Introduction
Worldwide, demography is changing, with a steady rise in the aging population seeking better care in nearly every country. The United States Census Bureau estimated that the adult population aged 65 and above would be at 1.5 billion by 2050 (Gates & Cooke, 2011, as cited in Albougami et al., 2016). In response to this dramatic rise in the elderly population, gerontological nurses should be educationally prepared to care for this population. They should recognize the differences in cultural, psychosocial, physiological, and social needs among the elderly (Cordella & Poiani, 2021). For this reason, it is necessary to reflect on the eight outcomes learned from gerontological nursing and demonstrate their practicability in improving the health care service delivery for older adults in a clinical setting.
Learning Outcome
Issues in Gerontological Nursing
Age-Related Physiologic Changes
Like all other organisms, physiological changes occur with aging in all human organs. Flint and Tadi (2020) explained that as one advance in age, their lungs experience impaired gas exchange, slow expiratory flow rates, and reduced vital capacity. In terms of cardiovascular, arteriosclerosis develops, which increases blood pressure. The elderly also experience functional changes in motility patterns in the gastrointestinal systems and altered hepatic drug metabolism (Amarya et al., 2018). Thus, these and other age-related physiological changes explain why most aging patients are less active and prone to more health complications.
These age-related physiologic changes have important practical implications for managing elderly patients in a clinical setting. Since the rate of metabolism is altered in older adults, there is a need to design the commonly used drug based on these changes to prevent overdose. Moreover, it is imperative to adopt a rational preventive program such as regular exercise and diet to reverse these changes.
Age-Related Psychological Changes
Aging is associated with several psychological disorders, including loss of abilities, social isolation, and role transition. As one attains old age, the brain’s capability to transmit signals to special senses decreases (Amarya et al., 2018). Many older adults also become vulnerable to neurological disorders, such as Alzheimer’s disease. Similarly, elders are prone to social isolation in society; hence, they experience immune dysfunction and depression (Flint & Tadi, 2020). Since older adults are susceptible to most illnesses, they tend to disengage from their families and become less active in discharging social responsibilities.
In a clinical setting, the knowledge of age-related psychological changes is handy as an intervention to manage late-life stressors. Psychotherapists care for older patients with different age-related life stressors such as losing loved ones and declining health. When faced with this clinical situation, as a psychologist, I can apply bibliotherapy, exercise, reminiscing, and computer-based therapies to older patient’s life to improve their emotional being.
Demonstration of Intentional Learning with Reflection
Intentional- learning allows nursing students to reflect on the experience and skills gained to meet the patient’s needs. In this approach, I acquired skills that enable me to thrive in a student-centered nursing curriculum and become competent in today’s dynamic and complex clinical setting, as demonstrated the two personal experiences:
Communication
I have experienced that young nursing students are afraid of their seniors in a clinical setting. My fellow students told me they do not know how to communicate with them. However, I desire to become a nurse who has a positive ageistic attitudinal view. To achieve this outcome, I attended long-term care facilities where adult patients share their life histories. From this experience, I learned my client was once a young person with the same aspirations like I am today, and this experience will impact my future nursing practice (NP). In clinical practice, this experience will help me resist stereotypes of older age, which can be detrimental to the care of older people if unchecked.
Age-Related Prejudice
Finally, I am doing significant justice to the elderly population. Besides gaining experience to take care of this vulnerable population, I guaranty older people lovely care, and they deserve to be treated with respect. As a nurse student, I was ashamed of the care my 82-year-old mother received from the incompetent nurse that ended up terminating her life because of malpractice. My mother underwent hemiarthroplasty due to a hip fracture and was transferred to the rehabilitation room for further care. The staff treated her badly; they used diapers instead of taking her to the washrooms and fed her cold food. I knew these practices were being taught in school, but in a clinical setting, the nurse told me this was a real-world where things are done differently. I learned that elderly should be treated with lovely care just like other people of different ages. This first-hand experience has changed my attitude towards protecting patients’ rights and treating older people with dignity.
