cont elders and their caregivers 2

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cont elders and their caregivers 2
2015-05-31 16:46:23

didn't need them all one set
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  1. Care giving cont public issue
    • care giving considered a major public health issue:
    • Inc demands on home services
    • - shorter hospital stays with limited d/c planning
    • - better technology available in the home
    • - aging population
    • estimation by CDC:
    • need for family caregivers will incr by 85% (by 2050) but available members to provide care will decre
  2. positive aspects of caregiving
    • enhanced self esteem and wellbeing
    • personal growth and satisfaction
    • finding or making meaning thru caregiving
    • relationship prior is important
  3. Spousal care giving wife v husband
    • Wives:
    • may need to learn to:
    • drive
    • manage money
    • makes decisions by themselves
    • Husbands:
    • may need to leanr to
    • cook
    • shop
    • do laundry
    • provide personal care for their wives
  4. Nursing assessment
    • comprehensive assessment
    • - identify the family members- family dynamic
    • - the functions of each family member esp caregiver
    • - include a family medical hx
    • - sources of stress and methods of coping
    • - support system
    • cargiver assessments includes stressors and benefit
    • nurses perform a risk assessment of caregiver stress
    • nurses respite care- long term care- caregiver may need a break
  5. Nursing interventions
    • focuses on strengths of the family unit
    • build on strengths
    • identify weakness and provide support and those areas
    • ** goal is to maintain health and wellingbeing of family unit
    • most families are in crisis before nurses become involved
    • avoid personal beliefs or definition of family
  6. Mistreatment: identify abuse and neglect of older adults
    • a person in need is at risk for harm from the care giver
    • the caregiver struggles with frustration, anger, fraudulent and carelessness in giving care
    • mistreatment leads to abuse and neglect
    • Abuse: seems to be episodic and recurrent can be physical, psychological, sexual, financial
    • Medical Abuse: subjecting a person to unwanted treatment or procedures
  7. Mistreatment: identify abuse and neglect of older adult
    • Neglect: an identified caregiver has not met their obligation to care for the family members
    • self neglect: the older adult is not caring for themselves in a manner in which their peers do
    • medical neglect: is when desired treatments are withheld
  8. Characteristics of elder abuse and neglect
    • frequent unexplained crying
    • unexplained fear or suspicion of a particular person
    • sudden changes in behaviors
    • caregivers refusal to allows vistors to be alone with them
    • inconsistents stories
    • missed appt (red flag)
  9. As risk elders
    • Home setting
    • spouse or children as caregivers
    • women
    • past hx of abuse
    • target is viewed as aggressive, combative or unappreciated
    • incr dependency= incr tendency to be abused
  10. Physical abuse
    • Broken bones, sprains, lacerations
    • injuries in various stages of healing
    • elders report of being mistreated
    • lab findings of meds overdose or under dose
    • broken eye glasses or frames
  11. sexual abuse
    • nonconsensual sexual contact at anytime
    • includes any sexual contact with any person who is incapacitated or unstable to give consent
    • s/s:
    • - torn clothing
    • - unexplained STD
    • - unexplained vaginal or anal bleeding
    • - elders report
  12. Emotional or psychological abuse
    • be aware of behaviors:
    • - withdrawn- flat affect
    • - upset or agitated
    • - unusual behavior (absent or dementia)
    • ---biting hitting rocking
    • - elders report
  13. Neglect
    • any refusal or failure to fulfill any part of an elder's caregiving obligations including life necessities
    • S/s:
    • - dehydration, malnutrition or poor hygiene
    • - untreated bedsores
    • - unsanitary or hazardous conditions
    • ---lice, dirt on person, fecal or urine smell
  14. abandonment
    • desertion of an individual by a person who has assumed care
    • s/s
    • desertion of an elder at an institution or any public location
    • elders report
  15. Prevention of mistreatment
    • geronto nurses are alerted to situation that can cause mistreatment to older adults
    • geron nurses can identify potential victims
    • nurses can work with caregivers and community support
    • team approach
  16. Evidence based practice: prevention of elder abuse and mistreatment
    • learn how to access for actual or potential abuse
    • know your state statutues and regulations related to the nurses role in elder abuse and reporting suspicions
    • keep informed, attend continue education programs
    • help care givers find and obtain respite services for intermettent relief
    • help care givers and pt broaden their social network support
    • provide money management programs for care giver and elder
    • help families develop and nurture informal support systems
    • link families with support groups
    • teach families stress management techniques
    • arrange comprehensive care resources
    • provide counseling for high risk familes
    • utilize other family members
  17. Mandatory reporting
