In Chapter 2 of the course text book “Toward Healthy Aging” the topic of transition of care is a leading problem in the older adult population that leads to hospital readmissions. Read this section of the text on “transitions across the “continuum: the role of nursing.” Identify some of the major causes of readmission and the role of the gerontological nurse in improving and preventing readmissions. Read the following article on “The Prevention of Hospital Readmissions in Heart Failure.”
In this discussion (5 paragraphs) you will address will address the following:
1. Summarize the contents of the article: The Prevention of Hospital Readmissions in Heart Failure
2. What are some of interventions that can be used to prevent hospital readmissions. Use additional sources to support your work. Cite your sources in APA format.
3. What care setting interest in your future role as a nurse (pediatrics vs adults, outpatient vs inpatient vs community) and why?
4. Be sure to include in-text references and a reference summary.
Chapter 2
Gerontological Nursing:
Past, Present, and Future
Copyright © 2020 by Elsevier, Inc.
All rights reserved.
Care of
Older
Adults
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2
It is essential that nurses have
the knowledge and skills to help
people of all ages, races, and
cultures to achieve health aging
To enhance health in aging
requires attention throughout
life, along with the expert care of
nurses
Estimates are by 2020 up to 75%
of nurses’ time will be spent with
older adults
Who Will Care for Older Adults?
In the United States, eldercare is projected to be the
fastest growing employment sector in health care
Less than 1% of registered nurses and fewer than 3%
of advanced practice nurses are certified in geriatrics
Less than 3% of medical students choose to take
geriatric electives
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rights reserved.
3
Gerontological Nursing
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Gerontological nurses have made significant contributions
to the body of knowledge guiding best practices for older
adults
It has emerged as a specialty area of practice only within
the past six decades
The specialty was defined and shaped by nursing pioneers
who saw that older individuals had special needs and
required subtle, holistic, and complex nursing care
See what the pioneers have to say (Box 2-1)
Gerontological Nursing
Perspectives
Gerontic nurse pioneers and leaders
• Origins of gerontological nursing rooted in England
• Began with Florence Nightingale
• Expanded in United States with passage of Social Security
Act
• AJN article (Gelbach, 1943) recommended that nurses have
specific geriatric education
• 1950—first textbook on nursing care of elderly
• 1952—first published nursing research on chronic disease
and the elderly
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Gerontological Nursing
Perspectives
Current initiatives
• Hartford Institute of Geriatric Nursing,
established in 1996 by the John Hartford
Foundation
• Nurse Competent in Aging (NCA) Project; check
out ConsultGeriRN.org as one resource
• Resourcefully Enhancing Aging in Specialty
Nursing (REASN)
• Sigma Theta Tau’s Center for Nursing Excellence
in Long-Term Care
6
Copyright © 2020 by Elsevier, Inc. All rights reserved.
Gerontological
Nursing
Perspectives
Gerontological
Nursing
Perspectives
• Organizations devoted to gerontology
research and practice
• Gerontological Society of
America (GSA)
• American Society on Aging (ASA)
• Association for Gerontology in
Higher Education (AGHE)
• National Council on Aging
(NCOA)
• National Gerontological Nursing
Association (NGNA)
• Gerontogical Advanced Practice
Nurses Association (GAPNA)
• National Association Directors of
Nursing in Long Term Care
(NADONA/LTC)
• Canadian Gerontological Nursing
Association (CGNA)
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Research on Aging
• Early studies focused on older people who were ill and failed to adequately address
aging issues
• The current impetus for research has focused around the impact of disease and
morbidity, impending death on quality of life, and experience of aging
• A need to shift from the “biomedical” model of aging
• The National Aging Institute, the National Institute of Nursing Research, the National
Institute of Mental Health, and the Agency for Healthcare Research and Quality have
contributed to our understanding of older persons and provide federal funding
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Nursing Research
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rights reserved. 10
Has evolved to the point of producing best practice
standards
The National Institute of Nursing Research provides
considerable funding for research with older adults
Nurse researchers publish in many journals related
to gerontology
Nursing research has significantly impacted the
quality of life of older people
Future directions of nursing research (Box 2-2)
Gerontological
Nursing Roles
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Gerontological nursing offers a wide
variety of settings and circumstances with
limitless opportunities
Can function in generalist or specialist
roles
Functions in variety of settings: primary
care, acute care, home care, subacute
and long-term care (LTC) facilities, and the
community
National certification is a way to
demonstrate knowledge in care of older
adults
Gerontological Nursing
Roles Perspectives
12
Specialist roles
• APRN may specialize, but are not licensed solely in a specialty
• APRNs with certification and interest in geriatrics is low
• Adult nurse practitioner and gerontological nurse practitioner
specialty education is now combined and will hopefully lead to more
expertise in care of the older adult
• Adult-gerontological nurse practitioners may be trained in acute or
primary care
• Geriatric nurse practitioners and clinical nurse specialists have made
a big difference in LTC over the last 40 years.
