ANA STANDARDS FOR PROFESSIONAL GERONTOLOGICAL NURSING PRACTICE

• Standard l – Quality of Care

The geron nurse systematically evaluates the
quality of care & effectiveness of nursing
practice

• Standard ll – Performance Appraisal

The GN evaluates his own nursing practice in
relation to professional practice standards &
relevant statutes & regulations

• Standard lll – Education

The GN acquires & maintains current
knowledge in nursing practice

• Standard lV – Collegiality
The GN contributes to the professional
dev’t of peers, colleagues & others

• Standard V – Ethics
The GN’s decisions & actions on behalf of clients
are determined in an ethical manner.

• Standard Vl – Collaboration
The GN collaborates w/ the aging person,
significant others & health care providers in
providing client care

• Standard Vll - Research

The GN uses research findings in practice

• Standard Vlll - Resource utilization

The GN considers factors related to
safety, effectiveness & cost in planning &
delivering client care.

CORE COMPETENCIES FOR GERONTOLOGIC NURSE EDUCATORS

Competency 1:
Maintains knowledge and skills in the care of older adults.
The Gerontological Nurse Educator possesses the requisite knowledge and skills to prepare
students to deliver high quality nursing care to diverse older adult populations. This includes
gerontological, geriatric, and geropsychiatric knowledge and skills that can be obtained through
post-baccalaureate formal education, or other professional development programs/activities.
Experience in working with older adults is crucial.
Exemplars that may demonstrate competency include:

1.1. Incorporates comprehensive geriatric assessment and evidence-based interventions for

older adults and families into his/her teaching.

1.2. Educates students about normal aging and the complex factors that influence the health,
function, and independence of older adults such as socioeconomic and environmental issues,
multiple chronic conditions, geriatric syndromes, atypical illness presentation, and
geropharmacology.

1.3. Integrates theories and science of aging into didactic and clinical teaching.

1.4. Maintains national certification(s) in the care of older adults.

Competency 2:
Serves as an advocate and positive role model for quality care of older adults.
2.1. Applies principles of effective teaching, knowledge of the science of learning, national
standards of nursing practice, and/or research evidence to inspire and motivate students in the
care of older adults, their families, and caregivers within the context of varied health care
settings.

2.2. Develops collegial working relationships with students, faculty, interprofessional team
members, and community members/partners to promote positive learning environments and
commitment in the care of older adults.

2.3. Serves as a consultant or resource for evidence-based practice, theoretical development,

and/or teaching in gerontological nursing.

2.4. Provides leadership related to care of older adults at local/organizational, regional, national,
and/or international levels.

2.5. Advocates for policies that promote the health and quality care of older adults.

Competency 3:
Implements innovative teaching strategies for engaging students in learning about healthy aging
and care of older adults.
Exemplars that may demonstrate this competency include:
3.1. Incorporates conceptual frameworks about aging into teaching.

3.2. Uses evidence-based teaching and learning strategies that generate student value for and
interest in the care of older adults.

3.3. Integrates effective learning activities associated with reflection on the aging process and
individual experiences.

3.4. Engages students in activities that increase awareness of their own attitudes, values, and
expectations about aging and how these influence the care of diverse older adults, families, and
communities.

3.5. Develops innovative learning opportunities for students to interact with older adults and
their families across the wellness-illness continuum and a variety of settings.
Competency 4:
Facilitates interprofessional learning opportunities for students related to healthy aging and care
of older adults.
The Gerontological Nurse Educator builds strong collaborative relationships with other
disciplines to develop meaningful interprofessional education (IPE) and practice opportunities
for students in learning about healthy aging and care of older adults. IPE learning opportunities
occur in diverse practice settings ranging from the hospital to post-acute environments and
communities.
Exemplars that may demonstrate this competency include:
4.1. Uses nationally recognized competencies for interprofessional education in designing
learning opportunities for building team skills and collaborative practice (e.g., Core
Competencies for Interprofessional Education and Collaborative Practice [IPEC]).

4.2. Implements learning opportunities that promote positive attitudes for collaborative practice
in care of older adults and their families/caregivers and prepare students to deliver person and
family-centered care in interprofessional teams.

4.3. Uses case studies, simulation scenarios, and other active learning activities to foster
interprofessional practice.

4.4. Creates, implements, or actively participates in practice models that exemplify collaborative
practice in diverse settings to foster healthy aging and quality care for older adults and their
families/caregivers.
Competency 5:
Facilitates the integration of concepts of healthy aging and care of older adults in academic and/
or professional curricula.
The Gerontological Nurse Educator serves as an expert in knowledge of healthy aging and care
of older adults. Using this expertise, the Gerontological Nurse Educator periodically reviews
academic and/or professional curricula to ensure that current knowledge and care
competencies are integrated throughout courses and education programs.

Exemplars that may demonstrate this competency include:

5.1. Advocates for the integration of concepts of healthy aging and quality care of older adults in
academic and/or professional curricula.

5.2. Ensures didactic and practice learning opportunities in the care of older adults and their
families are incorporated into the academic and/or professional curricula.

5.3. Advocates for the periodic review of the academic and/or professional curricula to ensure
that concepts of healthy aging and care of older adults are well-integrated.

5.4. Provides faculty with current, evidence-based resources to enhance teaching and learning
about the care of older adults in a variety of settings.

Competency 6:
Collaborates in the evaluation of learning about healthy aging and care of older adults in
academic and/or professional curricula.
The Gerontological Nurse Educator clearly describes expected learning outcomes for students
in prelicensure, graduate, and professional development programs based on nationally
recognized gerontological/geriatric nursing and other related competencies (e.g., AACN
Competencies to Improve Care for Older Adults; Core Competencies for Interprofessional
Collaborative Practice; GAPNA Consensus Statement on Proficiencies for the APRN
Gerontological Specialist; and AACN/HIGN Geropsychiatric Nursing Competency
Enhancements). Learning outcomes are evaluated by the Gerontological Nurse Educator in
online, classroom, laboratory, simulation, clinical, and community settings using specific criteria
for evaluation related to care of older adults.
6.1. Describes learning outcomes specific to the curriculum expected of students that indicate
integration of content and experiences in healthy aging and care of older adults.

