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Running head: VULNERABILITY IN OLDER ADULTS

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Nurses’ Perception of Vulnerability in Older Adult and Effect on Care Outcome

By

Bosede Omolola Adedire

Coppin State University

A Non-Thesis Paper Submitted to the Faculty of the School of Graduate Studies of
Coppin State University in Partial Fulfillment of the Requirements for the
Degree of Master of Science in Nursing

Approvals
Advisor:__________________________________________

Date:______________

Chairperson:_______________________________________

Date:______________

Area Dean:________________________________________

Date:______________

Dean, Graduate Studies:______________________________

Date:______________

Format used: Publication Manual of the American Psychological Association, 6th edition.

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ACKNOWLEDGEMENTS
First, to God be the glory for great things he has done, without whom none of these would be
possible. I am grateful to God for the good health and wellbeing that were necessary to complete
this journey. Also, I am thankful to the entire faculty of Coppin State University and faculty of
the FNP program for leadership and guidance through this program.
A special thanks to my family. Words cannot express how grateful I am to my siblings for their
encouragements through this journey, thank you to my mother and father for all of their prayers
for me. I will also like to thank all of my friends who supported me and incented me to strive
towards my goal.
At the end I will like to express appreciation to my precious family Timmy, Tire and Teni, and
my beloved husband Dimeji Adedire who spent sleepless nights with me and was always my
support in the moments when there was no one to answer my queries. I appreciate the good life
we share together!

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Abstract
The title of this clinical project is Nurses perception of vulnerability in older adult and the effect
on care outcome. The question for this clinical project was to identify what nurses perceive as
being vulnerable in the older adult? The purpose of the clinical scheme was to educate nurses on
how to assess vulnerability in older adult. In order to achieve the purpose of this clinical project,
an educational presentation was given to the targeted audience. This clinical mission is important
because nurses’ perception of vulnerability in older adult may have a far reaching effect on care
outcome. The conceptual framework that was used for the clinical project was The Roy’s
Adaptation Model. This model emphasizes how nurses have the empowerment to assist an
individual to adapt to their health status or health changes, and their environment. The clinical
project was presented to a group of nurses, nurse managers and administrators. The clinical
project was implemented at Future Care Irvington, a nursing facility in Baltimore, Maryland.
A power point presentation was delivered on information on perception and how to assess
vulnerability. The session was interactive; paper handouts were given out to the audience with
presenting information to reinforce the content thought. All information presented was in
accordance with current research and national guidelines. In order to assess learning from the
presentation, a survey of questions highlighting the major topics were provided to the audience.
Research was not conducted so there was no need to seek Institutional Board Review for
approval to conduct a study.

VULNERABILITY IN OLDER ADULTS

TABLE OF CONTENTS
Chapter One - Introduction
Introduction…………………………………………………………………………………6
Significance of the Clinical Project…………………………………………………………7
Statement of the Problem……………………………………………………………………8
Purpose of the Clinical Project………………………………………………………………8
Clinical Project Question…………………………………………………………………….8
Assumptions………………………………………………………………………………….8
Theoretical Definitions……………………………………………………………………... 9
Operational Definitions……………………………………………………………………...9
Summary……………………………………………………………………………………10
Chapter Two - Literature Review…………………………………………………………...11
Introduction…………………………………………………………………………………11
Vulnerability Concept………………………………………………………………………12
Perception Concept….......………………………………………………………………….13
Identification of Model and Rationale……………………………………………………..14
Description of the Framework/Model……………………………………………………...15
Model Relation to Study Variables………………………………………………………...18
Summary……………………………………………………………………………………18
Chapter Three - Methodology……………………………………………………………....19
Introduction………………………………………………………………………………..19
The design of the Project…………………………………………………………………..19
The Sample…………………………………………………………………………………20

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Limitations of the Project……………………………………………………………….….20
Procedure…………………………………………………………………………………...20
Protection of Human Subjects……………………………………………………………...21
Instrument/Clinical Guidelines……………………………………………………………..21
Data Analysis………………………………………………………………………………21
Summary…………………………………………………………………………………...21
Reference List.……………………………………………………………………………..23
Appendices……………………………………………………………………………………26
Appendix A: Request Letter…..………………………………………………………….26
Appendix B: Advertisement……….……….………………..…………………………….27
Appendix C: Pre-assessment test......………………………………………………………28
Appendix D: Power Point Slides…………………………………………………………..29
Appendix E: Handout.......................……………………………………………………....32
Appendix F: Post Presentation Quiz……………………………………………………….37

