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AARP Presentation Deborah Rafferty American Sentinel University Capstone Project BSN 499 Professor Victoria Brahe August 18, 2012


When you think of a nurse, what comes to mind? White clothing, white hat, white shoes, maybe a stethoscope around her neck? Where are they found, in your doctors office, hospitals, nursing homes or maybe even a homecare visit after a hospital stay? What do they do, take blood pressures, draw blood, and give injections, medications, bed baths and empty bedpans? Did I miss anything? Of course I did The nurses of today wear many hats, clinician, teacher, advocate, leader, researcher, and collaborator (Allender, Rector, & Warner, 2010, p. 47), but they no longer wear a white cap. They are found in doctors offices, hospitals and clinics yet they may have taken on different roles. With the American population increasing in age from 39.4 million in 2010 to 69 million in 2030, the need will increase for nurses to take care of this aging group (Morris & Eliadi, n.d.). There are many different jobs for nurses; I would like to explore three that will have a positive effect on the baby boomers generation; case manager, researcher, and community health nurse. Nurse Case Manager The nurse case manager has many roles and functions; assessing the health and psychosocial needs of the clients, planning care that is cost effective, facilitating the communication between all of the health care members and educating the clients about their options, benefits, treatments, and resources (Finkelman, 2011). This means while you are a patient in the hospital a case manager is assigned to you. They focus on the communication between all of the healthcare team that treats the patients acute illness with the safest and cost effective treatment available. They also handle your discharge; getting a homecare nurse,

AARP PRESENTATION supplies and having constant communication with your insurance company (Case Management Society of America, 2008-2012). Case management provides a means for the patients to improve their health and promote wellness. They achieve a quality outcome by using the appropriate resources and empowering the patients to become independent ("Case management knowledge," 2012). The case manager accomplishes this by finding the best treatments for the patients at the best cost for them as well as their insurance carrier. In order for the case manager to contain the costs, they must identify the needs as early as possible, communicate these needs with the care team, and make sure the care is given in the safest, timeliest manner possible (Finkelman, 2011). Impact of the Nurse Case Manager on the health of seniors Studies have shown case management has had a positive affect on decreasing the length of stay in hospitals and increasing the functional health status of our seniors (Hutt, Rosen, &

McCauley, 2004). When a patient is admitted to the hospital, a nurse case manager is assigned to the case. They have to be well educated in the various problems seniors are admitted for, what conditions may exacerbate the situation, what tests and treatments are warranted, as well as making sure they are discharged at what the third party payers deem reasonable. Without this liaison, the patients would never know if the care they are receiving is reasonable and if it will be covered (Finkelman, 2011). I do not like making calls to the insurance companies when I am well, let alone when I am ill. Researcher Promoting research is essential to find the best evidence-based practice to have to best outcomes for patients. In order for our nurses to provide patients with the latest, safest and cost effective care, research is critical (Kleinpell, 2008). Since Americans are living longer their

AARP PRESENTATION healthcare needs are going to increase. As we get older our bodies change, these changes can affect the way our body responds to the treatments. The nurses need to know the newest evidence based-practice to take care of this aging generation (Kany, n.d.). With the emphasis for hospitals to go Magnet status, they are required to submit data about skin breakdown and patient falls that occur in the hospital to the National Database of Nursing Quality Indicators. Seniors are more affected by these indicators more than any other age group. Nurses should be at the forefront for conducting the research to decrease these complications that occur in hospitals (Kleinpell, 2008). Impact of the Researcher on the health of seniors Research has shown that evidence-based practice (EBP) will guide nurses to a higher level of care that will improve patient outcomes, reduce costs, and contribute to a higher quality

of care, and increase the satisfaction from the patients and the nurses (Mazurek Melnyk, FineoutOverholt, Stillwell, & Williamson, 2010). Without research for seniors, there would not be a decline in bedsores and falls that occur in hospitals. This is a major concern for the health of our seniors as well as for hospital reimbursement. Nursing research is needed to use the newest evidence-based practice to care for patients (Kleinpell, 2008). The concerns of seniors go beyond their chronic conditions, such as hypertension, diabetes, and chronic pain; they also have complaints of urinary incontinence ("Urinary continence," 2009), decrease in sexual function (Peate, 2012) and dementia (Ervin & Koschel, 2012). These concerns and many more affect the seniors all over this country. Research is a never ending process to provide seniors with a full and active life; after all, life doesnt end at 65.

AARP PRESENTATION Community Health Nurse Many of the lifestyle diseases such as hypertension, diabetes, obesity, cancer and depression are causing a loss of over 150 billion dollars a year in productivity (Americas lifestyle 2011). To decrease the health burden and the cost of these chronic life style diseases, nurses can promote life style changes by educating the community. A community health nurse

works directly in the community providing information on the lifestyle behaviors that play a part in the healthcare of the community. Even as you approach retirement age, these health problems need to be addressed. The other concerns the nurse can focus on would be smoking, alcohol use, physical inactivity and nutrition (Laws et al., 2010). Teaching people to change their bad habits into good ones is not always easy. The community health nurse must teach seniors how to increase their physical activity, eat healthier and discontinue bad habits such as smoking and drinking that can case a decline in their health; smoking and drinking (Miller, 2002). Although most seniors know what they should and should not be doing, they may not know the resources there are to help them reach their goals. The community nurse will supply the patients with all of the resources in their community (Renault, 2011). Impact of the Community Health Nurse on the health of seniors Every community has to deal with chronic diseases and health issues. For the adults over the age of 65 over 85% suffer from one or more of these chronic diseases; diabetes mellitus, congestive heart failure, and chronic back pain. Studies have shown that community centers that provide information on how to live healthier with their chronic conditions have shown that seniors have improved their health (Frosh, Rincon, Ochoa, & Mangione, 2010).