6.2. Incorporates reliable, valid criteria, standards, and assessment methods into the evaluation
of student learning related to healthy aging and care of older adults.
6.3. Provides faculty development opportunities related to the evaluation of competency-based
learning in the care of older adults.
Competency 7:
Demonstrates scholarship and leadership that advances gerontological nursing education and
practice, and fosters others’ professional development.
The Gerontological Nurse Educator demonstrates scholarly leadership in gerontological nursing
by disseminating scholarly work in the following areas: teaching, mentorship, and learning
related to the care of older adults in academic and professional development programs;
discovery that advances new knowledge about healthy aging and care of older adults;
integration of gerontology/geriatrics across disciplines and professions; application by engaging
in evidence-based practice and policy advocacy and/or leadership related to care of older
adults; or by application of new knowledge to improve care of older adults.

Exemplars that may demonstrate this competency include:

7.1. Presents on gerontological nursing research, education, practice, or policy at local, state,
regional, national, or international conferences..

7.2. Provides testimony on aging issues to policy-makers..

7.3. Publishes information about research, education, and/or practice projects related to healthy
aging and care of older adults.

7.4. Mentors students, faculty members, and/or clinicians interested in gerontological nursing or
interprofessional geriatric practice.

7.5. Demonstrates leadership at the local, state, regional, national, and/or international level that
influences the care of older adults.

CORE ELEMENTS OF GERONTOLOGICAL NURSING PRACTICE

Evidence-based practice:
- Nursing practice decision-making follows research
- Relies on synthesis and analysis of information
- Benchmarking: performance compared with best practices
- Nursing follows systematic approach for clinical decision-making: evidence-based practice
- Is among the ANA Standards of Professional Gerontological Nursing Performance
- Relies on synthesis and analysis of available information from research

Standards for nursing practice:

- Guides professional nursing practice
- State and federal regulations
- Joint Commission
- ANA Standards
- Reflect level and expectations of care
- Evaluate practices against standards to ensure highest quality of care
Principles are based on scientific data

Competencies
- Competencies specific to gerontological nursing promote highest quality of care
- Basic Competencies:
- Normal from abnormal findings - risks
- Assessment - empowerment
- Engage older adults in all care - preferences identified
 - Education - assist older adults in care needs
- Individualised care - facilitate advanced directives
SENIOR CITIZEN ACT
Senior Citizens Act – R.A. 7432 – is an act maximizing the contribution of senior
citizens, granting benefits & special privileges & for other purposes

Objectives of the Act:

- Establish mechanisms whereby the contribution of senior citizens are maximized
- Adopt measures whereby senior citizens are assisted & appreciated by the community as a
whole; and
- Establish a program beneficial to the senior citizens, their families & the rest of the community
that they serve

Benefits & Special Privileges Granted

20% discount on the purchases of meds & on the utilization of public transport,
restaurants, recreational facilities & other places of culture, hotels & lodging establishments;
free medical & dental services in gov’t hospitals anywhere in the country.

SC Covered by R.A. 7432

SC are resident citizens of the Phils at least 60 y.o., including those who have retired from
gov’t offices & private enterprises & have a yearly income of not more than P60K subject to
review by NEDA.
Resident Citizens – refers to Filipino Citizens who attest, to the satisfaction of the Office for
Senior Citizens Affairs, his physical presence in the Phils for at least 183 days w/ a definite
intention to reside here.

RA 9257 - "Expanded Senior Citizens Act of 2003.

RA 9994 - "Expanded Senior Citizens Act of 2010.”

HUMAN RESOURCES CODE: RIGHTS OF ELDERLY

- An elderly individual has all the rights, benefits, responsibilities & privileges granted by the
constitution & laws of this state & the United States.
- An elderly individual has the right to be treated with dignity & respect for the personal integrity
of the individual, w/o regard to race, religion, national origin, sex, age, disability, marital status
or source of payment.
- An elderly individual has the right to be free from physical & mental abuse, including corporal
punishment or physical or chemical restraints that are administered for the purpose of
discipline or convenience & not required to treat the individual’s medical symptoms.
- A mentally retarded elderly individual w/ a court-appointed guardian of the person may
participate in a behavior modification program involving use of restraints or adverse stimuli
only w/ the informed consent of the guardian.
- An elderly individual may not be prohibited from communicating in the individual’s native
language w/ other individuals or employees for the purpose of acquiring or providing any type
of treatment, care, or services.
- An elderly individual may complain about the individual’s care or treatment.
- An elderly individual is entitled to privacy while attending to personal needs & a private place
for receiving visitors or associating w/ other individuals.
- An elderly individual may participate in activities of social, religious or community groups.
- An elderly individual may manage personal financial affairs.
- An elderly individual is entitled to access to the individual’s personal & clinical records.
- A person providing services shall fully inform an elderly individual, in language that the
individual can understand, of the individual’s total medical condition & shall notify the
individual whenever there is a significant change in the person’s medical condition.
- An elderly individual may retain & use personal possessions, including clothing & furnishings,
as space permits.
- An elderly individual may refuse to perform services for the person providing services.
- An elderly individual may choose & retain a personal physician & is entitled to be fully
informed in advance about treatment or care that may affect the individual’s well-being.
- An elderly individual may participate in an individual plan of care that describes the
individual’s medical, nursing & psychological needs & how the needs will be met.
- An elderly individual may refuse medical treatment after the elderly individual:
- Is advised by the person providing the services of the possible consequences of
refusing treatment; &
- Acknowledges that the individual clearly understands the consequences of refusing
treatment.
- Not later than the 30th day after the date the elderly individual is admitted for service, a
person providing services shall inform the individual:
- whether the individual is entitled to benefits under Medicare or Medicaid; &
- which items & services are covered by these benefits, inc items or services for
which the elderly individual may not be charged.
- A person providing services may not transfer or discharge an elderly individual.
POLY-PHARMACY OF ELDERLY PATIENTS
Background: Polypharmacy (ie, the use of multiple medications and/or the administration of
more medications than are clinically indicated, representing unnecessary drug use) is common
among the elderly.
Objective: The goal of this research was to provide a description of observational studies
examining the epidemiology of polypharmacy and to review randomized controlled studies that
have been published in the past 2 decades designed to reduce polypharmacy in older adults.
Methods: Materials for this review were gathered from a search of the MEDLINE database
(1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify
articles in people aged >65 years. We used a combination of the following search terms:
polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search
of the reference lists from identified articles and the authors' article files, book chapters, and
recent reviews was conducted to identify additional articles. From these, the authors identified
those studies that measured polypharmacy.
Results: The literature review found that polypharmacy continues to increase and is a known
risk factor for important morbidity and mortality. There are few rigorously designed intervention
studies that have been shown to reduce unnecessary polypharmacy in older adults. The
literature review identified 5 articles, which are included here. All studies showed an
improvement in polypharmacy.
Conclusions: Many studies have found that various numbers of medications are associated
with negative health outcomes, but more research is needed to further delineate the
consequences associated with unnecessary drug use in elderly patients. Health care
professionals should be aware of the risks and fully evaluate all medications at each patient visit
to prevent polypharmacy from occurring.

