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Gerontological & Community Based Nursing. Care across the continuum Professor Adrianne Maltese. Housing Options for Older Adults. Elder friendly Communities Shared Housing (adult & children share) Cohabitation- Group homes(share home W/older adult/intergenerational) l.

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gerontological community based nursing

Gerontological & Community Based Nursing

Care across the continuum

Professor Adrianne Maltese

housing options for older adults
Housing Options for Older Adults
  • Elder friendly Communities
  • Shared Housing (adult & children share)
  • Cohabitation- Group homes(share home W/older adult/intergenerational)


benefits elder friendly communities
Benefits- Elder friendly communities
  • Address Basic needs
  • Optimize Physical & Mental Well being
  • Promote Social & Civic Engagement
  • Maximize independence for frail/disabled
new models of community care
New Models of Community Care
  • PACE (All inclusive care for elders)
  • Capitated system
  • Cost - monthly for all inclusive care
  • Must meet requirements for nursing home admission
  • Paid for by Medicare/Medical/Medicaid
adult day care services
Adult day Care Services
  • Community based programs
  • Provides social & health services
  • Caregiver respite
  • Dementia care
senior retirement communities
Senior Retirement Communities
  • Various economic levels /cost to consumer
  • Need for low-income public housing complex for older adults.

Other types:

Foster care, Residential Care Facilities

Assisted living

other housing choices costs
Other housing choices/costs
  • Foster care
  • Residential Care facilities
  • Assisted living
  • Continuity car Residence Communities
  • Population specific Communities
  • Nursing Homes
coalition of nursing home reform
Coalition of Nursing Home Reform

Issues to be dealt with:

  • Public - negative views
  • Lack of support & respect
  • Inadequate caregiver salaries
  • Poorly staffed ->unrealistic workload
  • Frail -very sick elders
  • Creating home environments
principles of culture change in nursing homes
Principles of Culture Change in Nursing homes
  • Empower staff
  • Involve residents in their care/decision making
  • Provide individualized care
  • Built relationships
  • Provide sense of community & belonging
  • Engage resident in meaningful activities
  • Create a homelike environment
  • Respect for all staff and the value of caring
omnibus reconciliation act 1987 obra
Omnibus Reconciliation Act 1987 (OBRA)
  • OBRA - mandated
  • MDS -Minimum Data Set
  • Increased training requirements
  • Elimination of use of meds/restraints
  • Bill of Rights for Long Term Care residents
loss grief
Loss & Grief

Loss ->grief->process of bereavement

“Grief is the individual’s response to a loss and mourning is an active and evolving process that includes those behaviors used to incorporate the loss experience into one’s life after the loss.”

loss grief end of life care
Loss, Grief & End of Life Care
  • Worden’s Model 2003- “grieving process series of evolving tasks”
  • Acceptance stage -person accepts of reality of loss
  • Working stage - person works through physical & emotional pain
  • Adjustment stage - person adjusts to a change in environment
  • Relocation of loss - person is able to emotionally move on with life
loss grief end of life
Loss , Grief & End of life
  • Jett’s Loss Response Model - incorporates a systems approach
  • Loss-> stage of disequilibrium
  • Search for meaning of loss
  • Story of loss is told repeatedly

(this helps in the grieving process)

  • Adaptation & accommodation of new roles
types of grief
Types of Grief
  • Anticipatory grief ->premature detachment = sociological death; premature withdrawal of a person =psychological death
  • Acute grief - a crisis. - person feels physically sick & is emotionally distressed - preoccupied with the loss->functional disruption - intense for first 3 months
  • Chronic grief - may temporarily inhibit activities; intermittent pain of grief -exacerbated on anniversary dates.
  • Pathological chronic grief - c/b excessive & irrational anger, insomnia, major depression
implications for nursing care
Implications for nursing care
  • Assessment

“tell me about recent events in your life”

Look for concurrent stressors

“what spiritual beliefs do you hold in relation to death?”

implications for nursing care16
Implications for nursing care
  • Goal- to attain healthy adjustment to the loss ; to reestablish equilibrium
  • Interventions -
  • Gently establish rapport
  • Offer reasonable hope /emotional support
  • Offer support for functional disruption
  • Provide information about the disease that may help person to process the loss.
  • Allow/encourage grievers to inform others
  • Facilitate elder to reorganize their life
  • Guide & encourage the reframing of memories
conceptual models death dying
Conceptual Models -Death & Dying
  • Living-Dying Interval - (Pattion 1977) -the time between first learning about the impending death “crisis knowledge until the time of the actual “physiological”death.
needs of the dying their families
Needs of the Dying & their Families
  • The “6 C’s Approach to caring for the dying & their families -
  • Care - best possible care
  • Control - active participant in own care
  • Composure -within the realm of one’s culture
  • Communication- 4 types of communication identified (Closed awareness,suspected awareness,mutual pretense;open awareness
  • Continuity - establish legacies
  • Closure - corresponds with reconciliation & transcendence
palliative vs hospice care ana elnec
No hospitalization

Focus on comfort vs. cure

No invasive procedures

Hospice org’s. provide medical,nursing,nurse assistants,chaplain,

social worker

24 hr support pt & family

Bereavement services

Palliative VS. Hospice Care(ANA-ELNEC)
nursing interventions22
Nursing Interventions
  • Encourage discussion of “end- of-life “
  • Decisions re: type of care
  • Advance directives
  • Euthanasia - Active vs. passive.