Dialogue Reflection on: Care of Older Adults

Dialogue

Reflection on: Care of Older Adults
Submitted by: Frances Lareau, MS
Date Submitted: February 7, 2011

Having recently been hospitalized and an older adult(69) I have to comment that one of the most important skills we can teach nursing students is how to provide common hygiene practices to not only older individuals but to all. During the whole time I was hospitalized I had to constantly ask to be given my dentures and to wash before meals. These are very basic needs that should not have to be requested. Now I know how lucky I have been to not have required hospitalization in over 40 years!

Reflection on: Care of Older Adults
Submitted by: Barbara Heise, PhD, APRN, BC
Date Submitted: December 15, 2010

My experience has been that young nursing students are afraid of seniors in any setting. Students tell me that they dont have anything in common with seniors and dont know how to talk with them. The bottom line to me is to get young nursing students to see older adults as people...who have more in common than not in common. The desired outcome is an attitude change toward seniors. To do this we have our students go to both long term care facilities and to healthy aging sites such as senior centers and the Huntsman World Senior Games where over 10,000 active seniors from around the world come each year. In long term care, students care for seniors and spend time with them taking a Life History. This reflective writing experience allows them to realize that their client was young once with the same aspirations that they now have. We ask them to reflect on how this experience will impact their future nursing practice. Interacting with healthy seniors, students are asked to interview them to find out their tips to successful aging. We require that each student give 2 hours of community service to seniors. Throughout the course we challenge their ageistic views and show them positive images of aging. We have a discussion board that students post their insights about working with seniors. We have established a gerontology minor for nurses. By the end of the semester students views have dramatically changed with the majority of students inspired by seniors with positive attitudes (even those in the nursing home) and they comment that now is the time for them to prepare for healthy aging. As Robert Browning said "Grow Old along with me. The BEST is yet to be..."

Reflection on: Care of Older Adults
Submitted by: Davie L. Johnson, RN, MSN, MS, LBSW
Date Submitted: April 26, 2010

Nursing students should be introduced to care of the older adult in settings such as adult day care centers or senior citizen centers. It is here that they can be introduced to the "well" older adult. Too frequently, students are introduced to care of the older adult in the nursing home so they can perform basic nursing care procedures. It is a TURN OFF and so frightening for them. The literature is replete with writings that bear this out. I had students tell me that they prrayed their way through each day of the clinical rotation and vowed never to go back. Though I protested, that is the way the curricula is set and could not be changed. This is my PLEA — Our nursing programs MUST be changed so that students have clinical experiences with well older adults before being introduced to the sick older adult in nursing home beds.

Reflection on: Care of Older Adults
Submitted by: Julia A. Sensenig, MSN, RN, CNE
Date Submitted: April 12, 2010

The Lancaster Campus of Harrisburg Area Community College (HACC) established a nursing care center in collaboration with SouthEast Lancaster Health Services (SELHS) medical clinic in the fall of 2004. This inner city clinic serves individuals who are underserved, uninsured, and underinsured. Since the HACC Nursing Care Center opened, there have been over 4000 patient visits. Of the 1710 patient visits during the years 2008 and 2009, 18.6% of them were 40 to 49 years of age, 21% were 50 to 59 years of age, 15.4% were 60 to 69 years of age, and 2.3% were 70 years of age and older. Nursing students at the nursing care center have numerous opportunities to provide culturally competent, individualized, and holistic care to older adults.

The nursing care center was created to meet three objectives: (a) to provide a challenging and meaningful community nursing experience for our nursing students, (b) to maintain the quality of our nursing education while increasing our enrollments, and (c) to positively impact the health of our community.

At the HACC Nursing Care Center, second-level associate degree nursing students spend four or five clinical days by meeting with patients who are referred to the center by the primary care providers at SELHS. The patients are referred for educational sessions on topics such as diabetes, hypertension, hypercholesterolemia, smoking cessation, weight loss, and exercise programs.

The nursing students learn cultural sensitivity through interactions with the patients, 80% of whom are Hispanic. Approximately 43% of the patients require Spanish translation. Two Spanish interpreters have been hired by HACC and one of these interpreters is present in the NCC every time patients are scheduled to visit. The nursing students learn while teaching the patients. They gain self-confidence and a sense of responsibility as they provide health information to the vulnerable populations in our community. There are many opportunities to refine the therapeutic communication skills they have learned in the classroom at HACC. The students learn to work effectively and cooperatively with groups — assisting the patients to set health goals for themselves and referring patients to community resources. The nursing students are empowered to share with their patients what they are learning in the classroom. At the same time, patients are empowered by the students to make healthier choices in relation to exercise, healthy eating, smoking cessation, and weight loss.

The students at the nursing care center provide to patients a valuable, free service that was not available before the nursing care center opened six years ago. The primary care providers in the SELHS medical clinic frequently express appreciation for the education given to their patients by the student nurses — education that they as providers are unable to provide due to time constraints. The primary care providers are able to see more patients in the medical clinic. At the same time, the patients they referred to the nursing care center are receiving the education they need to become healthier — at no cost for the patients.

