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The University Of Texas at ArlingtonSchool of Nursing
BSN Program
Senior II
N4261Nursing of Older Adults
SYLLABUS
Melinda Hiemenz, PhD, RN
Spring 2009
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The University of Texas at Arlington School of NursingUndergraduate Program
COURSE DESCRIPTION: Selected concepts and issues related to aging and its impact on society and health care. Introduction to gerontologic nursing principles. Clinical application in diverse settings across the continuum of care.
CREDIT HOURS AND 2 Credit hours, Lecture 30 hours, CLOCK HOURS: Class: On-Line WEB CT
PLACEMENT IN CURRICULUM: Senior Year Second Semester
PREREQUISITES: NURS 4581
FACULTY: Melinda Hiemenz, PhD, RN E-mail: [email protected] Phone: 214-914-3454Mail: 22185 Timberland Ct Clearwater MN 55320
STUDENT LEARNING 1. Discuss how the physiologic, psychological, cognitive, and emotional OUTCOMES: changes of aging can influence the assessment of an older adult.
2. Use therapeutic communication and effective interpersonal skills in interactions with older adults, their support systems, and other healthcare providers.
3. Examine how the standards of gerontologic nursing and current legal and ethical standards influence the care of older adults
4. Evaluate community resources available to the older adult.5. Synthesize theoretical knowledge and evidence based data with
experiences involving older adults.6. Examine self-awareness of personal and professional growth.
EVALUATION METHODS:1. Examinations
Two exams will be given, a midterm and a final exam. The midterm will be scheduled during a lecture day at UTA and the final during Senior II final week. Multiple choice questions and essay/short answer questions may compose these exams. The exams may be given either in the written (paper) format or on a computer at UTA. Tests are given at UTA only and are proctored. Make sure you bring your UTA ID card for all tests.
Missed Exams All students are expected to take exams at the scheduled time. In the event a student anticipates missing an exam, the student is expected to notify the lead teacher on or before the exam day. The lead teacher must approve a make-up exam. The make-up exam will cover the scheduled material and will be an essay/short answer format. The exam must be made up within one week.
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Testing Guidelines for On-line Quizzes
It is expected that students will work alone and without notes to take each of the unit quizzes. You are expected to maintain test security by not discussing the questions with your peers. If you discuss quiz questions or content of quizzes with these students, this is a violation of test security, and will result in being reported for academic dishonesty. WE TAKE TEST SECURITY very seriously at the school of nursing. Violations in quiz and test security are considered not just academic violations, but ethical violations, which is unacceptable behavior for nursing professionals.
1. The online quiz will be set to 1.0 minutes per question and then the question will disappear from the screen. You will not be able to go back to that question. You will not have time to use your notes to look up the answers. You are on the honor system, and I trust you would not participate in unethical behavior. It is expected you will NOT use notes, books, or study templates to take your quiz.
2. Each student is likely to have a quiz formatted differently than other students, as the questions are scramble.
3. During a quiz you will be unable to save or print the questions; this is for test security purposes.
4. Do not wait until the last minute to take the quiz. You will be given a window of time in which you can take it. I suggest taking the quiz as soon as possible.
5. Your computer connection must be reliable. If you know that you are cut off of the Internet every time use it, don’t rely on your home computer to take the quiz. There are many options for you to use a reliable computer with a reliable Internet connection, including the public library, the UTA library, and the UTA Learning Resource Center.
Web CT: General Discussion
The WebCT discussion board should be viewed as a public and professional forum for discussion. Students are free to discuss academic matters and consult one another regarding academic resources. The tone of postings on the WebCT discussion board should remain professional in nature. It is not appropriate to post statements of a personal or political nature, or statements criticizing classmates or faculty. Inappropriate statements will be deleted by the course faculty. Announcements from student organizations may be posted with faculty permission. Failure to comply may result in further action including removal from the discussion board.
Web CT as a Class Discussion and Management Board
Classroom time, classroom activities, and resources retrieved from WebCT, and clinical labs occur over the entire semester. Web CT is our classroom for this course, and although it does not meet at a designated date or time, it is expected that all students participate in the discussion of material as 5% of your total grade will be based on your discussion within this course. The instructor will base this on how often you respond to questions on Web CT and the quality of answers and also questions that your bring to the discussion board. Statements of agreeing or disagreeing to other students thoughts do not represent “discussion” unless a student backs up a statement with a well thought out statement based on clinical experience, the text, or other resources.
TEACHING METHODS:
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Lectures WebCTDiscussion Internet ResourcesInterview Application/experiential activitiesGRADING:Exam 1 40%Exam 2 35%Life Review Paper 15%Unit Quizzes’ (total 5) 10%
UTA School of Nursing Grading CriteriaIn order to successfully complete an undergraduate nursing course at UTA, the following minimum criteria must be met:
70% weighted average on proctored exams (Exam I & II)70% weighted average on major written assignments 90% on math test (not applicable for this course)90% on practicum skills check offs (not applicable for this course)
In undergraduate nursing courses, all grade calculations will be carried out to two decimal places and there will be no rounding of final grades. Letter grades for tests, written assignments and end-of-course grades, etc. shall be:
A= 90.00 – 100.00B= 80.00 - 89.99C= 70.00 – 79.99D= 60.00 – 69.99
NOTE: No extra credit projects are available to raise individual test or final grades.
The existing rule of C or better to progress remains in effect; therefore, to successfully complete a nursing course, students shall have a course grade of 70.00 or greater.If a student is not passing the exams with a 70% the student is responsible for making a plan of how to improve future grades and should make an appointment with Ms. Kristine Nelson(Ext. 20704; Room 657) to discuss how remediation will take place).
