NURS 4436 Week 1

Learning outcomes NURS 4436

By the end of the course students will demonstrate the following:

1. Application of gerontological nursing concepts to provide person and family centered care for older adults experiencing health challenges.

2. Knowledge of gerontological nursing in Canada and how the Canadian nursing practice standards guide evidence-informed practice.

3. Application of interprofessional and culturally competent approaches in caring for older adults. 4. Appraisal of evidence that informs the care of the older adult.

5. An understanding of the health challenges and factors that impact the quality of life for the older adult. Some of the concepts discussed include mobility, functional decline, frailty, polypharmacy, chronic disease, 3 D’s (dementia, depression, and delirium), pain, palliative, and end-of-life care. 6. An understanding and use of information and communication technologies in the delivery of care.

Course expectations

• Turn up

• Read BEFORE CLASS • Engage

• Learn

• Be respectful

• Do ‘a little bit extra’ • Give feedback’

Overview of course syllabus

We will cover key concepts through taught lectures and flipped class-room case studies.

Week 1- 5 taught lectures

Week 6, 7, 9, 10 Case studies (flipped classroom)

Week 11, 12 Case study presentations

There will be three evaluation points. I will provide additional information about the assignments when we cover the content.

- Blog (week 5)

- Quiz (including NCLEX style questions, week 8)

- Case study group presentation (submission week 11)

Turn up (physically and mentally), contribute to class and your group and complete the pre-reading/ pre-case study work.

Flipped classroom – case study approach

What is a flipped classroom?

“complete readings at home and work on live problem-solving during class time. This pedagogical style moves activities, including those that may have traditionally been considered homework, into the classroom. With a flipped classroom, students watch videos, collaborate in online/ outside of classroom discussions, or carry out research at home, while actively engaging concepts in the classroom, with guidance”

Case studies:

We will complete four case studies in flipped classroom approach. You can work on your own or in small groups. I will post the case study scenario and questions the week prior to the lecture. You need to read/ research the main information provided in the scenario (eg the condition, symptom presentation, possible care plans). For the first hour (approx.) of the lecture you will work through the case study on your own/ as a group. We will then go through the questions together and review the case as a whole class.

The scenarios will start off with a focal point, e.g. dementia, but we will look at the complexity of care. Consider evidence (literature), your own experience and RNAO BPGs to guide your learning and practice. Note down any questions that might come up.

The textbook and additional readings accompany your learning. These are examples of knowledge that you need to access but not limited to these. Please read more widely, particularly in relation to the case studies.

The book chapters for each are the minimum for you to read, however most chapters are relevant to each week, especially case study weeks.

So what are concepts in Gerontology? Consider an example of a health challenge for older people for each concept

- Perfusion

- Gas Exchange

- Mobility

- Digestion

- Elimination

- Cognition

- Metabolism and Glucose Regulation

- Immunity

- Tissue Integrity

- Infection

- Mood

What is gerontological nursing?

Care of older adults is the fastest-growing employment segment in the health care sector and industry. Older adults are the core consumers of health care, having higher rates of outpatient visits, hospitalizations, as well as home, retirement and long-term care (LTC) service use than any other age group.

Despite this high demand, the number of health care workers who are interested in and prepared to care for older adults remains low. Less than 1% of registered nurses (RNs) are certified in gerontology.

Gerontological nursing is a specialty requiring complex skill set to provide high quality care for patients with high acuity and long-term conditions.

Who wants to be a gerontological nurse?

Older People and Ageing – Burden or Success?

Older People and Ageing – Burden or Success?

• Life Expectancy 83.8

years

• Indigenous/ Black

Canadians: on average 10

years shorter

Burden to health care system and society? Bed Blocker

Frequent Flyer

Negative image and portrayal of older people through language and visuals increases the risk of ageism, discrimination and poor quality, undignified care.

Caring for older people requires highly skilled health care professionals due to the complexity of health challenges both in community and acute hospital settings.

• The infant mortality rate in Canada, for children under the age of one year old, was 187 deaths per 1000 births in 1900. This means that for all babies born in 1865, almost one fifth did not survive past their first birthday.

• The current infant mortality rate for Canada in 2022 is 4.055 deaths per 1000 live births

• Advances in medical science, welfare and care provision

• But consider health inequity and racism leading to disparate outcomes for Indigenous, Black and other ethnic minorities in Canada.

• But how do we view older people?

Who is old?

What does old age look like?

• The average per-person spending on health care for Canadians aged 64 and below is $2,700. The average per-person spending on Canadians aged 65 and over is more than four times higher at $12,000.

• Increase in LTC patients (almost double)

• Increase in people ageing at home and requiring home care (by 1/3)

• Projections that we will spend nearly $60 billion per year for older people’s services in 2031.

• Quality of care not just quantity

Frailty and falls – a typical old age problem?

Frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.

In the absence of a gold standard, frailty has been operationally defined by Fried et al. as meeting three out of five phenotypic criteria indicating compromised energetics:

• low grip strength,

• low energy,

• slowed walking speed,

• low physical activity,

• and/or unintentional weight loss

Who is at highest risk?

85+ age group

Women

More prevalent amongst Black older people than White older people What are the potential risks/ health outcomes/ impacts of frailty?

The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, malnutrition, infection, physical and mental health co-morbidities, and mortality.

Falls

RNAO BPG Preventing Falls and Reducing Injury from Falls

Who is at risk? Similar to frailty risk: Oldest old – 85 years and older - have highest prevalence (nearly 10% reported a fall related injury – almost double to 65–69 year-olds); more likely to be female; more likely to be living alone.

Falls are the No. 1 reason for injury-related death, hospitalization and emergency department visits for older adults in Canada. Falls among older adults cost $5.6 billion in 2018 – nearly 20 per cent of the total cost of injury in Canada. 1 in 3 people aged 65 and older are likely to fall at least once.

Assessment:

- Is the person at risk?

- Fall risk assessment tool

Prevention:

- Education

- Exercise and maintaining activity

- Best Practice Guidelines

- Fall prevention interventions: listen to patients/ clients

Falls risk assessment, prevention and nursing care

Assessment:

- Is the person at risk?

- Fall risk screening tool

Prevention:

- Education

- Exercise and maintaining activity

- Best Practice Guidelines

- Fall prevention interventions: listen to patients/ clients

Nursing Care:

- Best Practice Guidelines

- Patient and family -centred care

- Consider cause and outcomes of fall

Fear of falling

- A person has lasting fear of falling and may avoid activities they would otherwise be capable of performing

- As much of a concern to older people as crime, financial crisis or other adverse health events

- More often affects older women, those with previous falls and certain co-morbidities (chronic illness, frailty)

- Activity restriction in the long-term adversely affects mental and physical health and actually increases the risk of future falls.

- Rehabilitation focuses on reducing fear of falling through building strength, balance and confidence

Successful ageing – what does that look like and for whom?

“Successful ageing has become an important concept to describe the quality of ageing. It is a multidimensional concept, and the main focus is how to expand functional years in a later life span.” (Urtamo et al, 2019)

Ageing in the absence of disease?

Active Ageing?

Productive Ageing?

Ageing in place?

Holistic Ageing?

Diversity, patient centred care and dignity in older age and opportunities for nursing

• Each age cohort is different, and each older person is different • Personhood and identity in older age

• Be cautious in attributing specific characteristics simply to “old age” • Consider cultural differences and determinants of health • Gerontological nursing is an opportunity to make a significant difference in the lives of older adults

• Nurses have a responsibility to contribute to accessible health care and the reduction of health disparities.

• How would you like to age and have health care provided to you in older age?