COMMUNICATION WITH ELDERLY

Communication- basic element of human interactions; foundation of our way of life

Elements of the Communication Process:

- Referent or stimulus
- Sender or encoder
- Message
- Channels
- Receiver or decoder
- Feedback
Modes of Communication
Verbal Communication
- Clarity & brevity
- Vocabulary
- Denotative & connotative meaning
- Pacing
- Timing & relevance
- Humor
Nonverbal communication
- Personal appearance
- Intonation
- Facial expression
- Posture & gait
- Gestures
- Touch
Basic Characteristics of Communication
1. More than 1 person must be involved & participants must establish relationship
2. Communication is continuous & reciprocal
3. Messages may be sent through verbal & nonverbal means
4. Verbal & nonverbal communications occur simultaneously
5. Nonverbal communication is more likely to be involuntary. Thus, considered as being more
accurate expression of true feelings
6. Communicating persons respond to messages they receive
7. The message cannot always be assumed to mean what the receiver believes it to mean or
what the sender intended to mean it
8. Exchanging messages require knowledge
9. Past experiences influence messages sent, interpretation by the receiver is based on past
experiences
10. Communication is influenced by the way people feel

GERIATRIC HEALTH CARE TEAM

What Is Geriatrics?
Geriatrics is a branch of medicine that focuses on health promotion and the prevention and
treatment of disease and disability in later life.

Geriatrician
A geriatrician is a medical doctor who is specially trained to prevent and manage the
unique and, oftentimes, multiple health concerns of older adults. Older people may react to
illness and disease differently than younger adults. Geriatricians are able to treat older patients,
manage multiple disease symptoms, and develop care plans that address the special
healthcare needs of older adults.
Educational background:
 - A minimum of 90 semester hours of Undergraduate Study. Completion of a college
major or baccalaureate degree is strongly recommended.
- Primary Degree: M.D. or D.O. (4 yrs.)
- Residency: Internal Medicine or Family Medicine (3 yrs.)
- Fellowship: fellowship in geriatrics (1-2 yrs.).
Certifications:
Primary Boards-Internal Medicine or Family Medicine
Specialty Boards-Geriatrics ( through American Board of Internal Medicine [ABIM] or
American Board of Family Medicine [ABFM])
Tuition:
Tuition at the University of Nebraska Medical Center for a resident of the state of
Nebraska is approximately $111, 970 for an MD degree based on rates for 2012-2013. This
does not include living expenses and miscellaneous student fees.
Salary:
According to the Bureau of Labor Statistics, the 2010 median pay for physicians and
surgeons was $166,400.
What types of work do they do?
- Primary care providers in outpatient clinics
- Geriatric Assessment Clinic Consultants
- Medical directors of Nursing Homes and/or Hospices
- Hospitalists
- Medical Directors of Quality Improvement Organizations, Hospitals, Healthcare
Organizations,
- Insurance Companies
- Researchers
- Home Care Provider (independent, PACE)
- Academics

What types of patients need to see a geriatrician?

While primary care physicians—general internists and family physicians—care for most
older people, geriatricians frequently provide the primary care for older adults who have the
most complicated medical and social problems. Also, because of their unique qualifications and
training, geriatricians are often sought to provide consultations for the frailest of older persons.
A geriatrician should be consulted when:
 - An older person's condition causes considerable impairment and frailty. These
patients tend to be over the age of 75 and coping with a number of diseases and disabilities,
including cognitive (mental) problems.
- Family members and friends are feeling considerable stress as caregivers.

Nurse Practitioner
A nurse practitioner (NP) is an advanced practice registered nurse who provides health care
services similar to those of a physician. NPs may choose to specialize in family, pediatric or
geriatric nursing. Common duties include diagnosing and treating illnesses and injuries,
prescribing medications and educating patients.
Educational background:
There are two educational routes one can take to become a nurse practitioner. First, one can
become a registered nurse by obtaining a bachelor’s degree in nursing (BSN) and then continue
on to achieve a master’s degree as a nurse practitioner. The second route one can take to
become a nurse practitioner is to obtain an associate’s degree in nursing (ADN), then a BSN
and then a master’s degree.
1). Bachelor’s Degree in Nursing (BSN): program lengths vary from 18 months to 4 years. 2).
Master’s degree as a nurse practitioner (MSN): 2-5 years graduate study
Certification and Licensure:
Most states require additional licensure to work as an advanced practice nurse. Advanced
practice nurses operate in one of four roles: nurse practitioner, nurse anesthetist, nurse midwife
or clinical nurse specialist. Licensing is regulated by individual states, and requirements vary;
however, all NPs must first be licensed RNs with a master's degree in one of the four advanced
practice specialties. Some states mandate extra exams and professional experience. Many
states require continuing education classes or maintenance of a national certification to renew a
license.
The American Academy of Nurse Practitioners (AANP) and the American Nurses Credentialing
Center (ANCC) are two organizations that offer national certification commonly recognized by
state nursing boards. Certification usually requires passing an examination, and most
organizations mandate continuing education to maintain the credentials. Available specialty
examinations nurse practitioners may choose from include acute care, diabetes management,
family care, school nursing, mental health, gerontology and pediatrics.
Tuition:
1). Bachelor’s Degree in Nursing (BSN): The 2012-2013 tuition for a resident of Nebraska at the
University of Nebraska Medical Center is approximately $32,820 for the traditional BSN. This
amount does not include living expenses and miscellaneous student fees.
2). Master of Science Degree in Nursing (MSN) Specialty Track at the University of Nebraska
Medical Center: At the University of Nebraska Medical Center, to work toward the Nurse
Practitioner (NP) designation, the student may choose an MSN specialty track. Graduates from
these specialty tracks are eligible to take the Nurse Practitioner Certification Exam Required
credit hours vary by specialty track. Required credits range, for example, from 39 for Women's
Health NP to 66 for the dual/integrated Family NP/Psychiatric Mental Health NP. The 2012-1013
estimated tuition range for Nebraska residents at the University of Nebraska Medical Center for
these examples would be from approximately $17,140- $29,007. This does not include living
expenses, miscellaneous student fees, or undergraduate tuition.

