2/1/2020

GERONTOLOGICAL
NURSING
(NELECO02)—LEC | FIRST GRADING

BRYAN C. ROBLES, MSN, RN

@brydgr8 brydgr08

COURSE • NELECO02 is designed to focus on the

DESCRIPTION application of the nursing process in the care
of older adult/elderly patients experiencing
varied conditions in the health care continuum
in a variety of health care settings.

@brydgr8
brydgr08

1
 2/1/2020

• List landmarks that affected the development of

gerontological nursing;
COURSE • Discuss major roles in gerontological nursing;
OBJECTIVES
• Identify standards used in gerontological nursing
practice;
At the end of the • List principles guiding gerontological nursing
discussion, the practice ;
student nurses • Explain holistic gerontological nursing care;
should be able to:
• Contrast several major theories of aging;

@brydgr8
brydgr08

• Discuss the importance of the Transcultural

Nursing Society’s care standards and the culturally
COURSE and linguistically appropriate services (CLAS) in
OBJECTIVES health care.
• Apply the Cultural Care triad to the complex
interrelationships of the nurse, caregiver, and
At the end of the patient within community and institutional (home
discussion, the or residential) settings.
student nurses
• Create a plan of care for the older adult
should be able to:
integrating Cultural Care.

@brydgr8
brydgr08

2
 2/1/2020

I. Foundations of Gerontological Nursing

A. Principles of Gerontology
COURSE B. Contemporary Gerontological
CONTENT Nursing
II. Challenges of Aging and the Cornerstones
of Excellence in Nursing Care
A. Cultural Diversity
B. Violence and Mistreatment
@brydgr8
brydgr08

PRINCIPLES OF GERONTOLOGY @brydgr8

brydgr08

3
 2/1/2020

DEVELOPMENT OF GERONTOLOGICAL NURSING

• 1935—Federal Old Age Insurance Law (better known as Social Security) was
passed.
• 1961—American Nurses Association (ANA) recommended that a specialty group
for geriatric nurses be formed.
• 1966—Division of Geriatric Nursing was formed.
• 1969—Standards for Geriatric Nursing Practice was developed.
• 1970—Standards for Geriatric Nursing Practice was published.

@brydgr8
brydgr08

• 1975—Certification of Excellence in
Geriatric Nursing Practice was achieved by
74 nurses
—birth of the Journal of Gerontological
Nursing
• 1976—the Geriatric Nursing Division
became the Gerontological Nursing Division

@brydgr8
brydgr08

4
 2/1/2020

INTRODUCTION
• GERONTOLOGY—is the holistic study of aging
processes and individuals as they mature
throughout the adult life span.

• GERONTOLOGISTS—professionals who focused

on gerontology.

• GERIATRICS—is the field more closely aligned with

medicine.
@brydgr8
brydgr08

GERONTOLOGICAL NURSING CARE SETTINGS

• Skilled nursing facility
• Retirement community
• Adult day care
• Residential care facility
• Transitional care units
• Rehabilitation hospital
• Community-based home care @brydgr8
brydgr08

10

5
 2/1/2020

CORE VALUES AND PRINCIPLES OF

GERONTOLOGICAL NURSING
• Health promotion
• Health protection
• Treatment of disease

@brydgr8
brydgr08

11

AGING
• An inevitable and steadily progressive process that
begins at the moment of conception and continues
throughout the remainder of life.

@brydgr8
brydgr08

12

6
 2/1/2020

STAGES OF AGING
1. Antepartum 5. Adolescent
2. Neonate 6. Young Adult
3. Toddler 7. Middle Adult
4. Child 8. Old Adult

@brydgr8
brydgr08

13

SUBDIVISIONS OF OLD ADULT

1. Young-old 65-74 years
2. Middle-old 75-84 years
3. Old-old 85+ years

@brydgr8
brydgr08

14

7
 2/1/2020

GOAL OF GERONTOLOGICAL NURSING CARE

• To Improve the length and quality of life of older
adult (through provision of high-quality care).