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Chapter One
Introduction
Over the years, there have been diverse interpretations and definitions of vulnerability.
Vulnerability in nursing can have varied concepts to different people depending on the
perspective it is being viewed. However, there is no unanimity on its definition or basic
standards used to identify vulnerability. Three major groups have been identified as being part of
the vulnerable populations, “the elderly, the people with disabilities and children” (Cassidy,
Coverdale, Naik, & Nair, 2010). The inability to advocate for self and the need to rely on others
for some form of support further predisposes these populations to being vulnerable. However,
this study will focus on the older adult population and nurses’ perception of vulnerability in this
subgroup. There has been a projected estimate of “twenty percent increase in the population of
people aged sixty-five and older by 2030, this increase in longevity is associated with a higher
prevalence of chronic conditions characterized by unpredictable disease trajectories and episodic
needs for extended care needs” (McCullough, Molinari & Workman, 2010). Also, “there is a
45%-60% hospital admission and re-admission rate in this population” (Centers for Disease
Control, 2012).
Therefore, with the knowledge of future rise in longevity, and possible health
implications, nurses need to be conversant with the identification and assessment of vulnerability
in the population of older adult in order to implement care that ensures safe and quality care
outcome for this population. Nursing care for this population varies from care of terminal
condition, disability, illnesses, cognitive decline or the infirmity of old age (CDC, 2012). Many
associate old age as the primary reason for being vulnerable, however, different research studies

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have explored how vulnerability can be interpreted and construed by different health care
workers (Cassidy et al., 2010; Sarvima & Stenbock-Hult, 2011; Pauly & Pagan, 2010). The
misinterpretation of the “concept of vulnerability in the older adult population has increased the
hospital admission in this sub-group to as much as forty-five percent to sixty-percent in readmission rate based on the same initial hospitalization concern” (CDC, 2012).
The ability to incorporate useful proven criteria to identify vulnerability in the adult
population has the capacity to increase safety, reduce re-hospitalization and improve the quality
of life (Gerber, 2010; Girard & Murray, 2010). Though, recent studies have not been able to
provide clarification as to what measures to apply in identifying and assessing vulnerability in
the older adult population that resides out of the hospital setting. Research findings have reported
the effect of disease processes as a focus in determining vulnerability (Cassidy et al., 2010;
Sarvima & Stenbock-Hult, 2011; Pauly & Pagan, 2010), yet, other criteria need to be explored.
Significance of the Project
The clinical project is significant because it will provide important information for
community nurses about criteria useful in identifying and assessing vulnerability in the adult
population that receives care out of the hospital setting; the result will provide useful in sights
that will assist nurses to deliver effective holistic care which will promote quality care and
improved care outcome for the patient. While disease process could be a primary factor in a
patient being vulnerable, this study seek to provide guidance for nurses in recognizing
vulnerability in their patients. According to Pauly & Pagan (2010), perception of vulnerability by
nurses has a major role to play in care delivery and ultimately care outcome for the patient based
on the assessments and implementation of care provided by the caregiver; the nurses.

VULNERABILITY IN OLDER ADULTS
Statement of the Problem
Vulnerability is an important concept in the care of the older adult since the rate of older
adult re-hospitalization has been linked to unresolved initial hospitalization prognosis (CDC,
2011). According to a recent report, “sixty-percent of older adult re-hospitalized were seen for
same concern that they were admitted for in the initial phase of their hospitalization” (CDC,
2013). Therefore, nurses’ perception and identification of vulnerability in this population is
paramount to ensure continuity of the effectiveness of care they received while hospitalized.
Purpose of the Project
The goal of this project is to provide direction and guidance to community nurses in the
identification of vulnerability in older adult patient.
Clinical Project Question
The question for this clinical project will be to identify what nurses consider has
vulnerability in their patient.
Assumptions
An assumption associated with this project is that everyone at one point or the other will
continue to grow to old age, and may need to be institutionalized in a nursing home or need the
care of a home health nurse in their homes. It is assumed that the need to rely on someone else
for daily health care needs put that individual in a vulnerable state. It is general knowledge that
quality care is paramount to the nursing field, so there is a need to provide guidance to nurses to
help them achieve quality and effective care outcome in the care of their patients.
Theoretical Definitions