Application of Evidence-Based Practice
PICO Model
An excellent example of evidence-based practice (EBP) is the PICO (population, intervention, comparison intervention, and outcome) model. PICO defines a clinical question based on a specific patient condition to enable the clinician to find relevant evidence (Sarrakh et al., 2021). The PICO knowledge helped me to evaluate the effectiveness of treating a depressed patient as follows. While presented with a cancer patient complaining of signs -related to depression, I suspected that depression is highly prevalent in cancer patients. Abou Chaar et al. (2018) confirmed that depression is a common psychiatric illness among patients with cancer. In response to this high prevalence rate, I was prompted to conduct a clinical examination, which tremendously improved my skills as a future nurse. I consulted the World Health Organization (2020), which held that 76 percent of the deaths reported in acute hospitals account for depressed patients. I also consulted Hallgren et al. (2020) to determine the correct diagnosis based on documented symptoms such as feelings of guilt and thoughts of self-harm. Based on this approach, I correctly diagnosed the patient with depression and prescribed her proper treatment. This goodwill, from time to time, assists me in diagnosing older patients with depression.
Evaluation of Implementation of NP Based on Existing Literature
Another example of EBP involves evaluating the right decision based on existing literature. Consider where an accumulated body of knowledge concerning immeasurable NP (Oxygen Use in Patients with COPD) efficacy leaves an option to determine what is known or practiced. Professionals with long-term experience will not approve of it due to multiple reasons such as learning ability, age, culture, or attitudes (Clarke et al., 2021). Sarrakh et al. (2021) noted that numerous barriers might complicate the application of this NP. If the nurse has a much workload, then this might necessitate the adoption of the practice. Despite, lack of options for implementing NP, nurses complained about the heavy workload, and the NP was implemented. From this experience, I learned that a nurse plays a critical role in the utilization of EBP. If they can research NP in the university, they might demonstrate, apply the practice, and influence fellow students.
Demonstrating Clinical Reasoning and Decision-Making Skills
Assessment of Dementia
Assessment of the mental health status of an elderly dementia patient is a key example of clinical reasoning. In the diagnosis process, if the examination suggests a functional cognitive impairment, it would be a wise decision for a doctor to validate the information based on the past medical history with the patient’s family or relatives (Jost et al., 2017). By engaging the patient to describe a typical day, I obtained more information about the patient’s interests, eating habits, and social activities. However, I also found it necessary to back up data with another aspect of formal cognitive functions before arriving at the final treatment decision. This validation of information was made possible through examining the signs- related to dementia, such as gradual loss of memory, reasoning, and judgment impairment. Eventually, I diagnosed the elderly patient with dementia and prescribed the proper treatment. Again, this experience will be relevant in treating older dementia patients.
Evaluating Social Support
Clinical reasoning also applies in evaluating the social support of the elderly. While assessing the patient’s social support system, I found it necessary to construct a genogram to indicate family constellation, family-related diseases, and family influences on chronic diseases. I also ascertained to whom the patient considered as her most important support person or confidante. I reaffirmed with Fuller-Thomson et al. (2020), who holds that absence of any vital confidante is an indicator of mental illness; an inadequate support network implies an increased likelihood of the need for institutionalization of the patient if they are otherwise physiologically frail. In this view, I realized the need for institutionalizing the patient as an intervention for her treatment. Since then, my experience in evaluating the social support of the elderly has improved tremendously.
Leadership at Organizational, Local, and Global Level
National Family Caregiver Support Program
National Family Caregiver Support Program (NFCSP). NFCSP is an exemplary leadership program that supports informal caregivers and families that provide care for their loved ones at home. NFCSP offers numerous services, such as assisting caregivers in gaining access to services and providing information to caregivers about available services. These services have successfully enabled caregivers to offer long-term care to older adults, thereby avoiding the need for costly institutional care (Administration for Community Living, 2021). Informal and family caregivers present their preferences and needs for the types of programs and services they provide. Fortunately, numerous national programs and organizations exist to inform and support the development of such programs.
Expressing Leadership in Self-Management, Assistive devices, and Caregivers
Similarly, nurses can express leadership in self-management, assistive devices, and caregivers. Self-management is a way of sustaining people with chronic illness to live longer (Lenferink et al., 2017). Nurses have a role to play in supporting patients to make healthy choices and direct older adults to helpful information that can improve their health. Nurses also have a leadership role in assessing the client’s safety and providing assistive devices to patients with special needs. Some of the commonly used assistive devices for ambulation and mobility are wheelchairs, canes, and crutches. As a nurse, I learned that it is my responsibility to demonstrate leadership by committing most of my time to take care of older people with different special needs such as disability, depression, and anxiety. In relevance, the knowledge of self-management will be important to me in determining Arthritis Self-Management Program and Diabetes Self-Management Program to handle older people with arthritis and diabetes, respectively. Furthermore, assistive devices will be relevant in prescribing the correct device to older patients with different unique disabilities needs such as poor eyesight impairment.