REQUIRED TEXTBOOKS:Ebersole, Hess, & Luggen. (2008). Toward healthy aging: Human needs and nursing response. (7th ed).
St. Louis: Elsevier Mosby. ISBN 9780323047302
LIBRARY INFORMATION: Helen Hough, Nursing Librarian(817-272-7429, Email: [email protected] Research Information on Nursing:http://www.uta.edu/library/research/rt-nursing.html
UNDERGRADUATESUPPORT STAFF: Holly Woods, Administrative Assistant I, Senior II
646 Pickard Hall, (817) 272-2776 ext. 4811Email: [email protected]
Suzanne Mandell, Sr. Secretary, Junior I & Senior I645 Pickard Hall, (817) 272-2776 ext. 4817Email: [email protected]
Kendra Erskine, Sr. Secretary, Pre-nursing & Junior II
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644 Pickard Hall, (817) 272-2776 ext. 4833Email: [email protected]
FACULTY RESPONSIBILITIES:The faculty will clearly communicate with students; provide learning experiences designed to meet essential course content; collaborate with students to facilitate the learning process; support creative, independent learning; and provide guidance for students in the pursuit of professional development.
STUDENT RESPONSIBILITIES: Clear communication from students to course faculty, elders, and other healthcare professionals is
expected. As adult learners, and as life-long learners, students are responsible and accountable for their own
achievement, including seeking consultation with the professor about problems related to the course. Students are encouraged to make an office appointment regarding poor progress or course concerns to allow time to review, discuss and/or problem-solve in a private setting.
Students are responsible for all material presented in class and all required readings. Students are expected to attend all classes, participate in classroom activities, and complete all learning activities. Thus, students are required to bring course materials for each class to facilitate participation.
Written assignments should exemplify professional appearance and communication skills. Reports and papers must be legible, follow format guidelines, and use correct grammar, spelling, and punctuation. When a written work is required in APA format, the student is to follow the APA Publication Manual (5th edition) and Student Handbook guidelines.
Confidentiality a. Client confidentiality must be maintained at all times (e.g. not discussing family/
agency situation with another family member without permission, etc.). If questions or concerns arise, contact your clinical faculty for advice.
b. Violation of confidentiality is considered as unprofessional conduct.
UTA INFORMATIONSTUDENT CODE OF ETHICS:The University of Texas at Arlington School of Nursing supports the Student Code of Ethics Policy. Students are responsible for knowing and complying with the Code. The Code can be found in the Student Handbook.
ACADEMIC INTEGRITY:It is the philosophy of The University of Texas at Arlington that academic dishonesty is a completely unacceptable mode of conduct and will not be tolerated in any form. All persons involved in academic dishonesty will be disciplined in accordance with University regulations and procedures. Discipline may include suspension or expulsion from the University.
"Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, the submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts." (Regents’ Rules and Regulations, Series 50101, Section 2.2). For additional information please refer to the Student Handbook.
STATEMENT FOR AMERICANS WITH DISABILITIES ACT:The University of Texas at Arlington is on record as being committed to both the spirit and letter of federal equal opportunity legislation; reference Public Law 92-112 - The Rehabilitation Act of 1973 as amended. With the passage of federal legislation entitled Americans with Disabilities Act (ADA), pursuant
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to section 504 of the Rehabilitation Act, there is renewed focus on providing this population with the same opportunities enjoyed by all citizens.As a faculty member, I am required by law to provide “reasonable accommodation” to students with disabilities, so as not to discriminate on the basis of that disability. Student responsibility primarily rests with informing faculty at the beginning of the semester and in providing authorized documentation through designated administrative channels. Information regarding specific diagnostic criteria and policies for obtaining academic accommodations can be found at www.uta.edu/disability. Also, you may visit the Office for Students with Disabilities in room 102 of University Hall or call them at (817) 272-3364.
UTA 2008-2009 UNDERGRADUATE CATALOG POLICY FOR ADDING AND DROPPING COURSES OR WITHDRAWALSEffective Fall 2006, adds and drops may be made through late registration either on the Web at MyMav or in person in the academic department offering the course. Drops may continue in person until a point in time two-thirds of the way through the semester, session, or term. Students are responsible for adhering to the following regulations concerning adds and drops.
a. A student may not add a course after the end of the late registration period.b. No grade is posted if a student drops a course before 5:00 p.m. CST on the Census Date of that
semester/term.c. A student entering the University for the first time in Fall 2006, or thereafter, may accrue no more than
a total of 15 semester credit-hours of coursework with a grade of W during his or her enrollment at the University.
d. A student may drop a course with a grade of "W" until the two-thirds point of the semester, session, or course offering period.
e. Exceptions to this policy may be entertained because of extraordinary non-academic circumstances. Under such circumstances, approval must be received from the instructor, department chair, dean, and the Office of the Provost.
Students wanting to drop all courses for which they are enrolled must withdraw from the University for that semester/term. (Students should follow the procedure in the Withdrawal section of the UG Catalog.) Spring 2009 drop date is: April 3, 2009.
PLEASE NOTE: The aforementioned University policy describes the process and dates for traditional 15-16 week classroom courses as well as clinical courses with a 15 week clinical rotation and all RN-BSN courses. As in the past, the last date to drop the course for clinical reasons is adjusted. The adjusted date will now reflect a point two-thirds of the way through the course or clinical rotation.
Courses with adjusted drop dates in Spring 2009 are as follows:
Management, Trends, Community and Nursing of Older Adults: March 13, 2009 Capstone: May 1, 2009
STUDENT SUPPORT:The University of Texas at Arlington supports a variety of student success programs to help you connect with the University and achieve academic success. These programs include learning assistance, developmental education, advising and mentoring, admission and transition, and federally funded programs. Students requiring assistance academically, personally, or socially should contact the Office of Student Success Programs at 817-272-6107 for more information and appropriate referrals.
