Well Elder Health Assessment And Community Experience

Well Elder Health Assessment and Community Experience: Please copy instructions below on a document and use APA to complete this assignment. Submit in the drop-box

Purpose:

The purpose of this project is to provide an observational experience for the student in the community that meets the needs of the well-elderly and to allow the student a personal insight into the normal aging changes. Nurses need exposure to well-elderly clients to assess all dimensions of health, to evaluate any specific needs, to evaluate what community resources are available, and to describe the nursing practice implications appropriate to the well-elderly client. 

Objectives:

Upon completion of the experience the assignment, the nursing student will be able to:

  • Evaluate a well-elderly client’s health status in all dimensions of health: physical, psychological, social, spiritual, and sexual.
  • Describe the scope of services available within a specific community providing services to older adults by differentiating among services that are health-promoting, health maintaining, and health restoring.
  • Using Maslow’s hierarchy of needs, identify one primary health strength, one primary health need, and document one nursing implication needed to maintain and/or strengthen each one.
  • Delineate appropriate nursing implications for practice that meet well-elderly client’s needs.
  • Evaluate the well elderly client’s needs in relation to available resources.
  • Identify one evidence-based content area that will be helpful in your role as the RN with the geriatric client.

Directions for Assignment:

  • Select an older adult (65 years or older) that is currently in the community you have been assigned and is independent in their living arrangements. The person needs to be able and willing to answer questions.
  • Also, plan to talk with a community agency representative to get the necessary information for your community agency assessment.
  • Complete the following assessment. You are interested in the well elders perspective of health.

No physical examination is done.  At the end of each subsection, complete the evaluation portion.

4)            Summarize your finds on the summative evaluation sheet.

5)            Wear professional street clothes (no jeans), and your MPI name tag. Follow dress code guidelines. Report to your assigned placement for one day of clinical experience.

Grading criteria:

  1. You must achieve competency on this project. Points are calculated to determine if you receive 11.25/15 points. You need 75% of the points to achieve competency.  You have two chances to achieve competency. This is a double-starred criterion on your clinical evaluation tool.

Instructional Resource: http://consultgerirn.org/topics/age_related_changes/

NUR 230: COMMUNITY HEALTH NURSING

Well Elder Health Assessment and Community Experience

Student Name: ­­­­­­­­­­­­­­____________________________________________

Instructions to cover with the participant:

  1. First, establish your relationship with introductions.
  2. Review the purpose of the interview and the project.
  3. Review the outcome to be achieved.
  4. Share the tool, with the participant prior to another interview.
  5. Clarify that the process is voluntary.
  6. All information is confidential and will only be shared with your instructor via a written tool without any participant name identification. However, if the participant shares any information regarding suicidal thoughts or aspects of abuse, you will need to report such information together to a representative of the community.
  7. The participant has the right to refuse to answer any question.

Well-Elder Demographics:

Age: _________  Sex: _________   Occupation: __________________________

Health Perception and Health Management (½ point)

1a)    How would you describe your health status during the past year?

1b)    How would you describe your health status during the past 5 years?

  • What do you do to maintain your health?
  • In your life, what priority does health play?
  • In your life, what is more, important than health?
  • What is your top health concern currently?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE THIS OLDER ADULT CURRENT HEALTH STATUS?  USE THE SCALE OF 1 AS POOR AND 5 AS EXCELLENT.

Physical Health Exercise (½ point)

  • What do you do for exercise?
  • How often do you exercise?
  • How long do you exercise?
  • Would you say that you are an inactive, somewhat active, or active person?
  • Is this degree of activity a change for you? If yes, since when and why?
  • Are you satisfied with your level of activity (are you able to do what you need and what you like to do)?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE THIS OLDER ADULT ACTIVITY/EXERCISE STATUS?  USE THE SCALE OF 1 IS INACTIVE AND 5 IS ACTIVE.

Spirituality (½ point)

  • What gives your life meaning?
  • Do you have any religious or philosophical beliefs which make your life easier?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE THIS OLDER ADULT SPIRITUALITY STATUS?  USE A SCALE OF 1 AS NO SPIRITUALITY DIMENSION IN LIFE TO 5 AS SPIRITUALITY PLAYS A SIGNIFICANT PART OF LIFE.

