Tuesday, 29 October 2013

The adult greontology nurse practitioner



THE ADULT-GERONTOLOGY NURSE PRACTITIONER

Introduction and description of role

Introduction
Adult gerontology is the caring for the aged patients who may be found in nursing homes or even in hospitals. Due to their low immunity, old age people suffer from various illnesses such as diabetes, cancer, tuberculosis, lung infections etc. Thus, they require services from a more specialized advanced nurse who has the required experience and is conversant with these illnesses. It is therefore the duty of an adult-gerontology nurse practitioner to provide the required care for these patients.

Reason for choosing adult-gerontology
I chose adult gerontology because I have previously worked in a geriatric population in the nursing homes and with hospice. My interaction with the aged people in these homes was an inspiration to a new challenge in advanced nursing practice. Also, through the interaction, I gained a lot of knowledge and experience in this advanced nursing field. In addition, the old people suffer from many ailments that result from their low immunity hence provide room for more research and experience in the nursing field thus influenced me to choose to choose this topic.
Roles of an adult-gerontology nurse
An adult gerontology nurse provides a special care to the old people in the nursing homes. He or she is charged with the responsibility of ensuring that the nutrition levels of the patients are as required, the patients receive medication at the correct time, the patients undergo the required daily exercises and in some instances they are charged with the responsibility of providing psychological support to the patients (Tsilimingras, 2003).
For them to deliver these important services to the patients, the adult gerontology requires vigorous training in this field. Apart from going to the nursing colleges, nurses they require further training in seminars and workshops organized by their institutions or even their affiliate associations (Jones 2003). Some states are also strict on the issuance of certifications before a nurse can fully practice.

Scope of practice
 The American Nurses Association has a set of the scope and revised guidelines for nursing practices to be followed by all nurses operating in the United States. The scope of the adult gerontology includes those of the certified clinical nurses and also advanced nurses. The specific skills approved for the adult gerontology are the provision of psychological help, emergency medication and acting on the best interest of the patient. However, the adult-gerontology nurses are limited to make some decisions on their own (Fall, (1997). This is because certain decisions require the consent of the family members who may be absent at that time.
Difference in scope of practice between a gerontology nurse and hospital CEO
An adult-gerontology nurse interacts with the patients hence he or she is able to analyze and come up with solutions to the problems experienced by the patients. Though they have limited scope of working, they play a very important role in the provision of health care to patients. On the other hand, a hospital CEO manages the whole institution. He or she is charged with the responsibility of ensuring that all the sectors of the institution are working in harmony. As opposed to a nurse, they do not come into direct contact with patients but rather they delegate duties through the department heads.
Typical day of a nurse
The nursing profession has one of the busiest schedules in the whole world. After waking up at about six o’clock in the morning; a nurse would start preparing himself or herself to go to work. Some take a ride while others walk to the hospitals depending on the distance between their homes and the hospitals. At about eight o’clock in the morning, they have to go through the patients’ documents and reports so that they can be kept updated. During the day, they ensure that the patients are given their medications at the right time, the required exercises, interacting with the patients, and also, ensure the patients are entertained. In some cases, some nurses get so involved in their activities that they skip lunch or even take snacks for lunch. At the end of the day, they file a report about their patient’s observations and sometimes recommendations. These reports play a vital role during examinations by the doctors.

