Geriatric Patients FNP Perspective Responses

Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

Do you agree with your peers’ assessment?
Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.

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Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles.Include the DOI. Also, be sure you are italicizing titles of online sources.No more than 200 words maximum.

Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:

Do you agree with your peers’ assessment?
Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Nora’s Response:

Elderly mistreatment is under-reported (Boltz, et. al., 2012).This may be due to lack of knowledge about manifestations of elderly mistreatment or how reporting and investigation by state agencies functions” (Boltz, et. al., 2012). You are the healthcare provider at a local nursing home facility.
- What monitoring strategies will you implement to prevent elderly mistreatment?
- State your rationale.
- Use at least 5 evidence-based research references.

Question #2–Elder Mistreatment

According to one report, 5 million or more older Americans have been abused, neglected, or exploited, and at a minimum, one in fourteen cases is reported (Rosen, 2014). Elders that are at the greatest risk for elder abuse include “those who suffer from physical, mental, or cognitive impairments” (Rosen, 2014). To understand what strategies can be implemented in a nursing facility to prevent elder abuse, you must first have an understanding of what is considered elder abuse. Elder abuse can be physical, in the form of bruises, pressure ulcers, or broken bones, neglect, such as poor hygiene or leaving someone who needs assistance unattended, sexual abuse, financial abuse-stealing money, rearranging finances, or misusing financial accounts, psychological or verbal abuse (Nisbet, 2013). Governmental agencies have tried to make many changes in the area of elder care but have often come up short. “While a number of federal agencies have made efforts to help states address these challenges, federal elder justice activities have been scattered across agencies and, as a whole, have had a limited impact on the elder justice field—a clear indication that federal leadership in this area has been lacking” (Kohl, Sanders, & Blumenthal, 2012).

In a nursing home facility, there are various levels of care providers. As an advanced practice nurse in this setting, we should be leading by example and encouraging training for the prevention of elder abuse. To safeguard against elder abuse, everyone involved in the care of the elderly individual should be equally responsible for reporting abuse from the maintenance and kitchen personnel, to the healthcare team. Research shows that “staff may be more prone to abusing residents if they lack training, have too many responsibilities, are unsuited to caregiving, or work under poor conditions” (Nisbet, 2013). Ongoing training of the team, including simple interpersonal skill training may be of value. Asking the residents and their family members when visiting how things are going and if there is anything that would make them more comfortable in this living environment may be of great value to their care. Providing educational tools that are easy for staff to access will promote awareness of the types of abuse, and how to be watchful for abuse. The main strategy would be encouraging all staff to be on guard for small indicators of abuse, such as change in behavior, new physical complaints, or changes in personal interactions. Other measures to encourage reporting are promoting a work environment that promotes openness, without retaliation, and patient centered care. Employees may be under the impression that making reports does not make any difference in the patient care and may fear that reporting comes with consequences to them (DeLiema, Navarro, Enguidanos, & Wilber, 2015). If a CNA is caring for a patient and sees that they have bruising or may seem dehydrated, they are more likely to the nurse overseeing care so that further investigation can be made and reported if appropriate. In my opinion, I also believe it is of value to promote a work environment that encourages professional responsibility and investment in the patients you are caring for. If employees feel valued in the care, they provide they are less likely to experience the stress of caregiving, and may be less likely to participate in elder abuse in any form.

Reference:

DeLiema, M., Navarro, A., Enguidanos, S., & Wilber, K. (2015). Voices from the Frontlines: Examining Elder
Abuse from Multiple Professional Perspectives. Health & Social Work, 40(2), e15-24.
https://doi.org/hsw/hlv012 (Links to an external site.)

Kohl, H., Sanders, B., & Blumenthal, R. (2012). Elder Abuse: What is the Federal Role? Generations, 36(3), 106–
110. Retrieved from https://search.ebscohost.com/login.aspx? (Links to an external site.)
direct=true&db=rzh&AN=104423429&site=ehost-live

Nisbet, R. J. (2013). A practical guide to safeguarding. Nursing & Residential Care, 15(1), 45–48. Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104313835&site=ehost-live(Links to an external site.)

