NURS 6540 – Advanced Practice Care of Frail Elders Essay

A female caretaker assisting senior women in knitting while man reading book in background at nursing home.
Week 3: Geriatric Care Teams
Interdisciplinary geriatric care teams are a critical component of geriatrics, and I truly believe that geriatrics really does interdisciplinary care probably better than most other areas of health care because we have to—because we need to. Older adults have care needs that require the expertise of a community. No single provider can do it all well. The needs are just so vast. NURS 6540 – Advanced Practice Care of Frail Elders Essay

—Dr. Barbara Resnick, CRNP, FAAN, FAANP, AGSF, President of the American Geriatrics Society

Dr. Resnick emphasizes the importance of interdisciplinary geriatric care teams, as geriatric patients often have complex health needs. This was the case for 90-year-old Gus Snare. A diagnosis of bile duct cancer resulted in the need for surgery to remove parts of his stomach, duodenum, pancreas, bile duct, and gallbladder. Snare’s care team included a geriatrician, surgical oncologist, and a team of nurses, including an advanced practice nurse. Together, they determined his eligibility for surgery, performed the surgery, and developed a treatment and management plan post-surgery (The University of Chicago Medicine, 2011). As an advanced practice nurse, you must identify your role within care teams for patients like Snare to ensure patients receive comprehensive care. NURS 6540 – Advanced Practice Care of Frail Elders Essay

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This week you explore models of interdisciplinary geriatric care teams and compare the roles of advanced practice nurses at various sites of care. Then, as you complete your first SOAP Note, you examine the assessment, diagnosis, and treatment of a geriatric patient from your practicum site.

Learning Objectives
By the end of this week, students will:
Compare models of interdisciplinary geriatric care teams
Analyze models of interdisciplinary geriatric care teams used in various sites
Analyze the roles of advanced practice nurses in different clinical sites
Evaluate diagnoses for patients*
Evaluate treatment and management plans*
*These Learning Objectives support assignments that are assigned this week, but due in Week 4. NURS 6540 – Advanced Practice Care of Frail Elders Essay

Photo Credit: Maskot/ Maskot/Getty Images

Learning Resources
Note: To access this week\’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

Chapter 18, “Hospital Care” (pp. 134-145)
This chapter explores systems of care for assessing and managing hospitalized older patients. It also examines alternatives to hospital care and transitions from hospital care.

Chapter 20, “Rehabilitation” (pp. 152-166)
This chapter describes essential components of geriatric rehabilitation, including sites of rehabilitation, roles of core health care providers on rehabilitation teams, and disease-specific care plans for older adults. It also explores mobility aids, orthotics, adaptive methods, and environmental modifications for older adults with disabilities.

Chapter 21, “Nursing-Home Care” (pp. 167-174)
This chapter identifies the demographic and functional characteristics of older adults living in nursing homes as well as the availability of nursing homes in the United States. It also describes staffing patterns, quality issues, and legislation related to nursing home care. NURS 6540 – Advanced Practice Care of Frail Elders Essay

Chapter 22, “Community-Based Care” (pp. 175-180)
This chapter explores characteristics of care in communities, including home care, community-based services not requiring a change in residence, and community-based services requiring a change in residence. It examines older adult populations, health care issues, and the primary provider’s role in these sites of care.

Chapter 23, “Outpatient Care Systems” (pp. 181-185)
This chapter describes current approaches that maximize patient outcomes in geriatric outpatient care systems. It also examines new approaches that may benefit older adults in outpatient care systems.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Mosby.

Chapter 26, “Recording Information” (pp. 792–813)
This chapter outlines the components of SOAP notes and provides guidelines for writing SOAP notes after patient examinations.

Note: You should have this textbook in your personal library, as it was the required text in NURS 6512: Advanced Health Assessment and Diagnostic Reasoning.

Arbaje, A., Maron, D., Yu, Q., Wendel, V., Tanner, E., Boult, C., & … Durso, S. (2010). The geriatric floating interdisciplinary transition team. Journal of the American Geriatrics Society, 58(2), 364–370.

This article examines the Geriatric Floating Interdisciplinary Transition Team, a geriatric transitional care model. It describes the roles of health care providers on this care team and identifies potential benefits of this model.

The geriatric floating interdisciplinary transition team. Journal of the American Geriatrics Society, 58(2), by Arbaje, A., Maron, D., Yu, Q., Wendel, V., Tanner, E., Boult, C., & … Durso, S. Copyright 2010 by John Wiley& Sons, Inc. Journals. Reprinted by permission John Wiley & Sons, Inc. Journals via the Copyright Clearance Center. NURS 6540 – Advanced Practice Care of Frail Elders Essay

Gagan, M. (2009). The SOAP format enhances communication. Nursing New Zealand, 15(5), 15.

Note: Retrieved from the Walden Library databases.

This article outlines the four parts of SOAP notes and examines the importance and effectiveness of SOAP notes in clinical settings.

American Geriatrics Society. (2011). The principles of geriatric care. Retrieved from http://www.americangeriatrics.org/files/documents/Adv_Resources/PayReform_fact3.pdf

This article identifies the principles of geriatric care, focusing on the geriatric care team, geriatric assessment, and care coordination. It also presents three models of care that encompass geriatric assessment and care coordination: the GRACE (Geriatric Resources for Assessment and Care of Elders) model, PACE (Program of All-inclusive Care for the Elderly) model, and the Guided Care model.