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The theoretical terms and their definitions used in this clinical project are listed below as
follows:

Vulnerability is defined “as the failure to engage in acts of self-care that adequately
regulate safe and independent living or to take actions to prevent conditions or situations

that adversely affect personal health and safety” (Cassidy et al., 2010)
Perception is described as “what caregivers considers or think about their patient care

needs during assessment and care implementation” (Sarvima & Stenbock-Hult, 2011).
Care Outcome is defined “as the effect of care given to care recipient” (Pauly & Pagan,

2010).
Older Adult is defined “as people aged sixty-five and above who lives in a health care

facility” (McCullough et al., 2010).
Effect is defined “as the implication of an event on its target” (Sarvima & Stenbock-Hult,
2011).

Operational Definitions
Operational definitions for this project are listed below:

Vulnerability: is operationally defined as “susceptibility to physical or emotional factors from the


environment” (Merriam-Webster 2014).
Care outcome: refers to “result or response from care received” (Merriam-Webster 2014).
Older adult: in the context of this study are “people aged sixty-five and above who lives in a

health care facility or outside of the hospital that needs nursing care” (Daddario, 2010).
Perception: is defines “as a person’s insight or discernment about a condition or situation”

(Merriam-Webster 2014).
Effect: refers to “the impact an intervention or event has on its target” (Daddario, 2010).
Summary

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In summary, vulnerability is a concept that affects older adult population. Nurses’
perception of this concept can have either a positive or negative impact on the adult population.
Older adults that require nursing care in the community may have care outcome in relation to
interventions given by the nurses. However, there can be increase in the level of positive care
outcome and decrease re-hospitalization with continuous use of individualized care path that
addresses the patient holistically. This clinical project will have a positive impact on the nursing
profession by empowering nurses through the use of appropriate care path and clinical judgments
in providing quality care that decreases hospital admissions and readmissions of the older adult.

Chapter Two: Literature Review
Introduction
To guide this clinical project, extensive literatures were reviewed to identify what nurses
perceive as vulnerability in the older adult population and its effect on care outcome. The areas
selected for review include older adult and vulnerability, nurses’ perception of vulnerability in

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older adult, and the impact of care on outcome. This section of the paper reviews different
research studies done on older adult and caregiver perception of vulnerability in this population.
The importance of this study is expanded given the estimates by experts that “at least sixtypercent of all individuals will need extended help in one or more in the areas of activities of daily
living during their lifetime” (Dyer, Pickens & Brunett, 2010; Skelton, Kunik, Regev, & Naik,
2010). Additionally, older adults have a high probability of living the latter part of their lives in a
nursing home or to receive care in their home environment (CDC, 2011). Perception of nurses in
the assessment and implementation of care of the older adult was included in the review of
literature because of the implication that care given has on the care outcome for the patient.
According to the report of CDC (2012), 45%-60% of older adult usually are rehospitalized within two weeks of initial hospital admission. Guidance to reduce hospitalization
are included to guide nurses in the path to choose in implementing care (CDC, 2012). This
section of the clinical project will examine the concepts of vulnerability and perception. Also in
this chapter, literature review will include a review of the Roy’s Adaptation Model. The review
will include detailed explanation of the model as it relates to this clinical project. The model was
chosen for the clinical project due to its framework and adaptability to patient centered care.

Concept of Vulnerability
The term vulnerability has been used frequently and in different context in nursing
articles and general studies. Vulnerability has been defined “as the degree to which a subgroup of
the population is exposed to susceptibility or risk of injury” (Cheater, 2010). Vulnerability has
been used “interchangeably to mean at risk for, but still distinct from each other” (CDC, 2013).