@brydgr8
brydgr08

15

DEMORGRAPHICS AND AGING

• COUNTRIES WITH LARGEST NUMBERS OF
OLDER PEOPLE
• China 129M
• India 77M
• U.S. 40M
• Russian Federation 27M

@brydgr8
brydgr08

16

8
 2/1/2020

LIFE EXPECTANCY
• Is a number of years from birth that an individual
can expect to live.
• Japan 83.98 years
• Central African Republic 47 years

@brydgr8
brydgr08

17

LIFE EXPECTANCY OF OTHER COUNTRIES

(World Bank, Jul.6, 2018)
• Australia 82.5 years • U.K. 80.96 years
• Canada 82.3 years • Germany 80.64 years
• Sweden 82.2 years • U.S. 78.69 years
• Finland 81.78 years • Poland 77.45 years
• Netherlands 81.51 years

@brydgr8
brydgr08

18

9
 2/1/2020

• Arthritis
LEADING CAUSES • Hypertension
OF ACTIVITY • Heart Disease
LIMITATION • Diabetes
• Respiratory Disorders

@brydgr8
brydgr08

19

• Primary Prevention (Health Promotion)

NURSING
INTERVENTIONS • Secondary Prevention (Early Diagnosis and
TO PROMOTE Prompt Treatment)
HEALTH IN OLDER
PEOPLE • Tertiary Prevention (Restoration and
Rehabilitation)

@brydgr8
brydgr08

20

10
 2/1/2020

• Heart Disease • Diabetes Mellitus

LEADING CAUSES • Malignant Neoplasm • Influenza/Pneumonia
OF DEATH • Cerebrovascular • Nephritis/Nephrosis

(men & women) • Bronchitis/Emphysema/As • Accidents

thma • Septicemia
• Alzheimer’s Disease

@brydgr8
brydgr08

21

• Heart Disease
FIVE CHRONIC • Cancer
DISEASES • Stroke
(cause of death) • COPD
• Diabetes

@brydgr8
brydgr08

22

11
 2/1/2020

HEALTHY PEOPLE 2020

• A statement of national health objectives designed
to identify the most significant preventable threats
to health and to establish national goals to reduce
these threats.

@brydgr8
brydgr08

23

• Attain high-quality, longer life free of

preventable disease, disability, injury and
premature death;

• Achieve health equity, eliminate disparities, and

improve the health of all groups;
FOUR BASIC GOALS
• Create social and physical environments that
promote good health for all;

• Promote quality of life, health development and

@brydgr8
healthy behaviors across all life stages. brydgr08

24

12
 2/1/2020

CONTEMPORARY GERONTOLOGICAL NURSING

@brydgr8
brydgr08

25

SENESCENCE
• Term used by Gerontologist when
characterizing the aging process
• Progressive deterioration of body systems

@brydgr8
brydgr08

26

13
 2/1/2020

• Brain loses some axon and neurons.

• Visual Changes: difficulty focusing, increased
sensitivity to glare, diminished nighttime
vision.
NORMAL • High frequency hearing loss.

CHANGES OF • Arteries stiffen and blood oxygenation levels

decline.
AGING
• Maximum breathing capacity in the lungs
declines.
• Heart muscle thickens with age, maximum
@brydgr8
pumping rate declines. brydgr08

27

• Kidneys becomes less efficient at removing

waste from blood.
• Body fats increases in the trunk.
NORMAL • Bladder capacity declines.
CHANGES OF • Muscle mass is lost, especially in women who
usually have less baseline bone mass than
AGING
men.
• Muscle mass can decline rapidly without
exercise.
@brydgr8
brydgr08

28

14
 2/1/2020

• Bone mineral is lost and replaced throughout

life, but the loss outpaces the replacement for
NORMAL women at about age 35.
CHANGES OF • Older people who experience health
AGING problems, chronic illness, and pain are at risk
for depression and social isolation.

@brydgr8
brydgr08

29

ORGAN RESERVE
• Loss of the ability of a given organ to react quickly
and efficiently to physiological stress.