Honors College CreditStudents who are members of the Honors College may wish to take this course for Honors credit. If you wish to do so, please provide the Lead Teacher (or other designated faculty member) with an Honors Credit Contract (downloaded from http://honors.uta.edu/documents/credit.pdf). You and the Lead Teacher/faculty member will together determine an appropriate supplemental assignment to justify the awarding of Honors credit. If you are not in the Honors College and would like to learn more about the
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benefits of membership, visit the website at http://honors.uta.edu/, where you will find an application form for electronic submission.SCHOOL OF NURSING INFORMATION:APA FORMAT:APA style manual will be used by the UTASON with some specific requirements for the undergraduate courses. www.uta.edu/nursing/APAFormat.pdf
CLASSROOM CONDUCT GUIDELINES:The Faculty of the BSN Program believes that classroom teaching has two goals: the provision of content pertinent to the discipline of nursing and the socialization of students into the professional role. We are committed to providing the curriculum in an atmosphere conducive to student learning and in a manner that will prepare graduates to be successful in the health care workplace. Refer to the Student Handbook for more information.
NO GIFT POLICY:In accordance with Regents Rules and Regulations and the UTA Standards of Conduct, the School of Nursing has a “no gift” policy. A donation to the UTA School of Nursing Scholarship Fund would be an appropriate way to recognize a faculty member’s contribution to your learning. For information regarding the Scholarship Fund, please contact the Dean’s office.
The Student Handbook can be found by going to the following link: http://www.uta.edu/nursing/handbook/toc.php or by going to the nursing website www.uta.edu/nursing and using the link provided under Current Students.
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The University of Texas at Arlington: School of NursingN4261 Nursing of Older Adults: Spring 2009
Dr. Melinda HiemenzDate and Week Topic Readings
Week 1
1/20/ 09
Orientation to Course: On Web CT *Schedule *Syllabus * Web Ct Course Format * Papers *Testing Procedures
Unit I. Theoretical Foundations of Gerontologic NursingUnit Objectives:
A. Aging in America B. Nursing’s Response (History) C. Social, Role Changes, and Cultural : Consideration in Aging
D. Theories of Aging
Text: Toward Healthy Aging, Human Needs & Nursing Response. Ebersole, Hess, Touhy, Jett, & Luggen: 7th Ed.
Chapter: 1
Chapter 20: p. 483-488; p. 498-505Chapter: 21
Chapter 2
Week 21/26/09 Unit II. Holistic Health Assessment
Unit Objectives: A. Assessment of Older Adults B. Chronic Illness in Late Life C. Assessment Tools and Techniques D. Mobility, Exercise, Falls, & Restraints
E. Environmental Safety
Chapters 4 & 6Chapter 10Chapter 6Chapter 4: p. 68-70Chapter 7: p. 142-151Chapter 15Chapter 16
Date and Week Topic Readings
Week 32/2/09
Unit III: Nursing Care of Adults with Physiologic Alterations
Unit Objectives:
A. Nutritional Issues and Aging B. Sensory Changes
Unit I & II Quiz
Chapter 9
Chapter 4: p. 79-82Chapter 14
Week 42/9/09
C. Osteoarthritis, Osteoporosis, RA, Polymyalgia Rheumaticia, Bursitis & Tendinitis & Gout
D. Sleep and Sleep Changes in Aging
E. Elimination/Continence
Chapter 15: p. 385-396
Chapter 7: p. 135-142
Chapter 7: p. 121-135
Week 52/16/09 F. Pain and Pain Management
G. Issues of Drug Therapy in Elders H. Laboratory Values and Diagnostics in Elders
UNIT III Quiz
LIFE REVIEW PAPER DUE ON LINE BY MONDAY FEB 16TH AT 9:00 A.M.
Chapter 11Chapters: 12 &13Chapter 5
Week 62/23/09
TEST 1 (MIDTERM) on Friday February 27th Rooms TBA according to names.
Date and Week Topic ReadingsWeek 73/2/09 Unit IV: Mental Health Issues and Aging
Unit Objectives : A. Issues in Mental Health B. Depression in Older Adults C. Suicide in Older Adults D. Substance Abuse with Older AdultsE. Elder Abuse and Case Study
Chapter 25
Chapter 18Week 83/9/09 F. Delirium and Dementia
G. Alzheimer’s Disease: Nursing Care and Management Unit IV Quiz
Chapter 23
Week 103/22/09
Unit V. Advocacy in Elder Care: Legal, Ethical, and Public Policy Issues
Unit Objectives :
A. Legal and Ethical Issues in Aging
B Legislative and Public Policy Issues with Elders
C. Retirement Communities, Assisted Living, and Skilled Nursing Care
Unit VI: End of Life Issues & Care of Older Adults
Unit Objectives
A. Advance Directives
B. Caregivers of Elders
UNIT V Quiz
Chapter 17
Chapter 26: p. 659-663
Chapter 20: p. 488-498
Date and Week Topic Readings
Week 113/30/09 C. Spiritual Issues, Grief, Loss, & Bereavement
D. End of Life Care
Unit VI Quiz
Chapter 26: p 639-647; & p.. 654-655Chapter 27: p. 676-684
WEEK 12
4/6/09
FINAL EXAM : FRIDAY 4/10 : Time and Place TBAEnd of Semester Evaluation of Clinical and Course
The University of Texas at ArlingtonSchool of Nursing
N4261 Nursing of Older AdultsSpring 2009
Exam Blueprint
Exam 1 Content Approximate # of Test ItemsAging in America 4History/Attitudes toward Aging 4Nursing Standards in Gerontology 4Theories of Aging 6Social/Cultural 4Assessment (Overall & Functional) 12Chronic Illnesses in Later Life 6Mobility/Exercise/ Falls & Restraints 6Environmental Safety 5Nutrition 5Sensory 8Osteoarthritis, Osteoporosis, RA, 6 Polymyalgia Rheumaticia, Bursitis, Tendinitis, GoutSleep 5Elimination/ Continence 5
Total Approximate Questions 80
Exam 2 Content Approximate # of Test Items
Pain & Pain Management 8Drug Therapy 8Lab Values & Diagnostics 7 Depression/Suicide/ Substance Abuse 6 Elder Abuse 4Delirium/Dementia 4Alzheimer’s 5Legal & Ethical Issues in Aging 4Legislative & Public Policy 4Retirement Communities, Assisted 4 Living & Nursing HomesAdvance Directives
5Caregivers
5
Spiritual Issues/ Grief/Loss & Bereavement 8End of Life Care 8
Total Approximate Questions 80The University of Texas at Arlington
School of NursingN4261 Nursing of Older Adults
Spring 2009
Literature Resources
This selected bibliography provides a representative sampling of the wide literature available on gerontology, geriatrics, gerontologic nursing, and related issues. Its primary purpose is to provide an introduction to resources that will be useful for assignments and projects.