American Geriatrics Society. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Retrieved from http://www.guideline.gov/content.aspx?id=49933. NURS 6540 – Advanced Practice Care of Frail Elders Essay

This article examines three categories of medications that impact older adults: those that are potentially inappropriate and must be avoided, those that are potentially inappropriate and must be avoided in older adults with certain diseases, and those that must be used with caution.

Document: Comprehensive SOAP Note Template (Word document)

Required Media
Laureate Education (Producer). (2013b). Care team models [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 16:29 minutes.

In this video program, Dr. Kristen Mauk and Dr. Barbara Resnick discuss the importance of interdisciplinary geriatric care teams, as well as the role of the advanced practice nurse within these teams.

Accessible player
Discussion: Models of Interdisciplinary Geriatric Care Teams
With the growing population of frail elders, there is an increase of geriatric patients requiring ongoing care for multiple medical conditions. This creates the need for interdisciplinary geriatric care teams. Often, the dynamics and culture of these teams differ across various sites of care, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities. As an advanced practice nurse, it is important to understand your role in the care team as well as your potential impact on patient care. In this Discussion, you explore models of interdisciplinary geriatric care teams for different sites of care and the varying roles of the advanced practice nurse. NURS 6540 – Advanced Practice Care of Frail Elders Essay

Consider the following three case studies:

Case Study 1
Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”

Case Study 2
Mr. Williams, a 79-year-old African American widower, resides in a foster care home. He has lived there for 4 years since his wife died. He is a former minister. His medical history includes long-term diabetes, high blood pressure, and benign prostatic hypertrophy. The home care provider has requested a home visit to evaluate Mr. Williams’s ability to remain in the home. The provider states that because Mr. Williams’s vision is seriously compromised (he is nearly blind), and because he has been unable to get to the toilet as quickly as necessary (he is very unsteady on his feet), his care is becoming burdensome. According to the home care provider, for safety reasons, Mr. Williams may not fit the criteria for remaining in the foster care home. NURS 6540 – Advanced Practice Care of Frail Elders Essay

Case Study 3
Mrs. Randall is a 77-year-old female who resides in a long-term care facility. She has a history of frequent falls and is severely cognitively impaired. The nursing staff at the long-term care facility called the nurse practitioner at the medical home office to report the recent development of productive cough and high fever. There have been cases of flu in the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner in the office requests a chest x-ray in the long-term care facility. The nurse on duty in the facility states that there is no portable chest x-ray equipment available. She further requests that Mrs. Randall be transferred to the emergency room of the local hospital. Mrs. Randall’s daughter has durable power of attorney for health care decisions for her mother. The long-term care facility has notified the daughter of the change in her mother’s condition. The daughter says whatever the nursing home wants is fine with her. NURS 6540 – Advanced Practice Care of Frail Elders Essay

To prepare:

Review this week’s media presentation, as well as the American Geriatrics Society and Arbaje et al. articles in the Learning Resources.
Research models of interdisciplinary geriatric care teams that are used at various sites, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities.
Consider the model used for the interdisciplinary geriatric care teams at your current practicum site. Compare this model to models used at other sites.
Reflect on how the role of the advanced practice nurse differs according to the site of care.
Select one of the three case studies. Consider how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric care teams at your practicum site. NURS 6540 – Advanced Practice Care of Frail Elders Essay
By Day 3
Post a comparison of the model used for the interdisciplinary geriatric teams at your current practicum site to models used at other sites. Then, explain how the role of the advanced practice nurse differs according to the site of care. Finally, explain how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric teams at your practicum si

NURS 6540: ADVANCED PRACTICE CARE OF FRAIL ELDERS – interdisciplinary geriatric care teams eassy assignment paper – assisted living, home care, hospitals, long-term care, and rehabilitation facilities

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as the advanced practice nurse, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of geriatric patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, consider which assessment tools would be appropriate for the patients in the following three case studies: NURS 6540 – Advanced Practice Care of Frail Elders Essay

Case Study 1:

Mr. Smith, age 77, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

To prepare:

• Review the Rosen and Reuben article in this week’s Learning Resources. Consider how assessment tools are used to evaluate patients.
• Select one of the three case studies. Based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
• Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc. NURS 6540 – Advanced Practice Care of Frail Elders Essay

Poost on or before Day 3 an explanation of your evaluation plan for the patient in the case study you selected and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.

Models of care for frail older adults have increasingly used advanced practice nurses (APNs) to achieve outcomes. Knowledge of the common APN functions and skills that contribute to the success of these models could better inform education and evidence‐based practice and guide further research, but published investigations associated with models of gerontologic care neither describe fully these functions and skills nor link the activities of the APN with specific outcomes. Using examples primarily from the University of Pennsylvania School of Nursing, this paper identifies, describes, and analyzes common functions and skills of APNs in published gerontologic care models; examines the strength of the evidence for the effect of APNs on outcomes of care; and identifies areas for further study. NURS 6540 – Advanced Practice Care of Frail Elders Essay