Salary:
In early 2011, the American Academy of Nurse Practitioners (AANP) conducted the 2011 AANP
National Nurse Practitioner Compensation Survey. Based on this survey, the average base
salary for a full-time NP (those who practiced clinically 35 hours or more per week) was
$91,310.
What types of work do they do?
Obtain medical histories and perform physical examinations
Provide immunizations and other preventative care
Diagnose and treat illness
Identify, treat, and manage chronic diseases such as diabetes and arthritis
Order and interpret diagnostic tests such as x-rays, blood work, and EKGs
Prescribe Medications
Prescribe physical therapy, massage therapy, and other rehabilitation therapy
Perform procedures such as sutures, casting, cryotherapy, and skin biopsy

Pharmacist
Pharmacists provide information to patients about medications and their use and distribute
drugs prescribed by physicians and other health practitioners. They advise physicians and other
health practitioners on the selection, dosages, interactions, and side effects of medications.
Pharmacists also monitor the health and progress of patients in response to drug therapy to
ensure the safe and effective use of medication. Pharmacists must understand the use, clinical
effects, and composition of drugs, including their chemical, biological, and physical properties.
Educational background:
Pre-pharmacy requirements: A minimum of 90 semester hours including coursework in
chemical, physical, and biological sciences.
The Doctor of Pharmacy (PharmD) degree: 4 years
 Pharmacy Residency or Fellowship Programs: (1-2 years)
MS or PhD degree: many colleges of pharmacy offer these degrees after completion of a
PharmD degree. (2-5 years) Licensure:
A license to practice pharmacy is required in all states, the District of Columbia, and all US
territories. To obtain a license, the prospective pharmacist must graduate from a college of
pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE) and pass a
clinical examination as well as a state specific law exam. Some states also require a third exam
on patient counseling or compounding. Practicing pharmacists can also obtain specialty board
certification through exam after graduation and residency training.
Tuition:
Tuition for Nebraska Residents at the University of Nebraska Medical Center for 2012-2013 is
approximately $73, 310.00 for a PharmD degree. This does not include living expenses and
miscellaneous student fees.
Salary:
According to the Bureau of Labor Statistics, the median annual wage for pharmacists was
$111,570 in May 2010.

What types of work do they do?

Fill prescriptions, verifying instructions from physicians on the proper amounts of medication
to give to patients
Check whether the prescription will interact negatively with other drugs that a patient is
taking or conditions the patient has
Instruct patients on how and when to take a prescribed medicine
Advise patients on potential side effects they may experience from taking the medicine
Advise patients about general health topics, such as diet, exercise, and managing stress,
and on
other issues, such as what equipment or supplies would be best for a health problem
Complete insurance forms and work with insurance companies to be sure that patients get
the
medicines they need
Oversee the work of pharmacy technicians and pharmacists in training (interns)
Keep records and do other administrative tasks
Teach other healthcare practitioners about proper medication therapies for patients
Some pharmacists who own their store or manage a chain pharmacy spend more time on
business activities, such as inventory management. Pharmacists also take continuing education
throughout their career to keep up with the latest advances in pharmacological science.
 Pharmacists who work in universities or for pharmaceutical manufacturers are involved in
researching and testing new medications.
Clinical pharmacists work in hospitals and other healthcare settings. They spend little time
dispensing prescriptions. Instead, they are involved in direct patient care. For example, they
may go on rounds with a doctor and recommend medications to give to patients. They also
counsel patients on how and when to take medications and monitor patients’ health.
Consultant pharmacists advise healthcare facilities or insurance providers on how to make
pharmacy services more efficient. They also may give advice directly to patients, such as
helping seniors manage their prescriptions.
Some pharmacists work full time or part time as college professors.

Physical Therapist
Physical therapists (PTs) are highly-educated, licensed health care professionals who can help
patients reduce pain and improve or restore mobility - in many cases without expensive surgery
and often reducing the need for long-term use of prescription medications and their side effects.
Physical therapists can teach patients how to prevent or manage their condition so that they will
achieve long-term health benefits. PTs examine each individual and develop a plan, using
treatment techniques to promote the ability to move, reduce pain, restore function, and prevent
disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by
developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
Educational Background:
Physical Therapy Program requirements: Most require a Bachelor’s Degree (4 years)
Other programs offer a 3+3 curricular format in which 3 years of specific pre-professional
(undergraduate/pre-PT) courses must be taken before the student can advance into a 3-year
professional PT program.
Freshman Entry: A few programs recruit all or a portion of students directly from high school
into
guaranteed admission programs. High school students accepted into these programs are
guaranteed entry into the professional phase of the PT program pending the completion of
specific undergraduate courses and any other stated contingencies (eg, minimum GPA).
Doctor of Physical Therapy (DPT) Degree (3 years for most programs)
Master of Physical Therapy (MPT) or Master of Science in Physical Therapy (MSPT) Degree
(2 yrs)
*The Commission on Accreditation in Physical Therapy Education (CAPTE) will require all
programs to offer the DPT degree effective December 31, 2015.
Clinical Residency and Clinical Fellowships:
 Licensed physical therapists may choose to pursue a residency or fellowship program to
enhance
their knowledge and practice.
Specialty Certification:
Physical therapists have the opportunity to become board-certified clinical specialists through
the American Board of Physical Therapy Specialties (ABPTS).
Licensure:
After graduation, candidates must pass a state-administered national exam. Other requirements
for physical therapy practice vary from state to state according to physical therapy practice acts
or state regulations governing physical therapy.
PTs are licensed in all 50 states and the District of Columbia, Puerto Rico, and the Virgin
Islands. Licensure is required in each state in which a physical therapist practices and must be
renewed on a regular basis, with a majority of states requiring continuing education as a
requirement for renewal. PTs