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Therefore, “vulnerability is an analytical concept, seeking to produce its meaning in the context
which it is being used” (Cheater, 2010). Evidence from reviewed studies create a need to provide
guidance and reinforce the need to adequately assess vulnerability in this population living in the
community, outside of the hospital setting. The concept of vulnerability and older adult has been
explained and clarified by different schools of thought. However, the question arise whether
perception of vulnerability by nurses does indeed influence care outcome in older population, or
whether observed effect is linked to some other influences. McCullough et al. (2010) added that
older adult population receiving nursing care in the community need holistic assessment beyond
disease process to attain a more rounded outcome.
Girard & Murray (2010) describes community nurses as those who worked outside the
hospitals in poor and middle-class communities, nurses who care for patients outside of the
hospital, who taught about cleanliness, disease prevention, nutrition, and child care. However,
nursing interventions should be beyond caring for patient’s basic needs, but to include other
factors towards provision of all rounded care. Likewise, “care giver perception of vulnerability
and the influence on care outcome can either have a positive or negative effect while patient
residence in the community” (Patronis, 2007, p. 39). Collection of research outcome by Cassidy
et al., 2010; Skelton et al., 2010; Saliba, Elliot, Rubenstein & Solomon (2010) found out that the
inability to foresee a possible negative outcome or not planning for at risk situations predisposes
the patient to adverse effects from disease processes and increase hospitalization.
Cassidy et al. (2010) reports from their findings that cognitive level, socio-economic
factor, language barrier and most importantly the care recipient need to be factored into care
given to address needed interventions, for risk management this article reports that care
implementation that overlooks this factors increases the chances of the patient’s vulnerability.

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The strengths of this article is in its emphasis on risk managements for the patient, but the
weakness of the report rests on the inability to provide guidance for the present.
Similarly, Gerber (2012) reports that community-oriented nursing that addresses the
connection between this population's health status and the physical, social-cultural, and biologic
environment, ensures a more positive person-centered outcome. Likewise, Daddario (2010)
enlightens that each member of a care team play an essential role in maximizing quality patient
care outcomes, and these quality outcomes arise from the commitment and contribution of each
team member to care implemented, that is, patient, family support group and healthcare workers.
Concept of Perception
The “perceptual concept provides the opportunity to experience our environment”
(Gerber, 2012). According to Daddario (2010) the ability to detect stimuli in the environment and
to respond to such stimuli is based on our views and past experiences. Also the “capability to
recognize and internalize what is around us gives us the aptitude to respond appropriately to such
stimuli” (Patronis, 2007, p. 48). However, in nursing, “perception relates to nursing judgments
and clinical expertise applied to everyday nursing care delivery” (Gerber, 2012). Clinical
judgments help to appreciate and respond appropriately to nursing issues. However, care giver
perception of vulnerability is fragmented and often provides contradictory results for care
interventions (Cassidy et al., 2010). Furthermore, “individual perception of care can be complex
requiring caregivers to recheck their assessments and reflect on decisions made in reference to
planned care” (Girard & Murray, 2010), to ensure that all involved in implementing care
comprehend and able to contribute to quality care of the vulnerable adult.

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In order to decrease the likely increase in vulnerability of the older adult population from
caregiver point of view, there is the need to provide guidance that reinforces individualized care
in the observation and evaluation of patient’s response to treatment without generalizing
outcomes (Cassidy et al., 2010; Skelton et al., 2010; Saliba et al., 2010). Therefore, treatment
given needs to be evaluated based on the intervention given and “effectiveness ascertained within
a reasonable time frame to prevent complications or adverse reactions that may result in rehospitalization” (Anderson, 2008, p. 78). Girard & Murray (2010) also reports that older adults
are re-hospitalized for the same reason from the initial hospitalization. Older adult
“hospitalizations are preventable with the use of interact two tool which help to assess
vulnerability in older adult population” (Dyez et al., 2010).
Also, Frosch, Singer & Timmermans (2011) from their study mentioned that continuity of
care play an important role in the quality of care outcome for the elderly patient. They reiterated
that each intervention must have corresponding evaluations that assess the effectiveness of care
implemented.
Identification of Model and Rationale
The Roy adaptation model will be used as a conceptual framework for this clinical
project. This model is useful because it is applicable to the nursing process used in everyday
nursing delivery (Daddario, 2010). This model is applicable to this project because it uses step by
step approach in examining and caring for the patient holistically using the nursing process. This
model was chosen because it is applicable in examining patient centered care (Pauly & Pagan,
2010). The major purpose of the clinical project focuses on providing guidance to nurses to help
in identification of vulnerabilities in older adult patient. This model will facilitate the provision

