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Chapter Twelve. Environments of Care. Environmental Management. As far back as Florence Nightingale nurses were aware of the environment and the impact it had on patients The goal of environmental assessment is to promote independence
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Chapter Twelve Environments of Care
Environmental Management • As far back as Florence Nightingale nurses were aware of the environment and the impact it had on patients • The goal of environmental assessment is to promote independence • Assess all aspects of an older adult’s living situation that can be seen, heard, touched, or smelled. • Assess how well the older person functions in the living areas. For example: • Is the environment as barrier-free as possible? • Can the older person walk unencumbered or wheel a wheelchair through the entire setting?
Environmental Management (cont’d) • Transpersonal Caring-when the nurse relates to the older adult in a holistic way based on caring • Climate of caring • People in the environment • Family members, neighbors, friends, paid caregivers • Environmental tone and atmosphere • Includes being positive, respectful, caring, privacy, encouragement, involvement, independence • Safety • In any setting, safety for the older person is a primary concern. • Assess for environmental hazards. • Keep environment free of fall risks.
Environmental Management (cont’d) • Stimulation and personalization • Personalized items maintain a sense of identity. • A caring climate facilitates optimal independence and autonomy. • Personal space territoriality • Personal space is important to everyone. • Personal space varies from person to person. • Viewed as an intrusion when someone comes into it • Territory space is used by a person and seen as owned by the person.
Environmental Management (cont’d) • Privacy • Provide opportunities for privacy. • Respect right to privacy. • Activity and involvement • Provide multiple and diverse opportunities for activity and involvement.
Which would be an example of personalization? • Creating new routines • Photos of family members • Turning on the radio • Encouraging activities
Answer B. Photos of family members
What is the term for the return to a space out of habit? • Privacy • Activity • Territory • Relocation
Answer C. Territory
Relocation Trauma • Moving from one environment to another can be stressful to older adults. • Transitional Stress- refers specifically to the emotional stress that occurs during the time a person is changing from one phase of life to another • Orient to new surroundings slowly. • Incorporate personal furniture and objects into the environment.
Environments of Care • Various settings where older adults may receive health-care services • Adult day services • Provide supervised activities for older adults • Provide specific services to meet physical, psychiatric, and social needs • Ongoing assessments of participants are important.
Environments of Care (cont’d) • Home care • Provide services for older adults in their homes • Provide nursing services, therapy services, medical supplies, and equipment • Care is provided on a daily basis or intermittently. • Community-based care • Community clinic, dialysis center, or physician’s office
Environments of Care (cont’d) • Hospice • Provide care for the dying patient and the family • Care given by interdisciplinary team approach • Allows nurses to give direct patient care to patient and family members
Environments of Care (cont’d) • Assisted living • Provide services for older adults with physical care needs • Person must be ambulatory and fairly independent. • Environment is home-like. • Nursing homes • Area of practice that has been available to practical nurses for many years
Environments of Care (cont’d) • Nursing Home (cont’d) • Two categories • Skilled and nursing facility • Licensed by state • LPNs supervise nursing assistants and give medications and treatments.
Environments of Care (cont’d) • Acute care • 40% to 65% of hospital admissions are older adults. • Patients are admitted for a short period of time. • Difficult to develop trusting relationships with patients • Requires all the basic skills the practical nurse possesses
Which environment of care involves the services to help achieve more independence for safe return home? • Acute care • Skilled care • Assisted living • Community-based care
Answer B. Skilled care
Which type of environment is a wound clinic? • Acute care • Skilled care • Assisted living • Community-based care
Answer D. Community-based care