Selected books for reference sources:
Burke, M. M., & Walsh, M. B. (1997). Gerontologic nursing: holistic care of the older adult (2nd ed.). St. Louis: Mosby .
Ebersole, P., Hess, P., Touhy, T, & Jett, K. (2005). Geronotological nursing and healthy aging (2nd ed). St. Louis: Elsevier & Mosby
Eliopoulos, C. (2005) Gerontological nursing (6th ed). Philadelphia: Lippincott
Fulmer, T., Foreman, M., Walker, M. & Montgomery, K. (Eds.). (2001). Critical care nursing of the elderly. New York: Springer.
Mauk., K. L. (2006). Gerontological nursing: Competencies for care. Boston: Jones & Bartlet
Miller, C. A. (1999). Nursing care of older adults: Theory and practice (3rd ed). Philadelphia: Lippincott
Molony. S. L., Waszynski, C. M., & Lyder, C.H. (1999). Gerontological nursing: An advanced practice approach. Connecticut: Appleton & Lange
Tabloski, P. A. (2006). Gerontological nursing. New Jersey: Pearson & Prentice Hall
Journals for reference sources specific to gerontology and geriatrics:
Aging and Society Ageing International Aging
Aging and Human Development Alzheimer’s Care QuarterlyAmerican Journal of Alzheimer's Care and Related Disorders and Research American Journal of Hospice and Palliative Care Annual Review of Gerontology & Geriatrics
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
Clinical Gerontologist Contemporary Long Term Care Death Education Death Studies Geriatric Nursing
Geriatrics Gerontologist Gerontology Gerontology and Geriatrics Education Journal of Aging and Health Journal of the American Geriatrics Society Journal of Gerontological Nursing Journal of Gerontological Social Work Journal of Gerontology Journal of Long- Term Care Administration Nursing Home Direction: Journal of the American Medical Directors Association Older Americans Report
Many additional nursing, medical, psychology, and social work journals publish important references that are useful for nursing application.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
Unit I. Theoretical Foundations of Gerontologic NursingUnit Objectives:
A. Aging in America
1. Define terms related to elders, the study of aging, and elder care.2. Identify the major demographic trends in America related to the 65-year and older age
population segment.3. Describe effects of select demographic trends (including gender, marital status, ethnicity,
education and financial status) on life expectancy, functional health, and service delivery for older Americans.
4. Examine the process of aging. 5. Delineate myths about aging. 6. Discuss aging with an older adult and begin to develop a personal philosophy of aging B Nursing’s Response to Aging
1. Trace the historical development of gerontologic nursing as a specialty.
2. Differentiate nursing roles in gerontology3. Discuss how “ageism” affects the care of older adults.4. Discuss the Nursing Scope & Standards in Gerontological Nursing per ANA5. Describe the use and need for gerontological nursing research as support for
evidenced=based practice.
C. Social, Role Changes, and Cultural Consideration in Aging 1. Describe the major social role transitions associated with late stage aging. 2. Discuss major socioeconomic and environmental factors that influence the health of older adults. 3. Discuss cultural characteristics of the older adult population. 4. Discuss cultural beliefs, values, and their effects on behaviors related to health, illness, and functional status. 5. Discuss role and social changes with retirement.
D. Theories of Aging 1. Explain the role of theory in understanding aging.
2. Identify what is known about the causes of aging.3. Differentiate between stochastic and nonstochastic theories of biological aging4. Outline the major biological, sociological, and psychological theories of aging and
related nursing implications.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
5. Develop nursing implications for each of the major biologic, sociologic, and psychologic theories of aging.
6. Identify factors that promote a healthy aging process.
Unit II. Holistic Health Assessment Unit Objectives:
A. Nursing Assessment of Older Adults 1. Identify age-related changes that affect physiologic functioning of elders. 2. Explain how the changes of aging can result in an atypical presentation of and response to illness and disease. 3. List the essential components of a comprehensive health assessment with an older adult. 4. Discuss how health promotion and prevention activities can improve quality of life for elders.
5. Begin to differentiate normal changes of aging with disease or illnesses.
B. Chronic Illness in Late Life 1. Define chronic illness as related to older adults
2. Explain wellness within the context of chronic illness. 3. Identify common chronic illnesses or diseases in later life and their sequelae. 4. Identify strategies that have been used to help maintain comfort and maximum function in a older adult with a chronic illness or disease.
5. Identify nursing interventions to assist older adults maintain their independence with a chronic illness or disease.6. Discuss pharmacologic and non-pharmacologic management of chronic illness or
disease.