Tuition: The 2012-2013 tuition for a resident of Nebraska for a DPT degree at the University of
Nebraska Medical Center is approximately $43,800. This does not include living expenses or
miscellaneous student fees.
Salary:
According to the Bureau of Labor Statistics, the median annual wage of physical therapists was
$76, 310 in May 2010.
Where do physical therapists practice?
Although many physical therapists practice in hospitals, more than 80 percent practice in:
Outpatient clinics or offices
Inpatient rehabilitation facilities
Skilled nursing homes, extended care, or sub-acute facilities
Education or research centers
Schools
Hospices
Industrial, workplace, or other occupational environments
Fitness centers and sports training facilities

Physician Assistant
A physician assistant (PA) is a medical professional who works as part of a team with a doctor. A
PA is a graduate of an accredited PA educational program who is nationally certified and state-
licensed to practice medicine with the supervision of a physician. PAs perform physical
examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures,
assist in surgery, provide patient education and counseling and make rounds in hospitals and
nursing homes. All 50 states and the District of Columbia allow PAs to practice and prescribe
medications.
Educational Background:
Pre-PA Program requirements: At least two years of college courses in basic science and
behavioral sciences. Graduation from a PA program: Approximately 27 semester hours (this
typically leads to a Master of Physician Assistant Studies (MPAS) degree).
Licensure:
Upon graduation from an accredited program, PAs are eligible to take the national certifying
examination administered by the National Commission on Certification of Physician Assistant
(NCCPA).Only those passing the examination can use the title of “Physician Assistant-Certified
(PA-C).” In order to maintain national certification, PAs must complete 100 hours of Continuing
Medical Education (CME) every two years and take a recertification exam every six years.
Tuition:
The tuition to obtain a Master of Physician Assistant Studies at the University of Nebraska
Medical Center for a resident of the state of Nebraska is approximately $35,055 (based on
2012- 2013 tuition rates). This amount does not include living expenses and miscellaneous
student fees.
Salary:
According to the Bureau of Labor Statistics, The median annual wage of physician assistants
was $86,410 in May 2010.
What types of work do Physician Assistants do?
A hallmark of physician assistant practice is that PAs provide a broad range of medical and
surgical services as part of a team with their supervising physicians. As part of the physician/PA
team:
PAs diagnose and treat illness and injuries
Perform physical examinations
Order and interpret diagnostic tests
Prescribe medications
Provide patient education and preventive health care counseling
Perform therapeutic procedures such as suturing lacerations and applying casts

PAs are employed in virtually all types of health care settings -- hospitals, clinics, private
physician offices, schools, and HMO's. Although the majority of PAs work in primary care
medicine -- family medicine, internal medicine, pediatrics, and obstetrics and gynecology --many
also work in specialty medicine, such as cardiothoracic surgery and orthopedics. Voluntary
specialty certification in some areas will soon be available. PAs may also work in the areas of
medical education, health administration and research.

Registered Dietitian/Nutritionist
A Registered Dietitian (RD) is a food and nutrition expert who practices in the field of dietetics. A
Registered Dietitian must meet the education criteria given below and earn the RD credential.
Dietetics is the art and science of applying the principles of food and nutrition to health. Although
frequently used to refer to a Registered Dietitian, the term “nutritionist” is not a nationally
accredited credential.
Educational Background:
Bachelor’s degree (from an accredited U.S. university or college with coursework approved
by the Accreditation Council for Education in Nutrition and Dietetics [ACEND])
Internship (completion of 1200 hours of supervised practice in a program accredited by
ACEND) Licensure/Certification:
National Registry Examination (administered by the Commission on Dietetic Registration
Licensure (many states have regulatory laws for food and nutrition practitioners; all states
accept
the RD credential for state licensure purposes)
Board certification (awarded by the Commission on Dietetic Registration in specialty areas
such
as Gerontological Nutrition, Oncology Nutrition, Pediatric Nutrition, Renal Nutrition, and Sports
Dietetics)
RD’s may also hold additional certifications in specialized areas of practice such as Certified
Diabetes Educator, Certified Nutrition Support Clinician, and Certified Personal Trainer. These
certifications are granted by other medical and nutrition credentialing organizations.
Tuition:
Resident tuition (2012-2013 rates) for the UNMC Dietetic Internship Program is $6010.00. This
does not include living expenses and miscellaneous student fees.
Salary:
According to the Bureau of Labor Statistics, the 2010 median salary for a Registered Dietician
was $53,250 per year.
Where do Dietitians work?
Hospitals, clinics and other health-care facilities
Consulting in long term care facilities
Sports nutrition and corporate wellness programs
 Private practice
Food and nutrition related business and industries
Community and public health settings
Research
Universities and medical centers in education
What types of patients need to see a Registered Dietitian?
When there is a concern regarding the adequacy of oral intake
When there is a history of unintentional weight loss
When nutrition education is indicated (sodium intake, diabetes, fiber intake, need for
increased
calories and protein intake, etc.)
When tube feeding/TPN indicated