HOMEOSTASIS
• Ability to maintain equilibrium

HOMEOSTENOSIS
• Inability to restore homeostasis @brydgr8
brydgr08

30

15
 2/1/2020

• BIOLOGICAL THEORIES
• Programmed Theories
• Error Theories
• PSYCHOLOGICAL AGING THEORIES
THEORIES OF • Jung’s Theory of Individual
• Erikson’s Developmental Theory
AGING
• SOCIAL AGING THEORIES
• Disengagement Theory
• Activity Theory
@brydgr8
• Continuity Theory brydgr08

31

PROGRAMMED THEORIES
• Body’s genetic code contain instructions for the
regulation of cellular reproduction and death
BIOLOGICAL
THEORIES
ERROR THEORIES
• Body accumulate toxic by-products

@brydgr8
brydgr08

32

16
 2/1/2020

PROGRAMMED LONGEVITY
• Result of the sequential switching on and off of
certain genes
PROGRAMMED
THEORIES
ENDOCRINE THEORY
• Hormones control the pace of aging

@brydgr8
brydgr08

33

IMMUNOLOGY THEORY
• Decline in immune system functions lead to an
increased aging
PROGRAMMED
THEORIES

@brydgr8
brydgr08

34

17
 2/1/2020

WEAR-AND-TEAR THEORY
• Cells and organs wear out after years of use
• Body = Machine
ERROR THEORIES
CROSS-LINK THEORY
• Cross-linked proteins causes various problems

@brydgr8
brydgr08

35

FREE RADICAL THEORY

• Oxygen radicals cause loss of organ reserve

ERROR THEORIES SOMATIC DNA DAMAGE THEORY

• Aging increases genetic mutation that lead to cell
deterioration and malfunction

EMERGING BIOLOGICAL THEORIES

• Activated genes by enzymes increase aging @brydgr8
brydgr08

36

18
 2/1/2020

JUNG’S THEORY OF INDIVIDUALISM

• The aged focuses away from the world but toward
the inner experience.
PSYCHOLOGICAL
AGING THEORIES
ERIKSON’S DEVELOPMENTAL THEORY
• Ego integrity versus despair

@brydgr8
brydgr08

37

DISENGAGEMENT THEORY
• Older person and society engage in mutual and
reciprocal withdrawal
SOCIAL AGING
THEORIES ACTIVITY THEORY
• Older adults should stay active and engaged

CONTINUITY THEORY
• Continue being the same person @brydgr8
brydgr08

38

19
 2/1/2020

SCOPE OF PRACTICE
• A range of nursing functions that are differentiated
according to the level of practice, the role of the
nurse, and the work setting.

THREE ELEMENTS OF SCOPE OF PRACTICE

1. Quality
2. Evidence
3. Safety
@brydgr8
brydgr08

39

SCOPE OF NURSING PRACTICE

• Who: Registered Nurses and Advanced Practice
Registered Nurses
• What: Nursing
• Where: there is a healthcare consumer in need of
care, information, or advocacy
• When: need for nursing knowledge, wisdom, caring,
leadership, practice, or education
• Why: response to the changing needs of the society
• How: means, methods, and manners use to practice
professionally @brydgr8
brydgr08

40

20
 2/1/2020

• Standard 1. Assessment
• Standard II. Diagnosis
• Standard 3. Outcomes Identification
• Standard 4. Planning
STANDARDS OF • Standard 5. Implementation
PRACTICE • Standard 5A. Coordination of Care
• Standard 5B. Health Teaching and Health
Promotion
• Standard 6. Evaluation
@brydgr8
brydgr08

41

• Standard 7. Ethics
• Standard 8. Culturally Congruent Practice
STANDARDS OF
• Standard 9. Communication
PROFESSIONAL
• Standard 10. Collaboration
PERFORMANCE
• Standard 11. Leadership

@brydgr8
brydgr08

42

21
 2/1/2020

• Standard 12. Education

• Standard 13. Evidence-based Practice and
Research
STANDARDS OF
• Standard 14. Quality of Practice
PROFESSIONAL
• Standard 15. Professional Practice Evaluation
PERFORMANCE
• Standard 16. Resource Utilization
• Standard 17. Environmental Health