C. Assessment Tools, Techniques Functional, Cognitive, Depression, Spiritual, & Environmental Assessments
1. Discuss functional health assessments and status of health in older adults. 2. Identify strategies to promote/maintain optimal function in older adults. 3. Describe measurement tools (assessments) for activities of daily living, cognitive status, mood and depression, spiritual distress, and assessment of the home environment. 4. Describe the nurses role in the use of measurement tools (assessments) with older adults.
A. Mobility, Exercise, Falls, and Restraints
1. Discuss age-related changes in bones, joints, and muscles that affect elders and their mobility. 2. Discuss risk factors for impaired mobility 3. Describe measures to facilitate independence in persons with musculoskeletal problems.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
4. Identify safety issues and their effects on older adults. 5. Identify risk factors related to falls in older adults. 6. Discuss interventions for fall prevention and minimizing injury in older adults. 7. Discuss the use of physical and chemical restraints of older adults in acute and long-term settings.
8. Discuss nursing interventions to minimize restraint use in acute and long-term settings.
E. Environmental Safety & Security
1. Discuss factors of aging and health that may influence environmental safety and security for older adults.
2. Discuss the significance of the environment to physical and psychological health and well-being.
3. Recognize hazards in the home and environment that threaten the safety of elders.4. Identify how a home and home features can be evaluated to minimize household risks
and safety. 5. Discuss the effects of declining health, reduced mobility, limited financial resources, and
unpredictable life situations on maintaining independent living for older adults.6. Discuss how nurses can help families evaluate an older adult’s ability to function safely
within their home environment7. Identify assistive devices or community resources that may aid the older adult in staying
safely within their home environment8. Discuss strategies and programs designed to prevent, detect, or alleviate crimes against
older adults.
Unit III. Nursing Care of Older Adults with Physiologic AlterationsUnit Objectives:
A. Nutritional Issues
1. Review age-related changes related to body composition and digestion, absorption, and metabolism of nutrients.
2. Discuss the functional consequences of age-related changes in digestion and how this affects nutrition.
3. Identify nutritional recommendations for older adults based on Health People 2010. 4. Identify the influence of culture, ethnicity, and religious preference on diet. 5. Discuss factors that are barriers to older adults attaining an adequate diet. 6. Outline causes and consequences of undernutrition in the older person. 7 . Identify interventions to assist older adults attain and maintain optimal nutrition.. B. Sensory Changes (Vision, Hearing, and Taste) in Aging
1. Describe visual problems affecting the aging eye, treatment methods and appropriate therapeutic nursing interventions. (cataracts, glaucoma, macular degeneration, & detached retina). 2. Identify nursing interventions for older adults with low vision. 3. Describe age-related changes in hearing.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
4. Identify interventions to enhance hearing abilities in older adults with hearing problems. 5. Identify changes and taste in elders and how this can influence their nutrition.
C. Osteoporosis, Osteoarthritis, R.A., Polymyalgia, Rheumaticia, Bursitis, Tendinitis, & Gout.
1. Identify risk factors related to aging and the development of osteoporosis. 2. Discuss pharmacological and nonpharmacological treatments for the prevention and treatment of osteoporosis and osteoarthritis. 3. Differentiate between the different types of arthritis. 4. Discuss pharmacological and nonpharmacolgical treatments for older adults with rheumatoid arthritis, polymyalgia rheumaticia, bursitis , tendonitis, and gout. 5. Discuss methods of dealing with pain and disability from bone and joint disease.
D. Sleep and Sleep Changes in Aging
1. Discuss the need for sleep and rest in elders. 2. Identify age-related changes in sleep patterns 3. Discuss health conditions that could impair sleep patterns. 4. Discuss internal and external factors that influence sleep in older adults. 5. Discuss the stages of REM and Non-REM sleep and the consequences of deprivation of these stages. 6. Identify nursing interventions to restore sleep quality among older adults. 7. Describe nonpharmacological means to induce sleep. 8. Discuss the use of medication in long-term management of sleep problems with older adults.
E. Elimination/Continence
1. Identify measures that promote genitourinary health in older adults. 2. Discuss factors to consider in assessing genitourinary health. 3. Identify the prevalence of urinary incontinence and risk factors associated with involuntary loss of urine. 4. Identify the causes of stress, urge, and mixed incontinence. 5. Discuss assessment options for urinary incontinence 6. Identify the types of persistent urinary incontinence, with associated signs and symptoms. 7. Discuss treatment options for urinary incontinence. 8. Discuss measures to promote positive self-concept in older adults with genitourinary conditions. 9. Describe how aging effects the gastrointestinal system. 10. Discuss common gastrointestional problems in later life,
11. Discuss measures to promote gastrointestinal health.
F. Pain and Pain Management in Older Adults
1. Identify the incidence of pain in older adults. 2. Differentiate between acute and chronic pain indicators with older adults.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
3. Identify factors that affect the older adults pain experience. 4. Identify personal, interpersonal, and system related barriers to pain management in older adults. 5. Describe adverse consequences associated with pain in older adults. 6. Identify problems and strategies in assessing pain in cognitively impaired older adults. 7. Describe the use of pharmacological and nonpharmacological treatments for pain.
G. Issues of Drug Therapy in Elders
1. Describe the demographics of medication usage in older adults. 2. Identify physiologic changes of aging and their effects of drug absorption, distribution, and clearance. 3. Identify signs and symptoms of adverse reactions to medications commonly occurring in older adults. 4. Recognize high-risk drugs and their potential harm to older adults. 5. Recognize the risk and benefits of over-the counter (OTC) drugs in older adults. 6. Describe information that older adults should know regarding their medications and medication management. 7. Discuss barriers to medication adherence/compliance in elders 8. Describe interventions to enhance medication adherence/compliance in elders 9. Identify interventions directed toward enhancing the therapeutic effectiveness of medications and reducing the risk for adverse effects.