Registered Nurse
The practice of nursing means assisting individuals or groups to maintain or attain optimal
health, implementing a strategy of care to accomplish defined goals and evaluating responses
to care and treatment. This practice includes, but is not limited to, initiating and maintaining
comfort measures, promoting and supporting human functions and responses, establishing an
environment conducive to well-being, providing health counseling and teaching, and
collaborating on certain aspects of the health regimen. This practice is based on understanding
the human condition across the life span and the relationship of the individual within the
environment.
Educational Background:
The three major educational paths to registered nursing are:
Graduation from an Associate Degree nursing program (2-3 years of college level study with
an emphasis on technical skills) earning the degree of ASN/AAS in nursing.
Graduation with a three-year (diploma) certificate from a hospital-based school of nursing
(non- degree). Few of these programs remain in the U.S.
Graduation from a college or university with a Bachelor’s Degree in Nursing (a 4-5 year
program conferring the BSN/BA degree with enhanced emphasis on leadership and research as
well as technical skills and clinical reasoning).
There are a variety of areas of study at the post baccalaureate, masters level, or doctoral
level. Programs prepare scholars as scientists, researchers, and clinical innovators in health
care.
The College of Nursing at UNMC offers these undergraduate and graduate programs in nursing:
Undergraduate:
 Bachelor of Science in Nursing-Traditional
Bachelor of Science in Nursing-Accelerated
Registered Nurse to Bachelor of Science in Nursing
Graduate:
Master of Science in Nursing
Post Master’s Certificate
Doctor of Philosophy in Nursing
Tuition:
The 2012-2013 estimated tuition for a resident of Nebraska is approximately $32,820 for the
traditional BSN. This amount does not include living expenses and miscellaneous student fees.
Salary:
According to the Bureau of Labor Statistics, the median annual earnings of registered nurses as
of May, 2010 were $64,690.

Licensing:
Graduation from an accredited nursing program
NCLEX-RN: National Council Licensure Examination RN Certification:
Certification is a process by which a nongovernmental agency validates, based upon
predetermined standards, an individual nurse’s qualifications for practice in a defined functional
or clinical area of nursing.
Most certification programs are created, sponsored or affiliated with professional associations
and trade organizations interested in raising standards. Certifications are earned through an
assessment process and, in general, must be renewed periodically. Certification credentials are
nationally recognized and portable, meaning the credential is accepted from one hospital to
another.
Many nurses who choose a clinical specialty area of nursing become certified in that area,
signifying that they possess expert knowledge. Registered nurses are not required to be
certified in a certain specialty by law. State licensure provides the legal authority for an
individual to practice professional nursing, while certification is voluntary, obtained through
certifying organizations and validates knowledge, skills, abilities and experience in areas
beyond the scope of RN licensure.
What types of work do they do?
Ambulatory care • Critical care• Emergency or trauma • Holistic health• Home health care
Hospice and palliative care • Infusion • Long-term care • Medical-surgical • Occupational health
Perianesthesia • Perioperative • Psychiatric • Radiologic • Rehabilitation • Transplant •
Academics

Social Worker
Description:
The primary mission of the social work profession is to enhance human wellbeing and help meet
the basic human needs of all people, with particular attention to the needs and empowerment of
people who are vulnerable, oppressed, and living in poverty. Fundamental to social work is
attention to the environmental forces that create, contribute to, and address problems in living.
Social workers promote social justice and social change with and on behalf of clients. “Clients”
is used inclusively to refer to individuals, families, groups, organizations, and communities.
Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination,
oppression, poverty, and other forms of social injustice.
Educational Background:
To be a social worker, one must have a degree in social work from a college or university
program accredited by the Council on Social Work Education.
The undergraduate degree is the Bachelor of Social Work or BSW: (4 years)
A MSW is required to provide therapy. (Approx. 2 years)
A DSW or PhD is useful for doing research or teaching at the university level. (2-3 years)
Licensure:
All states and the District of Columbia have some licensure, certification, or registration
requirement, but the regulations vary.
Tuition:
Tuition for Nebraska residents at the University of Nebraska at Omaha to obtain a BSW (based
on 2012- 2013 tuition prices) is approximately $23,600. Tuition for Nebraska residents at the
University of Nebraska at Omaha to obtain a Master of Social Work in the Advanced Standing
Program (where the student already has a Bachelor’s Degree in Social Work) is $9,564.00. This
does not include living expenses or miscellaneous student fees.
Salary:
The median expected annual salary for a typical Social Worker (MSW) in the United States is
$55,904.

What types of work do they do?

There are two main types of social workers: direct-service social workers, who help people
solve and cope with problems in their everyday lives, and clinical social workers, who diagnose
and treat mental, behavioral, and emotional issues.
Social workers work in a variety of settings, including mental health clinics, schools, hospitals,
and private practices. They generally work full time and may need to work evenings and
weekends.
Direct-service social workers typically do the following:
Identify people who need help
Assess clients’ needs, situations, strengths, and support networks to determine their goals
Develop plans to improve their clients’ well-being
Help clients adjust to changes and challenges in their lives, such as illness, divorce, or
unemployment
Research and refer clients to community resources, such as food stamps, child care, and
healthcare
Help clients work with government agencies to apply for and receive benefits such as
Medicare
Respond to crisis situations, such as natural disasters or child abuse
Advocate for and help clients get resources that would improve their well-being
Follow up with clients to ensure that their situations have improved
Evaluate services provided to ensure that they are effective
Clinical social workers, also called licensed clinical social workers, typically do the following:
Diagnose and treat mental, behavioral, and emotional disorders, including anxiety and
depression
Provide individual, group, family, and couples therapy
Assess clients’ histories, backgrounds, and situations to understand their needs, as well as
their
strengths and weaknesses
Develop a treatment plan with the client, doctors, and other healthcare professionals
Encourage clients to discuss their emotions and experiences to develop a better
understanding of
themselves and their relationships
Help clients adjust to changes in their life, such as a divorce or being laid-off
Work with clients to develop strategies to change behavior or cope with difficult situations
Refer clients to other resources or services, such as support groups or other mental health
professionals
Evaluate their clients’ progress and, if necessary, adjust the treatment plan
Many clinical social workers work in private practice. Some work in a group practice with other
social workers or mental health professionals. Others work alone in a solo practice.
 Speech-Language Pathologist
Working with the full range of human communication and its disorders, speech-language
pathologists evaluate and diagnose speech, language, cognitive-communication and swallowing
disorders. Speech- language pathologists treat speech, language, cognitive-communication and
swallowing disorders in individuals of all ages, from infants to the elderly.
Educational Background:
Bachelor’s Degree. On the undergraduate level, a strong arts and sciences focus is
recommended, with course work in linguistics, phonetics, anatomy, psychology, human
development, biology, physiology, mathematics, physical science, social/behavioral sciences
and semantics. A program of study in communication sciences and disorders is available at the
undergraduate level. (Approx.4yrs)
Master’s Degree in Speech-Language Pathology: Applicants for the Certificate of Clinical
Competence in Speech-language Pathology (CCC-SLP) must earn a graduate degree. (Approx.
2 yrs.)
Doctoral Degree: Some areas, such as college teaching, research, and private practice,
require a doctoral degree. (2-5 yrs.)
Certifications/Licensure:
Speech-language pathologists must successfully complete the required clinical experiences and
pass a national examination. Additionally, the individual must acquire the requisite knowledge
and skills mandated by certification standards while enrolled in a program accredited by the
Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA).
In most states, speech-language pathologists and audiologists also must comply with state
regulatory (licensure) standards to practice and/or have state education certification.
Tuition:
2012-2013 l tuition rates to obtain a Master’s Degree in Speech Language Pathology at the
University of Nebraska at Omaha for a Nebraska resident is approximately $10,055.00 for a
student who has an undergraduate degree in Communication Sciences and Disorders. This
does not include living expenses and miscellaneous student fees.
Salary:
According to the Bureau of Labor Statistics, The median annual wage of speech-language
pathologists was $66,920 in May 2010.

