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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