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and guidance needed for nurses to comprehend the importance of identification of vulnerability
in their patient.
Description of the Model
The model was developed by Sister Callister Roy in 1976 to describe the nature of
nursing as a service to the society, which prompted her to create this model with the goal of
nursing in mind, to promote adaptation (Sarvima & Stenbock-Hult, 2011). The Roy adaptation
model “is the most common model used in education and health promotion, the components of
the adaptation model are: person, health, environment and nursing” (Pauly & Pagan, 2010).
According to Roy's model, “a person is a bio-psycho-social being in constant interaction
with a changing environment he or she uses innate and acquired mechanisms to adapt”
(McCullough et al., 2010). The model includes people as individuals, as well as in groups such
as families, organizations, and communities, this also includes the society as a whole (Daddario,
2010).
The Adaptation Model “states that health is an inevitable dimension of a person's life, and
is represented on a health-illness continuum” (as cited in Daddario, 2010). Health is also
described “as a state and process of being and becoming integrated as whole” (Gerber, 2012),
which in this context could affect a nurses perception of the patient’s state of health and
vulnerability on the continuum. As cited by Pauly & Pagan (2010) the environment has three
components: focal, which is internal or external and immediately confronts the person;
contextual, which are all stimuli present in the situation that all contribute to the effect of the
focal stimulus; and residual, whose effects in the current situation are unclear. All conditions,
circumstances, and influences surrounding and affecting the wellness of people and groups, with

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particular consideration of mutuality of person and earth resources, creates an avenue for nurses
to be able to identify and assess vulnerability in the adult population to effect a positive adaptive
outcome (McCullough et al., 2011).
According to the Roy framework, “the goal of nursing is to promote adaptation in four
adaptive modes” (McCullough et al., 2011). Nurses promote adaptation for individuals and
groups in four identified adaptive modes, thus contributing to health, quality of life, and dying
with dignity by assessing behaviors and factors that influence adaptive abilities and by
intervening to enhance environmental interactions (McCullough et al., 2011). The “four adaptive
modes of Roy's Adaptation Model are physiologic needs, self-concept, role function, and
interdependence” (Daddario, 2010). As cited by McCullogh et al. (2010) the Adaptation Model
includes a six-step nursing process:

The first level of assessment, which addresses the patient's behavior

The second level of assessment, which addresses the patient's stimuli

Diagnosis of the patient

Setting goals for the patient's health

Intervention to take actions in order to meet those goals

Evaluation of the result to determine if goals were met
This framework explains the need to make the patient the center of care, which will help
to provide holistic care that takes the needs of the care recipient into perspective (Daddario,
2010). The ability to “assess vulnerability in a patient provides nurses with tools that they need to
provide quality patient care” (Gerber, 2012). Moreover, the incorporation of the adaptation
model into patient care delivery will shape nurses perception on vulnerability (Daddario, 2010).

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The theory framework emphasizes individualized plan of care for each patient which makes the
theory relevant to the proposed clinical project, it recognizes each patient has an entity with plan
of care centered on the patient’s general care needs (Gerber, 2012). The concept of vulnerability
is multifaceted and awareness of Roy’s theory will reinforce the need to provide holistic
individualized care that is empowering to the patient and family (Patronis, 2007, p. 108).
Pauly & Pagan (2010) provides a structured approach to addressing the concept of
measuring vulnerability by using other factors to reinforce how an older adult can be vulnerable.
They measured the rate of hospital admissions and readmissions based on care provided by
nurses; they found out that perception of nurses affect treatment outcome for this population as
evidenced by nurses care implementations and noted missed assessments on documentations
(Pauly & Pagan, 2010). In line with this finding, McCullough et al. (2010) reinforced the use of
situation, background, assessments and recommendation tool to enhance care delivery and
documentation. They explained that the “incorporation of a standardized tool in assessment and
communication will assist nurses to communicate patient care needs effectively as it arises”
(McCullough et al., 2010).
Masotti, McColl, & Green (2010) in their research highlights that community nursing
involves quite a number of professionals who communicates with each other, the client and other
caregivers needs a medium to keep everyone updated with patient care needs. Frosch et al.,
(2011) went on to say that educating nurses via continuing education will provide shared
informed learning that strengthens holistic care and patient-centered approach to care.
Model Relation to study