@brydgr8
brydgr08

43

@brydgr8
brydgr08

44

22
 2/1/2020

• Safe & Quality Nursing Practice

• Management of Resources & Environment
• Health Education
CORE • Legal Responsibility
COMPETENCY • Ethico-moral Responsibility
STANDARDS FOR • Personal & Professional Development
NURSING • Quality Improvement
PRACTICE IN THE • Research
PHILIPPINES • Record Management
• Communication @brydgr8
brydgr08

• Collaboration & Teamwork

45

1. Fear of one’s own aging

2. Fear of showing emotion or being around
BARRIERS THAT emotional patients
CAN DISRUPT THE 3. Fear of missing something and feeling the
COMMUNICATION need to write down every detail of the
PROCESS encounter
4. Fear of being called on to rectify every
problem verbalized by the patient @brydgr8
brydgr08

46

23
 2/1/2020

5. Lack of knowledge of the patient’s culture,

goals, and values
6. Unresolved issues with aging relatives in the
nurse’s own family that can lead to
BARRIERS THAT
insensitivity
CAN DISRUPT THE
7. Feeling that professional distance must be
COMMUNICATION
PROCESS maintained at all cost
8. Being overworked, or overscheduled, and
lacking proper time to communicate with
@brydgr8
older patients brydgr08

47

CULTURAL DIVERSITY @brydgr8

brydgr08

48

24
 2/1/2020

CULTURAL CARE
• coined to describe nursing care that is culturally
competent, culturally appropriate, and culturally
sensitive

@brydgr8
brydgr08

49

CULTURALLY COMPETENT
• understands and attends to the total context of
the patient’s situation

@brydgr8
brydgr08

50

25
 2/1/2020

CULTURALLY APPROPRIATE
• applies the underlying background knowledge
that must be possessed to provide a given
patient with the best possible health care

@brydgr8
brydgr08

51

CULTURALLY SENSITIVE
• possesses some basic knowledge of, and
constructive attitudes toward, the health
traditions observed among the diverse cultural
groups

@brydgr8
brydgr08

52

26
 2/1/2020

Standard 1. Social Justice

Standard 2. Critical Reflection

Standard 3. Knowledge of Cultures

12 STANDARDS
Standard 4. Culturally Competent Practice
FOR CULTURAL
COMPETENCE Standard 5. Cultural Competence in
Healthcare Systems and Organizations

Standard 6. Patient Advocacy and

Empowerment @brydgr8
brydgr08

53

Standard 7. Multicultural Workforce

Standard 8. Education and Training in Culturally
Competent Care
12 STANDARDS
Standard 9. Cross-Cultural Communication
FOR CULTURAL
COMPETENCE Standard 10. Cross-Cultural Leadership
Standard 11. Policy Development
Standard 12. Evidence-Based Practice and
Research
@brydgr8
brydgr08

54

27
 2/1/2020

CULTURAL CARE NURSING

• is the provision of nursing care across cultural
boundaries

@brydgr8
brydgr08

55

CASE STUDY
Mr. Hernandez, a 73-year-old man of Mexican
heritage, was admitted to a long-term care facility and
presented the following challenges for nurses, other
healthcare staff, caregivers, and the institution:

■ He and his family could not read, speak, nor

understand English. @brydgr8
brydgr08

56

28
 2/1/2020

CASE STUDY
■ His strong Catholic faith and Hispanic cultural
traditions required modesty during physical
examinations and when personal care was delivered.