AARP PRESENTATION There are over 250 community health clinics located throughout this county, staffed by nurse practitioners. These nurses can examine, diagnose, order tests and treat the patients; some states even allow them to write their own prescriptions. Seniors no longer have to wait up to three weeks to be seen by a doctor. Not only do these nurses handle the communitys health concerns, it is accomplished by keeping the healthcare costs down (Jaret, 2010). This is a winwin situation for the community. Support Legislative Agendas With the release of The Institute of Medicines (IOM) report in 2010, The Future of Nursing: Leading Change, Advancing Health, nurses were finally getting the well deserved recognition as an important part of the medical community (Edwards, 2012). The key messages in this report were to have nurses working to their fullest scope of practice, continuing their education, assist in the redesigning of the health care system, and being a part of the data collection and policy making (Institute of Medicine [IOM], 2010). These recommendations can be accomplished with the continuing support from the Robert Wood Foundation and from you, AARP (Edwards, 2012). The scope of practice is a legislative issue; every state has its limit to what a nurse is legally allowed to practice (Howell, 2012). There are some states that will allow nurse

practitioners to diagnose, treat, order tests, and write prescriptions without a doctors permission. This is a fight that needs to be continued until all of the states recognize the nurse practitioners ability to serve their community with excellent care at a reduced cost (Jaret, 2010). There have been studies relating the increase of BSN and MSN staff will decrease the errors committed and risk of death. That being said, hospitals considering Magnet status have pushed their staff into continuing their education. Nursing organizations from all over are

AARP PRESENTATION making it known that increasing your education will increase the safety of the patients. With hospitals being reimbursed on the safety and satisfaction of their patients, it is a wonder they would hire a nurse without at least a BSN (Edwards, 2012).

The IOMs report is simply telling nurses to go back to school, to continually be educated on the newest evidence-based practice, and to be an intricate part of this changing health care system (Edwards, 2012). We are finally getting the autonomy we deserve, lets put it to good use. Thank you for your time and your continued support for our nurses.

AARP PRESENTATION References Allender, J. A., Rector, C., & Warner, K. D. (2010). Community Health Nursing (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Americas lifestyles diseases cost the economy over $153 billion per year. (2011). Retrieved from Case Management Society of America. (2008-2012). Retrieved from Case management knowledge. (2012). Retrieved from px Edwards, D. S. (2012). An 80% BSN workforce by 2020? [Journal]. Reflections On Nursing Leadership, 38(1). Retrieved from Ervin, K., & Koschel, A. (2012, May). Dementia care mapping as a tool for person centered care [Journal]. Australian Nursing Journal, 19(10), 32-35. Retrieved from Finkelman, A. W. (2011). Case management for nurses. Saddle River, NJ: Pearson Education. Frosh, D., Rincon, D., Ochoa, S., & Mangione, C. (2010). Activating seniors to improve chronic disease care: results from a pilot intervention study [Journal]. Journal of the American Geriatrics Society, 58(8), 1496-1503. Howell, W. L. (2012, March 1). The changing role of nurses [Magazine]. H&HN: Hospitals & Health Networks, 86(3), 39-49. Retrieved from Hutt, R., Rosen, R., & McCauley, J. (2004). Case -management long-term conditions. Retrieved from Kings Fund:

AARP PRESENTATION Institute of Medicine. (2010, October 5th). The future of nursing Leading change, advancing health [Report]. Retrieved from Institute of Medicine: Jaret, P. (2010). The doctor cant see you now - But the nurse can. Retrieved from Kany, K. (n.d.). . Retrieved Nursing care of older adults, from

Kleinpell, R. M. (2008). Promoting research in clinical practice. AACN Advanced Critical Care , 19(2), 155-163. Retrieved from Laws, R. A., Chan, B. C., Williams, A. M., Davies, G. P., Jayasinghe, U. W., Fanaian, M., & Harris, M. F. (2010). An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial). Retrieved from Mazurek Melnyk, B., Fineout-Overholt, E., Stillwell, S., & Williamson, K. (2010, January). Evidence-based practice: Step by step: The seven steps of evidence-based practice [Journal]. American Journal of Nursing, 110(1), 55-53. doi: 10.1097/01.NAJ.0000366056.06605.d2 Miller, W. C. (2002, November/December). The improbability of lifestyle change [Journal]. Healthy Weight Journal, 84-85. Retrieved from Morris, K., & Eliadi, C. (n.d.). Are changing demographics influencing the trend in nursing curricula in Massachusetts BSN programs? Retrieved from


10 e_trend_of_nursing_curricula_in_massachusetts_bsn_programs.htm Peate, I. (2012, March). Sexually transmitted infections in older people: the community nurses role [Journal]. British Journal of Community Nursing, 17(3), 112-116. Retrieved from Renault, V. (Ed.) (2011). Supporting and maintaining behavior change. Retrieved from Urinary continence management in older people. (2009, June 2). Nursing Older People, 1-22. Retrieved from