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The Roy’s adaptation model to nursing will be used to guide this project. This model is
related to this study in his step by step guide given to direct effective assessment and
communication of care among nurses. This clinical project will provide nurses with the guidance
that they need to provide individualized quality care to older adult patients. The information
given on perception of vulnerability in older adult will guide nurses to provide holistic care
which will optimize the patient’s overall health and care outcome. The “ability to determine what
constitute vulnerability in an elderly patient will guide in providing interventions that addresses
that concern” (McCullough et al., 2011). The consistent use of the nursing process will facilitate
the guidance needed by nurses to provide optimal care (Cheater, 2010).
Summary
In summary, there is quite a number of information relating to nurses’ perception of
vulnerability in older adult and its effect on care outcome. Nurses are responsible for adapting
the nursing care plan based on the patient's progress toward health goal. Therefore, the proposed
study will provide guidance to nurses on assessing vulnerability in the older population.

Chapter Three: Methodology
Introduction

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Due to the increase in the hospitalization and re-hospitalization rate of older adults, it
becomes imperative to provide guidance to nurses in the care of this population to reduce or
eradicate the rate at which this population are admitted or readmitted to the hospital. The clinical
project will serve to guide nurses in identification of vulnerability in the older adult and how to
provide effective care for this population to prevent any untoward outcome.
The Design of the Project
In order to implement this project an appropriate location was identified and approved
for the project. A long term care facility in west Baltimore was chosen for this clinical project.
This location was chosen because it has the target population of nurses that the clinical project
addresses. This facility has over fifty nurses that work there on different shifts to care for
hundreds of elderly patients. The facility nurse practitioner (FNP) was also in attendance.
The project implementation date was Friday, December 5th, 2014, at 1100 hours.
Clinical questions for this project were: which facets of patient care needs do nurses
consider as being vulnerable, and how these aspects impact patient care outcome? Following the
presentation, the nurses were able to identify the answer to the clinical question. Prior to the
presentation, a pre-assessment testing was given to the nurses to assess baseline understanding of
what they view as vulnerability in their patient population. Also, following the presentation a
question and answer segment took place, followed by a brief learning assessment.
The Sample
The samples of participants were nurses that provide nursing care at a long term care facility.
Others present were the social worker, the nutritionist, the Director of nursing services, the Nurse

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practitioner at the center. However, the targeted samples were the nurses that provide bedside
care.
Limitations of the Project
This project has limitations consistent with obtaining sample participants from one
demographic location which will be the one long term care facility in west Baltimore.
Procedure
This clinical project was approved by sending an email to the nurse practitioner at the
long term care facility (see Appendix A), requesting to have a clinical project presentation at the
facility. Upon approval of the project, materials for advertisement were made (see Appendix B),
to create awareness for the event coming up, the materials and posters were displayed on a board
at the entrance of the facility notifying nurses and other health care workers that want to
participate about information about the time, location and what to expect from the event. The
speaker arrived ninety minutes early for the presentation. Prior to the presentation, a preassessment test (see Appendix C) was given to participants to find out what the participants
perceives as being vulnerable in their patients. Then, power point presentation (see Appendix D)
followed with the discussion of the concepts involved in vulnerability and perception and how it
relates to older adult and care provision. The presentation involved how to identify vulnerability
in these patients using the nursing process and Roy’s adaptation model, also, handouts (see
Appendix E) of the discussion was given out to participants to facilitate learning. The
presentation lasted approximately thirty minutes. Following the presentation, question and
answer segment followed with a quick five minutes survey to assess what the participants
learned post presentation (see Appendix F). The option to identify self on the survey was