    • Licensed nurses are required to report suspicions of abuse to the state
    • reports to be anonymous
    • need solid evidence
    • ** mentally competent adults cause refuse assessment and intervention and cannot be removed from harm without their permission
  18. Competency and capacity
    • terms can be used to identify the person ability to make decisions and understand the consequence of his actions and choices
    • capacity: is the ability to handle finances, daily business, take care of self, make medical decisions
    • - the person has the ability to decline or accept medical tx
    • one maybe limited capacity in one area (paying bills) but still be able to make healthcare decisions
    • when the capacity of an individual is impaired and no longer can make decision the courts will determine if person is incapacitated
  19. Guardians and conservators
    • are individuals, agencies or corporations that have been appointed by the court to have care, custody and control of a disabled person to manage financial responsibilites
    • guardian is a person appointed to be responsible for another person
    • conservator is a person specifically appointed to control the finances of the client
    • both remain in effect until court rescinds the order
  20. decision making at the end of life
    • causes legal, ethical medical and personal concerns
    • as the result of technology the line between living and dying is blurred
    • advance directive includes:
    • - living will
    • - durable power of attorney for health
    • - medical powers of attorney
  21. Power Of Attorney
    • is a legal document that gives the designated person (relative or friend) the power to act on the behalf of a person
    • a specific request of the elder
    • may be activated when elder can longer act on their own behalf
    • as soon as person regains ablity it is no longer enforced (unless requested)
  22. Types of power of attorney (POA)
    • General POA
    • - right to make financial decision, pay bills etc
    • Durable POA (surrogate or proxy)
    • - additional rights to make healthcare decision
    • - allowed to make end of life decisions- advise the proxy is someone who will uphold person's wishes
  23. Loss and grief
    • loss can be physical function due to normal aging
    • Life transition:
    • - retirement
    • - moving from family home (loss of house down size)
  24. Grieving Process
    • First period of the grieving process is acute grief
    • - physical
    • - psychological
    • Middle period- despair or depression
    • - affects the day to day functioning of a person
    • Final Phase of the grieving process
    • - the person learns to adjust to life in a new way
    • process is not a rigid structure
    • pattern of grief is not always predictible
    • may flucuatuate back and forth
  25. Loss response model
    • person is in a state of disequilibrium
    • grieving family member search for meaning
    • loss becomes "real" as the person repeats the story
    • - shares emotions thru retelling: anger, frustration, relief
    • family structure is reorganized
    • change is accepted
  26. Types of Grief
    • in older adult the reaction to grief may be mistaken for another condition such as dementia
    • types of grief include:
    • - anticipatory guidance- perceive loss before it happens
    • - Acute- crisis
    • - chronic- PTS around aniversary
    • - disenfranchised- loss not publically mourn- no support
  27. factors affecting coping with loss
    • those at risk for adverse affects include:
    • - older spouses
    • - life partners
    • intense grief may cause a decre in cognitive function, such as dementia
    • decre in ability to mobilize or make decision
  28. Coping
    • Those who effectively cope:
    • - maintain composure
    • - use good judgement
    • - opitimistic without denying the loss
    • - talk openly about the challenges
    • Those who ineffectively cope:
    • - are more rigid and pessistimic
    • - are demanding
    • - have emotional extremes
    • - live alone, socialize little, have a few close friends
    • - may have a history of mental illness
    • - may have guilt
    • - may abuse alcohol and other substances
  29. Nursing Implication for loss
    • Goal: a healthy adjustment to loss
    • individual assessment: grief and coping assessment:
    • - personal growth
    • - continuing bonds
    • - health risk
    • working with grieving older adults is normal part of the work day for a geron nurse
    • nurses uses the skills of therapeutic communication
  30. Nursing intervention of loss
    • know the stages of transition
    • During crisis establish rapport:
    • - tell nurse role
    • - provide safe environment
    • - provide basic needs (food, rest)
    • - avoid fostering false hope but reassure availablity for assistance
    • middle transition provide support- allow the person to talk about loss
    • help build strength and confidence- reframe the memories to complete the cycle
  31. nursing inventions continue loss
    • Reminiscence therapy:
    • - to help accept and find meaning in life
    • - relating their story can result in a sense of self worth and acceptance
    • Allow for opportunity to express ones feelings:
    • - journaling- helps the person feel at peace
    • - daily list of things they appreciate
    • - use of lifting quotes
    • Pet Therapy:
    • - stimulate sharing of feeling from past memories
    • photo albums: allow for reflection of past events