What types of work do they do?

In addition to the description above, speech language pathologists:
Prepare future professionals in college and universities.
Manage agencies, clinics, organizations, or private practices.
 Engage in research to enhance knowledge about human communication processes.
Supervise and direct public school or clinical programs.
Develop new methods and equipment to evaluate problems.
Establish more effective treatments.
Investigate behavioral patterns associated with communication disorders.
Speech-language pathologists often work as part of a team, which may include teachers,
physicians, audiologists, psychologists, social workers, rehabilitation counselors and others.
Corporate speech- language pathologists also work with employees to improve communication
with their customers.
The practice and work of speech-language pathologists may take place in various settings:
Public and private schools
Hospitals
Rehabilitation centers
Short-term and long-term nursing care facilities
Community clinics
Colleges and universities
Private practice offices
State and local health departments
State and federal government agencies
Home health agencies (home care)
Adult day care centers
Centers for persons with developmental disabilities
Research laboratories

PRIVACY AND ACCOUNTABILITY

Challenge of Privacy Advocacy
• Privacy is often conceptualize:
– negative terms, right of being left alone, in metaphors of defense: the home, the self,
the citadels of individual and group privacy (Westin 1967) An idea of a universal, natural-law-like
value

• Privacy is a historical concept:

- challenged by technological change and
- changing with social trends…
- Privacy is part of the social fabric, constituted by mechanism of sorting, exclusion and
inclusion, such as surveillance and social control.
What is to be defended and protected against ... is constantly changing in itself…

Discourse on Data Sensitivity: Beliefs and Political Views or Health and Wealth?
• Idea: Sensitive data needs special protection!
• Issue: what is sensitive data?
– Legal recognized definitions: Council of Europe Convention (1981); UN-Guidelines (1990); EU
Data Protection Direction (1995):
Racial or Ethnic Origin,
Political opinion, Religious,
Philosophical or other Beliefs,
Sex life, Trade union membership, Association membership;
Health; Criminal convictions; Colour of skin
– Assessment of people:
Financial Data,
Health Information; Sex life Personal Contact Data,
Genetic & Biometric Information

Problem: Can data sensitivity – in an age of increasing interconnectivity, -operability, and data
link-ability – still be normatively defined without blinding out sensitive data ?

If law is not enough, how can accountability be of stakeholders, e.g. in the area of security, be
achieved?

Towards Accountability?
• Stepping beyond Law and Technology; focusing on organisation and their privacy awareness!
• Accountability depends on the privacy awareness of an entity or organisation collecting and/or
processing data.
• However, privacy awareness heavily depends on the relative position of an organisation with
in the security regime.

Privacy Awareness
• Privacy awareness may follow different rationales of security organisation depending on
market, market-state and/or state-citizenship relations.
• Thus, accountability will differ from security to security organisation may it be a Security
Technology Producer, a Security Service Provider, an Security Association, or a Governmental
Security Agency etc.
• To assess the privacy awareness of security organisation it can be distinguished between:
– the Incentive for privacy awareness: (1) Avoid public slaughter, (2) better
image, (3) ethical position
– the Scope of privacy awareness: (1) Achieve compliance, (2) achieve privacy compliance, (3)
privacy enhancement
– the Communication of privacy awareness: (1) intra-oganisational,(2) inter- oganisational, (3)
public

Delegation of accountability or the Americanisation of the Privacy

Organisational Prespective:
Privacy efforts rarely exceeds compliance; it is confused with data security.
• Privacy, if at all, is communicated mainly inter-organisational; public communication is often
avoided; only scandals triggers public debate;
• Privacy is not translated through market mechanisms (for most actors are mainly b2b-
producers or service providers).

Accountability
• Security organisations hold not themselves but the client accountable for privacy (consumer's
choice, no demand/awareness on client side).
• Interviewees point at (young) people's irresponsible behavior
• The attitude of “users' own fault” is very commonly used to relocate the privacy problem

Regulative Instruments
• Informative
– Privacy Seals
– Privacy Policies
• Regulative Self-Regulation
– Privacy Audits
– Privacy Codes of Conduct
• Participative & Deliberative
– Reputation Systems
– Privacy Nutrition Label
- Anonymisation
- Pseudonymization
- Storage Systems: eSafe
- EU-Directive
- Privacy Principles
- Legal Provisions
- BDSG