Copyright © 2020 by Elsevier, Inc. All rights reserved.
Gerontological
Nursing Roles
Perspectives
Acute care
• In the acute care setting, 60%
of medical-surgical patients
and 46% of critical care
patients are older adults
• Only a small number of the
6000 hospitals in the country
have practice guidelines,
educational resources, and
administrative practices to
support older adult care
• Because of the aging
demographics more nurses will
realize that they are
subspecialist or generalist in
geriatric care
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Nurses improving care of health system
elders (NICHE)
• Started in 1992 and designed to
improve outcomes for hospitalized
older adults
• The role of a geriatric resource nurse
is pivotal in influencing outcomes
and coordination of care
• Supports geriatric nursing
competencies
• Focuses especially on iatrogenic
complications, which occur at a rate
of 29%-38%
• More than 500 hospitals in more
than 40 states and part of Canada
are involved in the NICHE program
Gerontological
Nursing Roles
Perspectives
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Gerontological
Nursing Roles
Perspectives
Community and home-based care
• Much of the care of older adults
will occur in the community
because of escalating health
care costs and aging in place
• Nurses in the home setting
provide comprehensive
assessments
• Care management and working
with interprofessional teams are
integral components of home
care
• New roles such as care
coordinator, nurse/family
cooperative facilitator, remote
monitoring, and primary care
will become emerging roles
Copyright © 2020 by Elsevier, Inc. All rights reserved. 15
Gerontological Nursing Roles
Perspectives
Certified nursing facilities (Nursing home)
• Custodial care is no longer a valid description of the
nursing home
• One quarter of Medicare patients admitted to hospital
are discharged to PAC
• Professional nursing roles include nursing administrator,
manager, supervisor, educator, infection control,
Minimum Data Set coordinator, case manager, quality
improvement, and direct care
• Care in this setting requires independent decision-
making
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Transitions
Across the
Continuum
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Older people have complex problems and
often require care across multiple settings
This makes them more vulnerable to poor
outcomes during transition
Because each setting is considered an
independent entity, one setting may not
be aware of what the other does
This is slowly changing with the
development of accountable care
organizations, health home, and bundled
care payments
Transitions Across the
Continuum Perspectives
Readmissions: The revolving door
• One in four older adults is readmitted to the
hospital within 30 days of leaving
• 90% of these are unplanned and cost upward
of $17 billion
• 1 out of 4 Medicare patients admitted to a
skilled nursing facility will be readmitted
within 30 days
• The Centers for Medicare and Medicaid
Services has identified avoidable
readmissions as one of the top leading
problems facing the U.S. health care system
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Transitions Across the Continuum
Perspectives
Factors contributing to poor transitional care outcomes
• Can be related to the patient, provider, and system
• Most are related to a fragmented system of care
• Patient factors relate to language, literacy, and cultural and
socioeconomic factors
• Medication discrepancies are the most prevalent adverse
event following discharge from the hospital
• See Box 2-11 for Resources for Best Practice
• See Box 2-12 for Tips for Best Practice
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Promoting
Healthy Aging:
Implications for
Gerontological
Nursing
20
• Gerontological nurses will play a
significant role in research,
innovations in care, and provision of
services to the growing population of
older adults in global society
• Specialized knowledge will contribute
to initiatives that directly impact the
health and quality of life of our older
population
• Continued recruitment and education
of nurses to meet the needs of this
growing population
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Question 1
What is the most prevalent
adverse event following
discharge from the hospital?
a. Medication
discrepancies
b. Falls
c. Pneumonia
d. Dehydration
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reserved. 21
Question 2
By the year 2020, the
average amount of time
nurses will spend caring
for older adults is:
a. 25%.
b. 50%.
c. 75%.
d. 100%.
Copyright © 2020 by Elsevier, Inc. All rights reserved. 22