■ His family had both religious and cultural reasons

for not discussing end-of-life concerns or his
impending death. @brydgr8
brydgr08

57

CASE STUDY
As nurse of Mr. Hernandez, what is your
CulturalCare Nursing Plan? Apply the nursing
process: assessment, diagnosis, expected outcomes,
planning and implementation, and evaluation)

@brydgr8
brydgr08

58

29
 2/1/2020

VIOLENCE AND
@brydgr8
ELDER MISTREATMENT brydgr08

59

1. Psychopathology of the Abuser

THEORIES OF
2. Transgenerational Violence
ELDER
3. Situational Theory
MISTREATMENT
4. Isolation Theory

@brydgr8
brydgr08

60

30
 2/1/2020

PSYCHOPATHOLOGY OF THE ABUSER

▪ Caregivers who have preexisting conditions that
impair their capacity to give appropriate care
▪ For example: Caregivers has developmental
disability or alcohol dependency

@brydgr8
brydgr08

61

TRANSGENERATIONAL VIOLENCE
▪ Part of a family violence continuum
▪ A long-standing, contentious relationship with an
older parent.
▪ For example: a child who is abused by a parent and
then grows up to be the caregiver may ultimately
become aggressive and abusive toward the older
person.

@brydgr8
brydgr08

62

31
 2/1/2020

SITUATIONAL THEORY
▪ Related to caregiver stress
▪ For example: As care burden increases, the
caregiver’s capacity to meet the needs of the older
adult may be inadequate.

@brydgr8
brydgr08

63

ISOLATION THEORY
▪ Dwindling social network
▪ Older adults live alone
▪ Interact only with family members and have little
social interaction with the outside world.

@brydgr8
brydgr08

64

32
 2/1/2020

ELDER MISTREATMENT
▪ Intentional actions that cause harm or create
serious risk or harm to a vulnerable elder by a
caregiver or other person who stands in a trust
relationship to the elder

▪ Failure by a caregiver to satisfy the elder’s basic

needs or to protect the elder from harm (Bonnie
& Wallace, 2003).

@brydgr8
brydgr08

65

1. Physical Abuse—Intentional infliction of

physical injury or pain

TYPES OF ELDER 2. Psychological/Emotional Abuse—

Infliction of anguish, pain, distress
MISTREATMENT
3. Sexual Abuse—Any form of nonconsensual
sexual intimacy

@brydgr8
brydgr08

66

33
 2/1/2020

4. Financial Exploitation—Taking advantage

of an older person for monetary or personal
benefit

TYPES OF ELDER 5. Caregiver Neglect—Intentional (active) or

unintentional (passive) failure to meet needs
MISTREATMENT necessary for elder’s physical and mental
well-being

6. Self-neglect—Personal disregard or
inability to perform self-care
@brydgr8
brydgr08

67

6. Abandonment—Desertion or willful
forsaking of an elder
TYPES OF ELDER
MISTREATMENT 7. Institutional Mistreatment—When older
adult has a contractual arrangement and
suffers abuse or neglect

@brydgr8
brydgr08

68

34
 2/1/2020

1. Physical Abuse
2. Psychological/Emotional Abuse
3. Sexual Abuse
TYPES OF ELDER 4. Financial Exploitation
MISTREATMENT 5. Caregiver Neglect
6. Self-neglect
7. Abandonment
8. Institutional Mistreatment
@brydgr8
brydgr08

69

REFERENCES • American Nurses Association. (2015). Nursing: Scope and

Standards of Practice (3rd Edition). Maryland, USA:
Nursesbooks.org

• Eliopoulos, C. (2010). Gerontological Nursing. China:

Lippincott Williams &
Wilkins.

• Meiner, S. E. and Lueckenotte, A. G. (2007). Gerontologic

Nursing (3rd Edition). Singapore: Elsvier Pte Ltd

@brydgr8
brydgr08

70

35
 2/1/2020

REFERENCES • Tabloski, P. A. (2014). Gerontological Nursing. New Jersey,

USA: Pearson Education, Inc.

• Welch, A. (October18, 2018). These Countries may soon

have the Highest Life Expectancies. Retrieved on January
12, 2020 from: https://www.cbsnews.com/news/countries-
highest-life-expectancies-by-2040/

• 11 Core Competencies. Retrieved on January 19, 2020

from:
http://thenursingprofession.blogspot.com/2009/09/11-
core-competencies.html

@brydgr8
brydgr08

71

@brydgr8
brydgr08

72

36