Theoretical background and practice
Patient exemplar
The patient is an 88 year old African American lady who has been hospitalized for the last nine months. She is currently on a ventilator and has been diagnosed of congestive heart failure, aortic aneurysm, respiratory failure and diabetes. In regard to her multiple illnesses; she was referred to the intensive care unit where the doctors and nurses can monitor her condition closely.
Aortic aneurism is an abnormal swelling in the aorta (largest arteries) hence hindering the flow of blood within a person’s body. It may occur as thoracic aortic aneurysm of abdominal aortic aneurysm depending on the region of occurrence. This condition is commonly found in people above the age of 65 as a result of aging body tissues. In addition, the lady suffers from congestive heart failure; a condition which limits her heart from pumping enough blood to the tissues (Kennedy-Malone 2006). The combination of aortic aneurism and CHF has resulted to the lady becoming very weak because the tissues lack enough blood thus becoming inactive.
The 88 year old lady showed severe signs of diabetes. According to the lab reports, her blood sugar levels were very high compared to the average diabetic person. Even though the doctors intervened to contain her diabetic condition, it was noted that her condition was not very stable. In addition, the lab report showed that the lady had an acute respiratory failure. This was due to the weakening of the lung muscles which resulted to low breathing levels hence low exchange of gases. As a result of respiratory failure, the skin of the lady had turned pale because of the accumulation of waste products in her body.
Nightingale’s concept
Analyzing Florence Nightingale’s concepts, the use of the concept of observation would be most realistic in this scenario. This is because the 88 year old lady suffers from various ailments hence observation of all the ailments are needed. She needs a close observation on the treatment of CHF, diabetes, respiratory failure and aortic aneurism.
When using the concept of observation, the nurses should consider various avenues for collecting the required data. They should observe her body temperature, changes in heartbeat, changes in skin texture, facial expression, sleeping pattern, breathing pattern etc. However, with advancement in technology; the need for physical observation has been reduced. This is because the special computer software and hardware are able to detect these changes and notify the nurses in case of an unusual occurrence (Thornlow (2006)..
By using the concept of observation, nurses would be able to issue insulin in time, issue lung muscle relaxants when she is unable to breath properly, issue emergency medication that help the heart in pumping blood. Moreover, apart from providing advice to the patient’s doctors; observation allows the nurses to write a detailed report on the necessary nursing interventions that would help in saving the patients’ life.
Application of quality safety education for nurses
Patient centered care
The patient centered care recognizes the importance of the patients in the provision of compassionate and well coordinated care. In the above scenario, the nurses must have the knowledge that lady requires physical comfort and emotional support. This is because she undergoes a lot of pain and struggle while facing her illnesses. In this regard, the nurses have to work harder in ensuring that she is given maximum comfort to prevent the pain caused by these ailments. In addition, she requires the presence of family members, psychologists or a religious leader to provide an emotional support for her. With the presence of emotional support, she would be encouraged to work harder in fighting these ailments (Manley (2003).
The nurses should be able to have the skills on how to assess and treat pain and suffering in light of patient values, preferences, and expressed needs. Using these skills, proper assessment and observation of the patient would be done hence contributing to proper prescription of the medicines. However, for the success of this skill, the patient needs to clearly communicate her preferences and needs so that they may be taken into considerations.
In regard to the nurses’ attitudes, they should willingly support patient-centered care for individuals and groups whose values differ from own. This is because different individuals have different opinions and the accommodating and listening to everyone would enable critical analysis of the situation hence best care to the patient. Therefore, the solidarity of the nurses would ensure quality service to the patients.
Team work and collaboration
Teamwork and collaboration is essential for the success of any nursing intervention that would help in improving the medical condition of the patient. In order for the nurses to cooperate, they need knowledge on how to identify system barriers and facilitators of effective team functioning and also examine strategies for improving systems to support team functioning. This would ensure that barriers to team work are rectified hence promoting proper team work and collaboration of the nurses (Sodeman, 2000).
The nurses also require the skills to function competently within own scope of practice as a member of the health care team, assume role of team members or leader based on the situation, guide the team in managing areas of overlap in team member functioning. Thus, these skills are beneficial in preventing loop holes during service delivery because all sections are covered.
Finally, the nurses need to posses the attitude of respect for the unique attributes that members bring to a team, including variation in professional orientations, competencies and accountabilities; and also respect the centrality of the patient/family as core members of any health care team. With respect among the nurses, each individual nurse would feel appreciated in his or her work hence being motivated to keep working harder for the benefit of the patient.