  32. countercoping
    • the client copes and the nurse countercoping
    • strategies of countercoping include:
    • - clarification and control= gathering infor
    • - collaboration- repeat stories
    • - direct relief- acting out feelings
    • - cooling off- put grieving aside and reestablish life
  33. dying death and pallative care
    • death is not the problem, dying the work
    • dealing with dying reflects ones own culture
    • older adult death seems normative
    • if the dying process is viewed as long and painful- then dying is viewed as a relief
  34. conceptual models- Dr. Kubler ross stages of death
    • Dr. Elizabeth Kubler- Ross stages of death:
    • - denial
    • - anger
    • - bargaining maybe it can changes
    • - depression- why me
    • - acceptance- help us move forward and plan for future
    • all stages are emotional reactions to dying
  35. Living- dying interval
    • dying begins at the moment called "crisis knowledge of death and ends at the moment of physiological death
    • the living-dying interval is the time between these two points
    • the chronological timeframe depends on the remissions and exacerbation in the diagnosis of a terminal illness
    • dying may take days, weeks, months, or years
  36. Dying time
    • crisis intervention is most important at this point
    • antipatory grieving may occur
    • most time is spent in chronic phase
    • life can still be lived bc it does go on, despite the antipated end
    • terminal phase is when the speed of physical dying is accelarated an the person no longer has the energy to maintain the activities of everyday life
  37. Response to death
    • The person who is dying may:
    • - withdrawl from outside work
    • - engage in coded communication
    • - give away cherished items
    • - urgently contact friends and family
    • In some cultures these actions occur during a period termed death watch
  38. Responsibilities of the nurse during dying period
    • provide safe care to the person and family
    • meets the needs of the dying person
    • uses the 6 C's approach:
    • - care
    • - control
    • - composure
    • - communication
    • - continuity
    • - closure
    • helps pt and family thru process
  39. role towards family
    • nurses are appreciated:
    • - if they keep family informed
    • - ask how family members are doing and offer support
    • - offer comfort when a family member cries and often cries too
    • - brings food
    • - knows fam members names
    • - brings bed to the clients room for fam members
    • - holds hand of fam member
    • - advises fam member holds hand of the dying
    • - calls a chaplian when need
    • - stays after their shift duties are over
  40. Dying and the nurser
    • death of client is not the failure of the nurse
    • nurses provide safe comfort to the dying and gentle care to the family
    • nurses must know the grieving process
    • nurses must have coping skills such as meaning making and the ability to disengage
    • nurses must be comfortable with their own lives
  41. pallative care
    • nurses care for older adults with irreversible and progressive chronic conditions (alzheimer disease, parkinson)
    • is the time when the client does not want anymore tx
    • focus is on care and comfort v cure
    • hospice care is an option
    • - generally reserved for terminal conditions
  42. Nurse role in pallative care
    • staff nurse giving direct care
    • nursing coordinator implementing the plan of the interdisciplinary team
    • nursing executive officer being responsible for clinical care
    • nurse advocacy for humane care foe the person whi is fying and his or her family
  43. Euthanasia
    • is the client's right to refuse life sustaining medical measure
    • terms associated with euthanasia incluse:
    • - physician assisted death
    • - physician assisted suicide
    • - physician helping the client during the dying process
    • - passive and active ethanasia
    • doctors are allowed to prescribed lethal medication injections in five states
  44. What is spirtuality?
    • religious faith and practices
    • can also be experienced and understood in non religious ways
    • spirituality is suggested as:
    • - the search for the scared
    • - a process of self-discovery in relation to a meaning of life
    • it is the central philosphy of life which guides a person through the dimension of human nature
  45. Spirituality and healthcare
    • positive outcomes linked to spirtuality
    • higher religious spirituality
    • - decre levels of death
    • - decre anxiety/alcoholism
    • - better marriages
    • - decre loneliness
    • - less distress among dementia care givers
    • better mental health
  46. Nursing consideration- spirituality
    • help individuals find meaning and purpose in living
    • stayed connected and engaged with oneself, others and the larger world
    • allow them ample time to articulate what brings them meaning and purpose
    • encourage self reflection
    • how can we support those activities or beliefs that will help them stay connected
    • assist with creative ways to support the spiritual journey of aging
  47. Nurturing the spirit of the nurse
    • nurses must consider:
    • what gives their own life meaning and value
    • will assist them in offering spiritual support to pts
    • taking care of nurses own spiritual needs help them to better meet the pt's spiritual needs