An article about the HACC Nursing Care Center was published in the August 2007 issue of Journal of Nursing Education (pp. 373-379): “Learning through teaching: Empowering students and culturally diverse patients at a community-based nursing care center.”

Reflection on: Care of Older Adults
Submitted by: Anonymous
Date Submitted: April 8, 2010

Thanks for making available such useful resources for faculty! Congrats and thanks for alll the efforts to make this possible.

Reflection on: Care of Older Adults
Submitted by: Anonymous
Date Submitted: March 25, 2010

Thoughtful, compassionate and thorough position statement. Consistent with NLNs quest for excellence. Kudos to NLN!

Reflection on: Care of Older Adults
Submitted by: Eileen Mateo-Roman
Date Submitted: March 17, 2010

Bravo! Finally we are soing justice to our elder population. Beside special skill to take care of this population, we need to guaranty them a lovely care, respect and they deserve to be treated as human being. As a nurse I`m ashamed of the care my father of 82 years received from incompetent nurse that finish with his life because a malpractice during nasogastric tube insertion provoque his death. I am writting an article about this traumatic and insensible experience with a colleague.

Reflection on: Care of Older Adults
Submitted by: Janice Costello, MSN
Date Submitted: March 17, 2010

The first 30 years of my career were in Long Term Care. For the past five years I have been faculty in an ADN program and have served as the Chair of that program for the past 4 years. I have an enormous amount of passion for caring for the elderly not only as a nurse but as the caregiver for my handicapped father for 12 years. I have incorporated two opprotunitie within our nursing program when I taech classes on care of the elderly as the main focus. certainly aspcts of carung for the elderly are woven into the curriculum, but these two lectures have a specific focus. In our fundamentals cousrse I teach about caring for elders in their home or in the long term care setting with a focus on the aging process in the absence of an acute disease process. However in their fourth of five semesters i do another lecture that focuses on the care of the eldrly in the acute care setting. It is notable that at the start of each courses I inquire as to which students are planning on working with the elderly after becoming licensed. Very few hand sare raised so i go on to state that i did not realize that so many of them were going into PEDI and OB. Studnts then come to the realiaztion that in a hspital setting they will care for eldrly patients. What they heard me ask was "Are you planning to work in long term care? My lived experiences allow me to add relevany an poignant examples to make the classroom come alive. The lecture that I give in the later nursing course is often requested to be repeated in the event that students have to miss it due to weather or persoanl issues.

As I have 4-5 graduates of each of my 3 annual graduating cohorts enter long term care, I believe that these lectures are having an impact and instilling a love for the elderly that I am only too happy to share with my students.

Reflection on: Care of Older Adults
Submitted by: Theresa Pulvano, RN/MSN/eD CSN
Date Submitted: March 16, 2010

This is so true about the care of the elderly client. I teach nursing students. I teach them that you can learn so much from an elderly client if you just listen to them. I also teach them that we are all going to be old one day and try to imagine what is like to be old. Take care of others like you would take care of yourself. This dialogue needs to be place in nursing journals for others to read.

Reflection on: Care of Older Adults
Submitted by: Roberta Pavy Ramont, Ed.D., RN
Date Submitted: March 15, 2010

Over the last three weeks I have experienced the care in skilled nursing as a family member. My father who is one month shy of 95 factured his rt hip and under went hemiarthroplasty. Came thru the surgery remarkably well, was transfered to "rehab" two days later and has deteriorated since that time. I have spent the last 19 years in education teaching, authoring textbooks, developing curriculum and overseeing programs, CNA, LVN and ADN-RN. The treatment of the elderly is unbelivably bad to the point that I am considering takinga leave from work so that I can monitor my fathers care. The staff members that I have dealt with think that a diaper subsitutes for taking a resident to the bathroom; If they have to be fed they eat cold food, because they get fed last; they are clothed in a hospital gown because they probably dont know the difference.They dont seem to understand that lost of eye sight and hearing need to be taken into consideration and making sure glasses and dentures are in place for meals.

No one seems to take into consideration that this resident was a competent, active professional and needs to have stimulation during the day. Two meals in a dining room and therapy is the only interaction residents get unless they request some activity.If they are slow eaters they never get to finish a meal.

When I was in the classroom I know these things were taught, but know I am being told by RN and LVN staff that this is the real world. Our population in aging and more and more of the clients/residents that need care will be the frail elderly, In addition to teaching more on the older adult in basic programs, states need to require continuing education on appropriate care and interaction with the older adult client to renew a nursing license. It is unfortunate that the American Cultural norms do not include respect for the older generation. The advances in medcine and care are permitting our population the live longer but without quality and compasionate treatment this is a diservice rather and a blessing. I am not thrilled that I have probably inherited my parents "longevity genes" since I see the prospects get much worse before they get better.