Changes to care or environment
In order to provide a more efficient nursing care to the patient, the following:-
Good air conditioning
Since the patient has respiratory failure, she may require a good air supply that would prevent her situation from worsening. The air in her room should be of the right moisture level, correct temperature and also free from pollution. Therefore, the nurses should ensure that the air condition of the patient’s room supports her quick recovery.
Emergency medication
The patients’ room should have an emergency insulin medication. This would be of help in the event of the worsening of her diabetic condition hence she may be injected the insulin by the nearest person present.
Frequent examination
Due to the patient’s delicate nature, she may require frequent examination by the nurses and doctors. This examination can either be done using observation or scientific testing of tissue samples. By examining the patient frequently, the nurses would be able to prevent the worsening of her medical condition hence safeguarding her life.
Evidence based support for the recommended changes
According to the American journal of nursing, a good environment plays an important role in the healing process of a patient. This was arrived at from a research done in 1935 by Paul Burt which indicated that patients with good and conducive environment recovered twice as fast as those in the normal hospital condition. Therefore, good air conditioning would provide an environment for quick recovery of the lady (Higashi 2007).
Good air conditioning would also help in the safety of the nurses. The patient has a respiratory failure which may have been caused by a lung infection hence maintaining a clean air environment around the room would ensure that the nurse does contact any airborne disease.
In addition, this journal also proposed the provision of an emergency insulin injection on the bed side of the patient; that would be used in times of emergencies.

Impact of information system and technology
The use of technology in modern hospitals has played an important role in proper care for the patient. This is because technology has ensured a faster response to emergencies; precise monitoring of the patient and heart beat recovery by use of charges etc. For example, the 88 year old lady has been kept alive by the ventilator system found in her room. According to the journal of clinical nursing, the incorporation of computers in the analyses of the heart beat were a great step in ensuring the safety of patients.
By use of technology, the internal organs can be scanned by specific rays and results printed out thus allowing doctors to make correct prescriptions. Also, technology has contributed to the treatment of fatal diseases like cancer by the use of radiation rays which kill the cancerous cells.
Due to the use of the internet, doctors are able to access one’s medical history from a specific period of time. The access to such important information is vital in times of emergencies and also facilitates easy diagnosis by the doctors (Cabana, (1999).
Since technology is dynamic, the hospitals should be updated with the current changes that take place in the hospitals hence ensuring the use of more efficient equipment.

Summary
In summary, the adult gerontology nurses play an important role in the provision of services to the old people. Their roles includes: ensure the patience exercise, take medications, provide emotional support etc. for this reason, the nurses have a very involving schedule in their work days. In a practical exemplar, the medical condition of an 88 year old was analyzed. She suffered from multiple diseases such as diabetes, aorta aneurism, congestive heart failure, and respiratory disorder. Using Nightingales’ theory, the concept of observation was found to be the most appropriate in the treatment of her ailments. In addition, the nurses required patient centered care and team work for the delivery of quality care as per the QSEN requirements. Finally, for there to be effective patient care, the nurses should consider a change of the environment and also incorporation of modern technology.












References

Tsilimingras, F. (2003).Patient safety in geriatrics: A call for action. Journal of Gerontology, 2003;29:27-33. Print


Jones E. (2003)  Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted living long-term care. JOGN 58A, 813 - 819.

Kennedy-Malone L, (2006). Integrating gerontology competencies into graduate nursing programs. J Prof Nurse; 813 -819
Thornlow D (2006). A necessity not a luxury: Preparing advanced practice nurses to care for older adults; 22:13-18.
Manley K.(2003) A conceptual framework for advanced practice: nursing journal: 45(3) 2:23-8. Print

O'Connor,T.(2003).Relishing the challenges of rural nursing :Tiaki Nursing NewZealand,5(7),23-77. Print

Fall, M.(1997).An evaluation ofA nurse-ledear care service in primary care: Benefits and costs. British Journal of General Practice,37(42),69-73
Cabana, M (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement journal. 8:18-146. Print

Higashi T (2007). Relationship between number of medical conditions and quality of care. 36 (2):232-432
 Sodeman, T (2000). Instructions for Geriatric Patients. Philadelphia, PA: Elsevier Saunders; 200

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