10. Discuss the roles of the health care team in medication management of older adults.11. Identify common herbs and supplements used by older adults and the effects that these
can have on them.12. Discuss the information that older adults should be aware of when taking herbs or
supplements and how they can discuss these with their health care providers.
H. Laboratory Values and Diagnostics in Elders
1. Identify laboratory values that may increase or decrease associated with normal aging. 2. Discuss the implications of key abnormal laboratory findings on organs and body systems 3. Discuss key laboratory test used to monitor common health problems in elders. 4. Discuss how medication management is related to increased or decreased laboratory findings in older adults.
Unit IV. Mental Health Issues and Aging
Unit Objectives:
A. Issues in Elders’ Mental Health
1. Discuss issues affecting the diagnosis and management of elders' mental health problems.2. Identify several aspects of stress and stressors in later life.3. Discuss coping styles and methods to relieve stress and crisis.4. Discuss the issues of “losses” of older adults and how this can affect their mental health
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
B. Depression in Older Adults 1. Describe the prevalence of depression in older adults. 2. Describe symptoms of late-life depressions and how symptoms relate to function in older adults. 3. Discuss the use of assessment instruments for assessing depression in an older adult. 4. Describe the use of medication management in the treatment of depression in elders. 5. Discuss the benefits and risk with medication management in older adults 6. Identify agencies and social support services for older adults with depression
C. Suicide in Older Adults
1. Examine suicide and suicide risks in the older population. 2. Discuss interventions for older adults at risk for self-harm or suicide. 3. Differentiate between physician assisted suicide and euthanasia.
D. Substance Abuse with Older Adults 1. Discuss the prevalence of substance abuse with aging. 2. Identify factors related to the use of medication and alcohol abuse with older adults. 3. Identify the nurse’s role in suspected substance abuse in an older adult. 4. Discuss screening tools used for suspected substance abuse 5. Describe clinical presentations of alcohol and medication substance abuse. 6. Discuss treatment options for the older adult with substance abuse .
E. Elder Abuse:
1. Explain the concepts of fraility and vulnerability as it relates to older adults. 2. Discuss the relationship of fraility to independent living. 3. Discuss what constitutes elder abuse. 4. Identify risk factors associated with elder abuse in family caregivers. 5. Discuss interventions used in families and in long-term care facilities to prevent elder abuse. 6. Identify the nurses’ role in reporting suspected neglect or abuse in older adults..
F. Delirium, Dementia
1. Discuss concepts related to cognition, memory, and learning in late life. 2. Describe delirium and dementia in older adults. 3. Contrast criteria for differentiating delirium and dementia in older adults. 4. Identify nursing interventions to assist the care and management of the older adult with delirium or dementia.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
G. Alzheimer’s Disease: Nursing Care and Behavioral Management
1. Describe warning signs, behavioral changes, and approaches to treating Alzheimer’s Disease. 2. Identify nursing interventions to assist with the care and management of older adults with
Alzheimer’s Disease. 3. Discuss how the nurse would delegate care of older adults with Alzheimer’s Disease in
long-term care facilities. 4. Identify support systems for families who are caring for an individual with Alzheimer’s Disease.
Unit V: Advocacy in Elder Care: Legal, Ethical, and Public Policy Issues
A. Legal and Ethical Issues in Aging
1. Discuss common legal issues of concern to older adults. 2. Discuss ways to protect the legal rights of older adults. 3. Identify public benefit programs that may assist older adults. 4. Define ethics, bioethics, ethical dilemma, and nursing ethics. 5. Describe the major ethical principles that have an impact on older adults’ health care. 6. Describe nurses’ roles in ethical decision making related to elder care. 7. Discuss the ethical principles of autonomy, beneficence, nonmaleficence, and justice to common ethical dilemmas of elder care.
B. Legislative and Public Policy Issues with Elders
1. Explain the basic mechanisms of our health care system as related to older adults. 2. Discuss the role of Social Security and the challenges that face older adults in accessing this system 3. Discuss the potential impact of health care financing in long-term care and home health.
C. Retirement Communities, Assisted Living, and Skilled Nursing Care
1. Explain the differences between retirement communities, Assisted Living and Skilled Nursing Care. 2. Compare the major features, advantages, and disadvantages of retirement communities, Assisted Living, and Skilled Nursing Care Facilities. 3. Discuss factors that families of older adults consider when trying to decide if the older adult is safe to live independently. 4. Discuss the influence of monetary reimbursement for alternative living situations 5. Discuss the role of the nurse in Assisted Living and Skilled Long-Term Care..
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
6. Discuss the problems resulting form the lack of a unique model for long-term care. 7. Discuss the role of the Omsbudsman and support of elders.
Unit VI: End of Life Issues Unit Objectives:A. Advance Directives/ End of Life Decisions
1. Define elders’ rights related to decision making, treatment options, confidentiality, and privacy issues.
2. Differentiate among the types of advance directives and explain the role and of the nurse in assisting clients and families understand these directives.
3. Describe nursing responsibilities related to end of life decision making.
B. Caregivers of Elders
1. Define caregiving in relation to caring for older adults. 2. Examine influences of family dynamics in the care of elders. 3. Identify specific positive and adverse consequences associated with caregiving. 4. Discuss “caregiving burden” and associated risk factors. 5. Discuss ways in which nurses can help caregivers find resources to help them with the care of their older adult.
