the person's abilities and mental capacity

Advocacy

refers to loyalty and a championing of the needs and interest of others.

Autonomy

is the concept that each person has a right to make independent choices and decisions.

Confidentiality

emphasizes respect for human dignity that is demonstrated in daily work.

Fidelity

refers to keeping promises or being true to another

Fiduciary Responsibility

refers to using both fiscal reserves and caregiving resources wisely,

Justice

refers to fairness of an act situation

Quality and sanctity of Life

(______)is a perception based on personal values and beliefs, (_____) referring to the value of life and the right to live.

Reciprocity

is a feature of integrity concerned with the ability to be true to one's self while respecting and supporting the values and views of another.

Veracity

means truthfulness and refers to telling the truth.

Actual Conflict of Interest issues

between family members and caregivers represent the elderly or assist them in decision-making

Issues on Confidentiality

In caring for an elderly patient, invariably, there is disclosure made by the family and relatives regarding information that may otherwise be personal and confidentiality to the patient alone

Issues on Decision- Making Capacity

Many times, the older patient's decision-making capacity (also referred to as "competence") may be required for certain decisions.

Republic act No. 344 or the Accessibility Law of 1982

provides for the minimum requirements and standards to make buildings, facilities, and utilities for public use accessible to persons with disability, including older persons

RA 7432

known as "an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges and for other purposes"

Republic Act No. 7876

"An Act Establishing a senior Citizens Center in all Cities and Municipalities of the Philippines, and Appropriating Funds Therefore"

Republic Act No. 8425

provides for the institutionalization and enhancement of the social reform agenda by creating the National Anti-Poverty commission (NAPC).

Republic Act No. 9994.

"Expanded Seniors Citizen Act of 2010" an act granting additional benefits and privileges to senior citizens, further amending.

Republic Act No. 10155, " The General Appropriations Act of 2012"

under Section 28 mandates that all government agencies and instrumentalities should allocate one percent of their total agency budget to programs and projects for older persons and persons with disability.

Republic Act No. 10645,

" An Act Providing For the Mandatory Philhealth Coverage for All Senior Citizens"

Republic Act No. 10868,

"Centenarians Act of 2016", An Act Honoring and Granting Additional Benefits and Privileges to a FILIPINO CENTENARIANS

Presidential Proclamation No. 470, Series of 1994

Declares the first week of OCTOCER of every year as "Elderly Filipino Week."

Presidential Proclamation No. 1048, Series of 1999,

declares a "Nationwide Observance in the Philippines of the International Year of Older Persons".

Executive Order No. 105, series of 2003,

approved and directed the implementation of the program providing for group homes and foster homes for neglected, abandoned, abused, detached, and poor older persons and persons with disabilities.

The Philippine Plan of Action for senior Citizens (2011- 2016).

This plan aims to ensure giving priority to community-based approaches which are gender responsive, with effective leadership and meaningful participation of senior citizens in decision-making.

RA 9257

It shall train community-based health workers among senior citizens and health personnel to specialize in the geriatric care and health problems of senior citizens.

Pharmacology and Older Adult

Older person are at a greater risk for adverse drug events, (Persons 65 and older are prescribed the highest proportion of medication in relation to their percentage)

Changes with Aging

Decrease in body water (as much as 15%) and an increase in body fat. Increased concentration of water-soluble drugs (e.g. Alcohol) , More prolonged effects of fat-soluble drug.

Inappropriate medications administered to older persons include:

Prescriptions for long-acting benzodiazepines, persantine, Long-term use of drugs that are to be used for short-term use only, Decreased hepatic blood flow results in increased toxicity, First pass effect.

Medication error

It may be related to: Prescribing, Dispensing, Administering or Monitoring of drug.

Adverse Drug Reaction (ADR)

any noxious, unintended, and undesired effects of a drug which occurs at doses in human for prophylaxis, diagnosis or therapy

Adverse Drug Event (ADE)

any injury that results in medications used, and this includes both ADRs and medication errors that lead to ADR

Pharmacokinetic Changes

what the body does to the drug. These include changes in Drug Absorption (Age-related changes in drug absorption do not usually contribute to a significantly altered drug response) Drug Distribution or Protein-binding (Drug distribution into the peripheral circulation and tissues is altered as a function of age)

Pharmacodynamic Changes

what then drug does to the body? Aging may result in different responses for older adults to the same drug concentrations at the site of action compared with those observed in younger adult.

Drug-Drug Interaction

an interaction between one drug and another can result from altered pharmacokinetics or pharmacodynamics. it is largely thought that alterations in hepatic metabolism are specifically responsible for drug-drug interaction. (warfarin+aspirin= prolonged bleeding)

Polypharmacy

Prescription, administration, or use of more medications than are clinically indicated in a given patient

Omnibus Budget Reconciliation Act (OBRA) 1987

Legislated the appropriate use of medications in institutionalized older persons

Beers Criteria

Commonly used consensus criteria related to inappropriate medications.

Non-Adherence (non-compliance)

Living alone without social support, Visual or auditory impairments. Increasing use of alcohol. Socioeconomic factors. Unpalatable bulk powders or large tablets.