Rosen, A. L. (2014). Where Mental Health and Elder Abuse Intersect. Generations, 38(3), 75–79. Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103862525&site=ehost-live(Links to an external site.)

Turner, P. (2013). Creating a culture of safe practice. Nursing & Residential Care, 15(1), 49. Retrieved from https://search.ebscohost.com/login.aspx?direct=tru…

Tonisha’s Response:

There has been a shift in thinking regarding the use of restraint in geriatric populations through physical, environmental and other means in the last decade. The use of actual physical restraints, side rails in nursing home settings, and medication to subdue or restrain clients in a variety of settings has decreased.In many situations, the risk of falling is provided as a rationale for client restraint.The causes of falls are known as risk factors. Although no single risk factor causes all falls, the greater the number of risk factors to which an individual is exposed, the greater the probability of a fall and the more likely the results of the fall will threaten the person’s independence. Conflict among caregivers, nurse practitioners, and the patient can occur when the need for client safety seems to indicate some form of restraint.
- Search evidence-based literature about different types of restraint used in home, community, and nursing home settings and the prevention of falls.
- Research the literature and guidelines for protocols and evidence to support safety in a variety of settings.
- As your initial post, select one protocol and describe how you will implement it in a specific setting. Subsequent posts should critique fellow students implementation of the protocol.

Evidence based programs can be utilized to assist geriatric patients in reducing the risk of falling. For patients, aged 65 and older, falls are the leading cause of fatal and nonfatal injuries (Moncada & Mire, 2017). As patients age, the risk of falling and receiving serious injury increases. This can cause a serious threat to the patient’s health, safety and independence. As a result of a fall, patients may experience social isolation, a decrease self confidence, and restrict participation in some activities (Martins, Santos, Silva, Baltazar, Moreira, & Tavares, 2018). This can lead to functional decline, dependence and negatively affect quality of life.

To assist in reducing patient falls, many evidenced based guidelines, protocols and interventions are made available to health care providers, patients and families. Initially, the health care provider should assess the patient’s risk factors for falls. Some modifiable risk factors include balance impairment, gait impairment, muscle weakness and medication use (Moncada & Mire, 2017). Within the clinical setting, all geriatric patients would receive a fall risk screening at each patient encounter to assess recent falls or issues with gait or balance. Patients presenting with no issues would be reassessed as needed. Patients that report falling and/or gait or balance disturbances would be further assessed and a focused history, physical examination, functional assessment, and an environmental assessment would be obtained (Huntzinger, 2010). Interventions would be based upon the individual’s fall history and fall risk factors. For example, a patient with strength and balance impairments may benefit from the Otago Exercise program. The Centers for Disease Control and Prevention (2015) recommend this intervention to reduce falls for patients within the home setting that may be unable to attend group exercise programs. After obtaining the above information, this exercise program can be modified to the patient’s need to ensure the patient receives the maximum benefit. A physical therapist would initially begin the exercise interventions with follow up visits allowed by a nurse if the physical therapist was unavailable. Interventions implemented would include strengthening, balance and stability and active range of motion exercises. Outcome measures would be evaluated on a weekly to monthly basis based upon strength and gait assessments.

Centers for Disease Control and Prevention. (2015). A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/pdf/…

Huntzinger, A. (2010). AGS Releases Guideline for Prevention of Falls in Older Persons. American Family Physician, 82(1); 81-82. Retrieved from https://www.aafp.org/afp/2010/0701/p81.html

Martins, A., Santos, C., Silva, C., Baltazar, D., Moreira, J. & Tavares, N. (2018). Does modified Otago Exercise Program improves balance in older people? A systematic review. Preventive Medicine Reports, 11; 231-239. DOI: 10.1016/j.pmedr.2018.06.015 (Links to an external site.)

Moncada, L. & Mire, L. (2017). Preventing Falls in Older Persons. American Family Physician, 96(4); 240-247. Retrieved from https://www.aafp.org/afp/2017/0815/p240.html#afp20…

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