C. Spiritual Issues, Grief, Loss, and Bereavement 1. Distinguish between loss, grief, bereavement, and mourning. 2. Discuss the characteristics of grief and the dynamics of the grieving process. 3. Describe basic spiritual needs 4. Discuss measures to support spiritual needs of older adults. 5. Identify psychological, physical, social, and spiritual aspects of the normal grief process. 6. Describe nursing care activities to assist grieving older adults and their families.
D. End of Life Care1. Describe the prevalent attitudes older adults and health care providers have toward dying
and death2. Discuss the physical, psychological, social, and spiritual aspects of dying for older people. 3. Discus the philosophy and services of hospice programs. 4. Identify the services covered by the Medicare Hospice benefit. 5. Distinguish between palliative and hospice care. 6. Identify resources describing dying as a final stage of growth. 7. Describe the dying process and the signs that families may recognize as an individual
goes through the dying process.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
8. Identify the needs of the dying and appropriate interventions.9. Describe how pain and presence of pain is important to treat in the last stages of life. 10. Describe nursing strategies for assisting dying older adults and their families11. Describe the nurses role in caring for the deceased and their family.
Suggested Web Sites for This Class
VirtualNurse.ComMedscapeAdministration of Aging. www.aoa.dhhs.govAARP www.aarp.orgAmerican Geriatrics Society www.americangeriatrics.or Ageism and Age Sterotyping: www.geron.org
Aging in a New Era: www.aging.com Scope and Standards of Gerontological Nursing: www.ana
American Society on Aging. www.asagin.orgGerontological Society of America www.geron.orgCenters for Medicare and Medicaid Services. www.cms.govNational Association of Geriatric Education Centers www.hcoa.org/nagecNational Gerontological Nursing Association www. ngna.orgNational Institute on Aging www.nih.gov/niaNational Council on Aging www.ncoa.org
Senior Net: www.seniornet.org Elder Web: www. elderweb.com Federal Interagency Forum on Aging Related Statistics: www.agingstats.gov
Alzheimer’s Disease Education and Referral Center: www.alzheimers.org/adearAlzheimer’s Research Forum Page: www.alzforum.org/member/index.htmlAlzheimer’s Disease Web Page: www.med-amsa.bu.edu.au/alzheimerNational Institutes of Mental Health: www.nimh.nih.govNational institute of Nuerological Disorders and Stroke: www.ninds.hih.govResources for Elder Mistreatment: www.NCCNHR.orgThe National Center on Elder Abuse: www.gwjapan.com/NCEAClearinghouse on Abuse and Neglect of the Elderly: www.aoa.dhhs.gov/aoa/dir/78.htmlThe Coalition of Advocates for the Rights of the Infirmed Elderly: www.carie.orgNational Institute for Mental Health: www.nimh.nih.govAmerican Association for Geriatric Psychiatry: www.americangeriatrics.orgIncontinence on the Internet: www.incontinent.comAmerican Speech-Language-Hearing Association: www.asha.orgLeague for the Hard of Hearing: www.lhh.orgLighthouse National Center for Vision and Aging:www/lighthouse.org
Nutrition www.aoa.dhhs.gov/nutrition . Cultural Diversity: www.DiversityRx.orgNational Senior Citizens Law Center: www.nsclc.orgAssisted Living Facilities Association: www. alfa.orgNational Bioethics Advisory Commission: www.bioethics.govThe American Society for Bioethics and Humanities; www.asbh.orgNational Reference for Bioethics Literature: www.georgetown.edu/research/nrcblCargiver Alliance: www.caregiver.orgAmerican Academy of Hospice & Palliative Medicine: www.aahpm.orgThe Center to Advance Palliative Care: www.capcmssm.orgNational Hospice and Palliative Care Organization: www.nhpco.orgHospice Foundation of America: www.growthhouse.orgGriefNet: www.riverdel.orgChildren of Aging Parents: www.careguide.netToday’s Caregiver Online:www.caregiver.comNational Caregiver Organization: www.nfcacares.orgNational Association of Area Agencies on Aging: www.n4a.orgNational Council on Aging: www.ncoa.orgResources for Caregivers: Alzheimer’s Association. http://alz.org
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
LIFE REVIEW ASSIGNMENT
Robert Butler (1974) saw successful aging as the ability to work through losses and maintain self-esteem. Life review, developed by Butler, provides older adults with an opportunity to come to grips with guilt and regrets and to emerge feeling good about themselves. Haight (1988) found life review to have a significant effect on both life satisfaction and psychological well-being.
At the completion of the interview, the nurse may be able to determine the degree to which the client has achieved ego integrity as defined by Erickson (1986). Failure to achieve ego integration may manifest itself in disgust and/or fear of death. Nurses can encourage elders to write about their life experiences by assigning topics which can be shared with a group or can use a guided interview to provide a sense of continuity and experience the human need for connectedness. Life that can be viewed across years may balance the highs and lows with a sense of completeness, as opposed to remembering the regrets.
This assignment provides the opportunity to develop one-to-one interactions with an elder who resides in the community. The focus is to develop and refine skills in communication and to examine successful aging through the lived experiences of an elder.
The Life Review Assignment with an Elder consists of two components:A visit consisting of the life review interviewA written paper based on the interview
The elder will be asked to:Give consent and sign an Interview Permission Form
A photocopy of the consent will be given to the elder.The original will be given to Dr. Melinda Hiemenz, the instructor for the course to
be filed at the school.
Participate in the Life Review Interview
The student will:Prepare for the visit and the interview.Document date, time, and place of the interview with the elder’s signature on the consent
form.Complete and turn in the written assignment and forms on the due date listed on the class
schedule.