METHODOLOGY FOR DEVELOPING QUALITY INDICATORS FOR THE CARE OF OLFDER

PEOPLE IN EMERGENCY DEPARTMENT
Background
Compared with younger people, older people have a higher risk of adverse health outcomes
when presenting to emergency departments. As the population ages, older people will make up
an increasing proportion of the emergency department population. Therefore it is timely that
consideration be given to the quality of care received by older persons in emergency
departments, and to consideration of those older people with special needs. Particular attention
will be focused on important groups of older people, such as patients with cognitive impairment,
residents of long term care and patients with palliative care needs. This project will develop a
suite of quality indicators focused on the care of older persons in the emergency department.
Methods/design
Following input from an expert panel, an initial set of structural, process, and outcome indicators
will be developed based on thorough systematic search in the scientific literature. All initial
indicators will be tested in eight emergency departments for their validity and feasibility. Results
of the data from the field studies will be presented to the expert panel at a second meeting. A
suite of Quality Indicators for the older emergency department population will be finalised
following a formal voting process.
Discussion
The predicted burgeoning in the number of older persons presenting to emergency departments
combined with the recognised quality deficiencies in emergency department care delivery to this
population, highlight the need for a quality framework for the care of older persons in emergency
departments. Additionally, high quality of care is associated with improved survival & health
outcomes of elderly patients. The development of well-selected, validated and economical
quality indicators will allow appropriate targeting of resources (financial, education or quality
management) to improve quality in areas with maximum potential for improvement.

THE 2030 PROBLEM: CARING FOR AGING BABY BOOMERS

Objective
To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom
generation ages.
Study Setting
A review of economic and demographic data as well as simulations of projected socioeconomic
and demographic patterns in the year 2030 form the basis of a review of the challenges related
to caring for seniors that need to be faced by society.
Study Design
A series of analyses are used to consider the challenges related to caring for elders in the year
2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures
on trends in disability, payment approaches for long-term care, healthy aging, and cultural views
of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns
of the Baby Boom generation are developed.
Principal Findings
The economic burden of aging in 2030 should be no greater than the economic burden
associated with raising large numbers of baby boom children in the 1960s. The real challenges
of caring for the elderly in 2030 will involve: (1) making sure society develops payment and
insurance systems for long-term care that work better than existing ones, (2) taking advantage
of advances in medicine and behavioral health to keep the elderly as healthy and active as
possible, (3) changing the way society organizes community services so that care is more
accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into
the fabric of community life.
Conclusions
To meet the long-term care needs of Baby Boomers, social and public policy changes must
begin soon. Meeting the financial and social service burdens of growing numbers of elders will
not be a daunting task if necessary changes are made now rather than when Baby Boomers
actually need long-term care.

INTERNATIONAL DAY OF OLDER PERSONS

On 14 December 1990, the United Nations General Assembly (by resolution 45/106) designated
1 October the International Day of Older Persons.
This was preceded by initiatives such as the Vienna International Plan of Action on Ageing –
which was adopted by the 1982 World Assembly on Ageing – and endorsed later that year by
the UN General Assembly.
In 1991, the General Assembly (by resolution 46/91) adopted the United Nations Principles for
Older Persons.
In 2002, the Second World Assembly on Ageing adopted the Madrid International Plan of Action
on Ageing, to respond to the opportunities and challenges of population ageing in the 21st
century and to promote the development of a society for all ages.
Globally, there were 703 million persons aged 65 or over in 2019. The region of Eastern and
South-Eastern Asia was home to the largest number of older persons (261 million), followed by
Europe and Northern America (over 200 million).
Over the next three decades, the number of older persons worldwide is projected to more than
double, reaching more than 1.5 billion persons in 2050. All regions will see an increase in the
size of the older population between 2019 and 2050. The largest increase (312 million) is
projected to occur in Eastern and South-Eastern Asia, growing from 261 million in 2019 to 573
million in 2050. The fastest increase in the number of older persons is expected in Northern
Africa and Western Asia, rising from 29 million in 2019 to 96 million in 2050 (an increase of 226
per cent). The second fastest increase is projected for sub-Saharan Africa, where the population
aged 65 or over could grow from 32 million in 2019 to 101 million in 2050 (218 per cent). By
contrast, the increase is expected to be relatively small in Australia and New Zealand (84 per
cent) and in Europe and Northern America (48 per cent), regions where the population is
already significantly older than in other parts of the world.
Among development groups, less developed countries excluding the least developed countries
will be home to more than two-thirds of the world’s older population (1.1 billion) in 2050. Yet the
fastest increase is projected to take place in the least developed countries, where the number of
persons aged 65 or over could rise from 37 million in 2019 to 120 million in 2050 (225 per cent).

DIFFERENCE BETWEEN HOME HEALTH & HOSPICE CARE

Hospice
Hospice care is comfort care for patients with a prognosis of six months or less if their disease
runs its natural course, as certified by a physician.
Home Health
Home health care provides services that are brought to patients who require intermittent skilled
nursing care, physical therapy, speech-language pathology services or continued occupational
services, as prescribed by their doctor. The patient's progress must be documented.
If the patient is eligible to receive Medicare benefits and you're unsure about the kind of care
they need, learn more about the differences between hospice services and home healthcare
below.

BEHAVIORAL HEALTH PROGRAMS FOR ADULTS

Healthy IDEAS (Identifying Depression Empowering Activities for Seniors)
Healthy IDEAS is a depression self-management program designed to detect and reduce the
severity of depressive symptoms in older adults with chronic conditions and functional
limitations. It includes screening and assessment, education, referral to appropriate health
professionals, and behavioral activation.
Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)
PEARLS is a highly effective method designed to reduce depressive symptoms and improve
quality of life in older adults and in all-age adults with epilepsy. During six to eight in-home
sessions that take place in the client’s home and focus on brief behavioral techniques, PEARLS
counselors empower individuals to take action and make lasting changes so that they can lead
more active and rewarding lives.
Prevention and Management of Alcohol Problems in Older Adults
The brief alcohol intervention approach is designed specifically for older adults and uses
motivational interviewing to enhance participants’ commitment to change their behavior. The
program includes alcohol screening, assessments, brief interventions, and a guide to referral for
more intensive care.
Brief Intervention and Treatment for Elders (BRITE)
BRITE is a substance abuse screening and intervention program for older adults who are
experiencing issues with alcohol, prescription medication, over-the-counter medication, or illicit
drugs. The program aims to identify non-dependent substance use or prescription medication
issues and provide effective service strategies prior to an individual’s need for more extensive or
specialized substance abuse treatment.