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optional since there was no confidentiality concern involved in the clinical project. The FNP in
charge at the facility ensured everyone that attended the conference signed off on a sign in sheet,
and a total of thirty employees were in attendance.
Protection of Human Subject
Not applicable to this clinical project.
Instrument/Clinical Guidelines
Information provided during the presentation portion of the clinical project was research
and evidence based. None of the information and guidance shared with the participants was
reflective of the author’s beliefs, opinions, or biases. The pre and post assessments were
constructed using the current national guidelines and peer reviewed journal articles.
References for the materials were also made available.
Data Analysis
A five question survey was given before and after the clinical presentation to assess
participant baseline understanding of the clinical questions and their understanding after the
presentation. Information about the setting and resident statistics were also collected without any
personal identifications.
Summary
In summary, this clinical project will provide nurses at the west Baltimore long term care
location the guidance that they need to identify vulnerability in their patients so as to give
optimal nursing care. This clinical presentation was implemented with reference materials
available to provide a visual aid to participants. All questions, comments and concerns were
appropriately addressed by the presenter of the project. All the information shared and discussed
were in accordance with the national guidelines and peer reviewed journals.

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References
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vulnerable older adults. Journal of American Board of Family Medicine, 23, 235-252.

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Centers for Disease Control and Prevention (2011). National Geriatric Fact Sheet:
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Frosch, D., Singer, K., & Timmermans, S. (2011). Conducting implementation research in
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Appendix A

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26

Hi Ms. Mitchell,
My name is Bosede Adedire, I am taking Nursing 513, a non-thesis research course this fall
semester. This course requires that we complete a clinical project. My topic would best be
presented to the nursing staff at a nursing facility such as a long term and rehabilitation center.
I have had clinical at Future Care Irvington and think that my topic would benefit the Staff and
patients in that magnificent facility.
I am reaching out to you to find out if you could assist to facilitate my plan to carry out a clinical
project at Future Care Irvington so that I can come in and present my topic sometime in early
December, 2014. The date and time can be arranged based on the facility’s available schedule.
I sincerely appreciate your time and efforts in assisting me to accomplish my educational goals.

Sincerely,

Bosede Adedire

Appendix B
COPPIN STATE UNIVERSITY GRADUATE
STUDENTS PRESENTS

VULNERABILITY IN OLDER ADULTS

27

INFORMATIVE NURSING SESSION
TOPIC:

DATE: FRIDAY DECEMBER 5th, 2014 11:00AM – 12:30PM

Refreshments Served!

Appendix C
Vulnerability in older Adult Baseline Assessment

VULNERABILITY IN OLDER ADULTS

28

Directions: Please select the best answer
1. What factors are responsible for vulnerability in older adult?
a. Internal factors
b. External factors
c. Wealth
d. Both a and b
2. Vulnerability assessment in a resident is a test to identify areas of weakness that might
make the resident susceptible to adverse outcomes.
a. True
b. False
3. Both internal and external factors contribute to vulnerability
a. True
b. False
4. All the patient receiving care in LTC are vulnerable.
a. True
b. False
5. The use of the nursing process in patient care waste time and effort.
a. True
b. False

Appendix D

VULNERABILITY IN OLDER ADULTS

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VULNERABILITY IN OLDER ADULTS

30

VULNERABILITY IN OLDER ADULTS

31

VULNERABILITY IN OLDER ADULTS

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Appendix E

VULNERABILITY IN OLDER ADULTS

33

VULNERABILITY IN OLDER ADULTS

34

VULNERABILITY IN OLDER ADULTS

35

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Appendix F

VULNERABILITY IN OLDER ADULTS
Vulnerability in older Adult Learning Assessment
Directions: Please select the best answer
1. What factors are responsible for vulnerability in older adult?
a.
b.
c.
d.

Internal factors
External factors
Wealth
Both a and b

2. Vulnerability assessment in a resident is a test to identify areas of weakness that might
make the resident susceptible to adverse outcomes.
c. True
d. False
3. Both internal and external factors contribute to vulnerability
c. True
d. False
4. All the patient receiving care in LTC are vulnerable.
c. True
d. False
5. The use of the nursing process in patient care waste time and effort.
c. True
d. False

38