Confidentiality:All information of a sensitive nature that is shared with you must be kept confidential unless your have the elder’s permission to share it with others. The Interview Permission Form offers assurance and informs the elder that the information is kept within the bounds of the course faculty and, where appropriate, with peers in the class. In all written work and discussions, the elder must be identified by initials only to protect privacy.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
Life Review Assignment Guidelines
Objective: Completing this assignment will enable the student to:A. Conduct a life review with an older adult. 1. Understand the significance of the life story of an elder. 2. Discuss the process of conducting a life review. 3. Identify possible legacies and their importance to elders. 4. Describe the degree of ego integrity (Erickson) reached by the elder (on a scale of 0-10)
Assignment: Choose an older adult (70 years or older) (not a member of your family) to interview for a life review. Obtain a written consent for the interview (use form provided). Use the interview guide listed below. Write up your findings as indicated. Use the person’s initials rather than name.
Preparation:Review the objectives for the assignment.Review the Interview Guide to become familiar with the questions.Schedule the interview with the elder. It is helpful to do this at least a week in advance; then
follow-up with a confirmation phone call the day before the visit.
Interview:Explain the purpose, length of the visits (The interview should not exceed two hours. If you
are unable to complete the interview in two hours, then schedule another meeting).Ask the elder to sign the Interview Permission Form. (Helpful to take two copies so that you
can leave a copy with the elder)Incorporate therapeutic communication skills in your interview.Use the Interview Guide. The elder does have the right to refuse to answer any question –
please honor that right.
Assignment GuidelinesReflect on the interview.Then respond to the assigned questions. The paper must be typed using APA format following the guidelines for the assignment. Submit one hard copy of the paper and related forms.
Please submit the following on the date indicated on the class schedule:Cover sheet (UTA format)Signed Interview Permission FormTyped Paper
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
The Life Review Analysis Paper should include the following 3 sections using APA style with Levels I and III
I. Introduction of Elder (Recall that APA format doesn’t actually use the word “Introduction” in the paper). (5 points)
a. Describe how and why you selected this elder (use only elder’s initials).
II. Analysis of the Life Review Interview (60 points)
a. Discuss the elements of a life review that are different from ordinary remembering. Ordinary memory is just remembering events. Life Review Analysis is an indepth review of one’s life and circumstances behind the events. During this time the individual is given time to discuss meaningful events on one’s life. You will need to seek references for this in your text or other areas that discuss Life Review (10 points)
b. Discuss your elders life by answering the questions on the Interview Guide and giving examples of their life as you tie their life story together. The Interview Guide helps you guide the discussion of their: childhood, family life, adolescence, adulthood, & data under the summary section. (35 points)
c. Based on your interview describe the degree of ego integrity (on a scale of 1 to 10) reached by the elder. Give a rationale for your assessment that includes at least one example from the interview. (15 points)
III. Student’s Refection (25 points )
Was this interview experience was/was not an enlightening experience. Why?Describe the most significant point of the interview to you.Describe a difficult/anguishing part of the interview, if any.In what way might you change your general approach to elders in your clinical
practice after this experience, if any?Discuss your ideas about legacy, and define a legacy that you would like to leave for
others.
IV. Use APA format throughout paper and references as appropriate. ( 10 points).
Papers should be no longer than 10 pages. If you have questions please discuss with your instructor.
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
Interview Guide
Brief Biography: Include the age, gender, race, ethnicity and distinguishing characteristics of the individual.
ChildhoodWhat was life like for you as a child?What were your parents like? What were their strengths and weaknesses?Did you have any brothers or sisters? If so, tell me what each was like.Did someone close to you die when you were growing up?Do you ever remember being very sick?Was religion a large part of your life?
AdolescenceWhat things stand out in your memory about being a teenager?Who were the important people for you (parents, brothers, sisters, friends, teachers, those you were
especially close to, those you admired, those you wanted to be like)? Tell me about them.Did you go to school? What was its meaning to you?Did you work during those years?What were the pleasant things about your adolescence?What was the most unpleasant thing about your adolescence?
Family and HomeWhat was the atmosphere in your home?Who were you closest to in your family?Who in your family were you most like? In what way?
AdulthoodNow I’d like to talk to you about your life as an adult, from when you were in your 20s up to today.
Tell me of the most important events that happened in your adulthood.What was life like for you in your 20s and 30s?Tell me about your work. Did you enjoy work? Did you earn an adequate livingDid you marry?
If [No], Why not?If [Yes], On the whole, would you say you had a happy or an unhappy marriage? Were you married more than once?
What were some of the main difficulties you encountered during your adult years?Did someone close to you die? Go away?Were you ever sick? Have an accident?Did you move often? Change jobs?Did you ever feel alone? Abandoned?Did you ever feel needy?
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Nursing of Older Adults N4261Spring 2009
Summary
On the whole, what kind of life do you think you have had?What would you say have been the three main satisfactions in your life? Why were they
satisfying?Everyone has had disappointments. What have been the main disappointments in your life?What was the hardest thing you had to face in your life? Please describe it.What was the happiest period of your life? What about it made it the happiest period? What was the proudest moment in your life?How do you think you have made out in life - better or worse than what you hoped for?Let’s talk a little about you as you are now. What are the best things about the age you are now?What are the worst things about being the age you are now?What are the most important things to you in your life today?What do you hope will happen to you as you grow older?What do you fear will happen to you as you grow older?Have you enjoyed participating in this review of your life?
The University of Texas at Arlington School of Nursing
Nursing of Older Adults N4261Spring 2009
LIFE REVIEW ASSIGNMENT(10% of Course Grade)
Grade Sheet
Name:
Directions: Turn in together: Coversheet (UTA format), Paper, Grade Sheet and Interview Consent Form
Points
Mandatory Interview Consent Form: completed and attached
5 Introduction of Elder and Life Summary
60 Analysis of Life Review Interview
25 Student’s Reflection
10 APA Format: Correct grammar, syntax, spelling, references
Total possible points = 100