Ethical Principles - Omission or commission of an act that departs from acceptable and reasonable standards, which can take several forms

Malfeasance

committing an unlawful or improper act.

Misfeasance

performing an act improperly

Nonfeasance

failure to take proper action

Malpractice

failure to abide by the standards of one's profession

Criminal negligence:

disregard to protection the safety of another person

Consent

granting of permission to have an action taken or procedure performed

Long-term care

is a variety of services which help meet both the medical and nonmedical needs of people with a chronic illness or disability who cannot care for themselves for long periods.

Nursing Homes Standards

"must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care."

Assisted Living Communities

Designed for older adults who are able to remain independent and active, but need a helping hand.

Palliative Care

is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness.

HOSPICE

a way of caring for terminally ill individual and their families. Although most hospice care is provided in the home, these services are required to be provided in nursing home settings also.

Loss

An actual or potential situation in which something that is valued is changed, no longer available or gone

Personal loss

Any significant loss of someone or something that can no longer be seen or felt, heard, known or experienced & that requires individual adaptation through the grieving process.

Perceived loss

Loss that is less tangible & uniquely defined by the grieving client (loss of confidence, prestige). Experienced by one person but cannot be verified by others.

Maturational loss

Change in developmental process that is normally expected during a lifetime. Loss that occur on the process of normal development.

Situational loss

Loss of a person, thing or quality resulting from a change in a life situation, including changes related to illness, body image, environment and death. Any sudden, unexpected and definable event that is not predictable.

Actual loss

Can be identified by others & can arise either in response to or in anticipation of a situation

Grief

The total response to the emotional experience related to loss which is usually resolved within 6 months to 2 years.

Abbreviated grief

Grief which is brief but genuinely felt; lost may not have been sufficiently important to the grieving person or may have been replaced immediately by another, equally esteemed object

Anticipatory grief

Process of accomplishing part of the grief work before an actual loss; grief response in which the person begins grieving process before an actual loss.

Dysfunctional grief

Occurs when there is prolonged emotional instability, withdrawal from usual task or activities that previously gave pleasure & lack of progression from one level to successful coping with the loss.

Unresolved Grief

extended in length and severity, bereaved may also have difficulty expressing the grief

Inhibited Grief

many of normal symptoms of grief are suppressed and other effects, including somatic are experienced instead.

Grieving process

Sequence of affective, cognitive & physiological states through which the person responds to and finally accepts an irretrievable loss.

Bereavement

The subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship

Loss of Aspect of Self

Any change the person perceives as negative in the way the person relates to the environment is loss of self.

External Object

Loss of inanimate object that has importance to the person (ex. Jewelry, money, etc...)

Accustomed Environment

Separation from an environment and people who provide security.

Loved Ones

Loss of valued person or loved ones through illness, separation, divorce, broken relationship, moving, running away, promotion at work, or death.

Loss of Life

Physical death, brain death, ability to reason. Concern is not about death itself but about pain and loss of control, fear of separation, abandonment, loneliness or mutilation.

Denial

It is the immediate response to loss experienced by most people and it is a useful tool for coping.

Anger

The client has no control over the situation and thus becomes angry in response to this powerlessness. The angry may be directed at self, God, and others.

Bargaining

The anticipation of the loss through death brings about bargaining through which the client attempts to postpone or reverse the inevitable.

Depression

When the realization comes that the loss can no longer be delayed, the client moves to the stage of depression. It helps the client detach from life to be able to accept death.

Acceptance

The final stage of acceptance may not be reached by every dying client, however, "most dying persons eventually accept the inevitability of death, many want to talk about their feelings with family members: Verbalization of emotions facilitates acceptance

COMMUNICATING WITH OLDER PERSONS

"Communication is the cohesive force in every human culture and the dominant influence in the personal life of every one of us."

The Role of the Brain in Communication

The brain has a major role in attending to new information, making sense of and organizing information, and deciding on a response.

Communication with Older Person Topics Information Sharing

Help older people make informed decisions by sharing information in the way they prefer writing or demonstrating something can be helpful.

Verbal communication

involves sending and receiving messages by means of words

Nonverbal communication

Takes place without words

Therapeutic communication

a conscious and deliberate process used to gather Information related to a patient's overall health status

six tips to effectively communicate with individuals non-verbal

Personal Appearance, Approach Individuals from the front, Body Language/ Eye Contact, Facial Expressions, touch, dance and music.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 is a United States federal statute enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996.

While the HIPAA Privacy Rule

safeguards protected health information (PHI), the Security Rule protects a subset of information covered by the Privacy Rule.

Physiotherapist

Mobility, balance and upper limb function

Occupational Therapist

ADL, e.g. dressing, cooking Home environment and care needs

Dietitian

Nutrition

Speech and language therapist

Communication and swallowing

Social worker

Care needs and discharge planning, including organization of institutional care

Nurse Gerontologist Nursing

specialist who works directly with older adults to provide them with

Doctor

Diagnosis and management of medical problems Coordinator of assessment, management and rehabilitation program.

Gerontologist

Someone who has an advanced education in the field of gerontology, the study of aging.

Geriatrician

An expert in the branch of medicine or social science dealing with the health and care of old people