Effective Communication
The Role of Effective Communication
Effective communication in a clinical setting is an essential aspect of the healing process. Effective nurse-patient communication can improve patients’ adherence to treatment and delivery of favorable health outcomes and express greater satisfaction with their treatment (Bhatt & Swick, 2017). Because proper communication is associated with several benefits, I learned that a nurse must communicate effectively and therapeutically in a nurse-patient clinical setting. They should pay close attention, show interest, and refrain from interrupting patients while addressing their concerns. In addition, I learned the nurse should avoid the use of medical jargon and be ready to compensate for hearing impairment if their need arises. Effective communication is relevant in a therapeutic setting; I will apply it to counsel old patients with mental disorders such as dementia. In addition, it will assist me in collecting relevant data when conducting a clinical examination of older patients.
Effective Communication in Culturally- Sensitive Environment
Effective communication also applies in a nurse-patient conversation involving different connotations based on cultural or ethnic background. Every culture demonstrates its tendencies, implicit assumptions, and prejudice when interacting face to face, and practicing effective communicating can sometimes be challenging and frustrating (Bhatt & Swick, 2017). Even in cases where a language barrier does not exist, cross-cultural communication can be problematic. Consequently, this knowledge will help me demonstrate culturally- sensitive care when handling an elderly patient from a different background by practicing active listening and becoming aware of cultural differences. As a culturally competent nurse, I will assure patients’ trust and rapport to increase treatment acceptance. In practice, effective communication in diverse cultural contexts will assist me in becoming a culturally competent nurse with an international presence who can treat older patients from different ethnic backgrounds.
A Proposed Culturally Competent Nursing Care
Globalization has led to an increase in diversity among patients, making culturally competent healthcare an absolute necessity. Like all other health specialists, nurses are expected to develop and practice culturally congruent care, which requires an in-depth understanding of cultural differences, practices, and beliefs to avoid premature generalizations. According to Albougami et al. (2016), culturally competent models are practical and efficient as an NP. They have enhanced the delivery of nursing care to a diverse population by offering means to address challenges when handling culturally diverse patients. In this context, two culturally competent care models were proposed.
The Leininger Sunrise Model
The Leininger Sunrise Model is one such model that represents the structure of culture care theory to establish the relationship between nursing principles and anthropological beliefs. Typically, nurses apply this model when evaluating patient’s cultural diversity. This model integrates theoretical concepts with clinical practices while systematically evaluating values, beliefs, behavior, and customs (Albougami et al., 2016). Besides, the model includes different cultural aspects such as social, educational, religious, financial, legal, political factors, environment, and language. Since this model encompasses a broad spectrum of cultural diversities, it is essential to address older adults’ physical, spiritual, and cultural needs.
Campinha-Bacote Model
Another model with cultural competence care is the Campinha-Bacote Model. Albougami et al. (2016) defined cultural competence as the ability of the nurse to work in a culturally diverse environment efficiently while caring for older people. To achieve cultural competence, a nurse should raise cultural awareness, obtain cultural skills from the patients, understand cultural variation in traits, avoid cultural stereotypes, and embrace cultural desire to become skilled, competent, and aware of cultural differences (Albougami et al., 2016). This model is also helpful in evaluating the cultural background of elderly patients.
Team Collaboration to Improve Patient Care
Importance of Teamwork
Worldwide, effective teamwork is an essential tool in developing an effective patient-centered health care delivery system. Bhatt and Swick (2017) noted that patient safety experts consider teamwork and communication skills vital for providing quality patient-centered health care. My knowledge of the effective collaboration between clinical and non-clinical staff will improve patient outcomes, increase patient satisfaction, prevent medical errors, and reduce the risks of miscommunication among healthcare providers.
Team Work Intervention
Given the complex and unique needs of older adults, different strategies can be adopted to ensure the safety- net health care workforce is prepared to serve the needs of the aging population. Bachireddy et al. (2020) noted strategies for taking care of such older people. Firstly, it should be recognized that not one caregiver can give this population’s medical and behavioral needs within a short time. Secondly, an informed team approach should be adopted to provide comprehensive service. These efforts will enhance my interest as a nurse to recognize the needs of older people.
Conclusion
Conclusively, students can learn numerous topical issues in gerontological nursing, and these competencies have practical implications in any clinical setting. Gerontological nursing (the study of aging-related health issues) describes physiological, psychological, cultural, social, socio-economic aspects of aging as an intervention to promote an effective health care delivery system. Most importantly, its goal is to improve the health outcome of older patients by equipping health care professionals to be effective and competent in the delivery of patient-centered health care services.
References
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