Nutrition (½ point)

  • How would you rate your nutritional status?
  • How many meals +/or snacks do you eat a day?
  • Are there any types of food you are not supposed to eat?
  • Could you do a 24-hour diet recall including the type and amount of food?

TYPE AMOUNT

   

Breakfast

 

Snack

 

Noon meal

 

Snack

 

Dinner meal

 

Snack

 

Other:

  • Who prepares your meals?
  • How much money do you spend on food for yourself each week?

NURSING EVALUATION:  USING THE FOUR MAJOR FOOD GROUPS (MILK PRODUCTS, MEATS, FRUITS AND VEGETABLES, GRAINS) HOW WOULD YOU RATE AND DESCRIBE YOUR OLDER ADULT NUTRITIONAL STATUS?  USE THE SCALE OF 1 FOR POOR TO 5 FOR EXCELLENT.

Social Health/Social resources (1 point)

{Student}  Now, I would like to ask some questions about your family, friends, and social activities. 

  • What is your current relationship status (single, married, divorced, living together, separated, widowed)?
  • How many people do you have in your life that you can depend on?
  • About how many times did you talk to someone (friends, relatives or others) on the telephone in the past week (either you called them, or they called you)?
  • What type of social activities do you participate in? How often?
  • What other types of support do you have that are helpful to you (pets, church groups, community services)?
  • How often do you see relatives or friends?
  • Is there someone who would help you if you were sick or in need?
  • How have your social resources changed over the past 5-10 years?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE THIS OLDER ADULT SOCIAL HEALTH STATUS?  USE A SCALE OF 1 FOR LIMITED TO 5 FOR EXTENSIVE.

Psychological Health (1 point)

{Student}  “Now, I’d like to ask you some questions about how you feel about life.”

  • In general, do you find life exciting, interesting, routine, or dull?
  • Taking everything into consideration, how would you describe your satisfaction with life in general at this present time—–Excellent, good, fair, or poor
  • Are you under any unusual stress in the following areas? Mark if Yes.

___Financial situation                      ___Home living situation  ___Transportation

___Personal health            ___Family relationships    ___Friend relationships     ___Other

  • How would you rate your mental and emotional health at this present time —-excellent, good, fair, or poor?
  • How has your mental or emotional health changed in the past 5 years?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE YOUR OLDER ADULT PSYCHOLOGICAL HEALTH?  USE A SCALE OF 1 FOR POOR TO 5 FOR EXCELLENT.

Sexuality (2 points)

{Student}  “Sexuality is an important dimension of health.  In the broadest sense, sexuality is defined as love, warmth, sharing, and touching between people.  It can give meaning to life and bolster security, belongingness, and esteem.  It has an emphasis on companionship, physical nearness, intimate communication, and a pleasure-seeking physical relationship.”

  • How would you describe yourself as a sexual being?
  • Have you noticed any changes about yourself that have impacted how you feel about yourself as a sexual being in the last 5-10 years?
  • Has your definition of sexuality changed over your life?
  • Are you currently in a relationship with someone?

NURSING EVALUATION; IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE YOUR OLDER ADULT SEXUALITY STATUS?  USE THE SCALE OF 1 UNINVOLVED TO 5 FOR INVOLVED AND FINDS IT SATISFYING.

Medications (1 point)

  • What medications do you regularly and or occasionally take?

Prescription 

   

Drug

Dose

How often?

Med for?

SE

 

 

 

 

Over the Counter

   

Drug

Dose

How often?

Med for?

SE

 

 

 

 

  • Are there currently any medications that have been prescribed but that you do not take? Why?
  • Do you have any drug allergies? If so, what type of reactions did you have?
  • How much money a month do you spend on medications?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU RATE AND DESCRIBE YOUR OLDER ADULT MEDICATION STATUS (KNOWLEDGE, COMPLIANCE, ETC)? USE A SCALE OF 1 FOR POOR TO 5 FOR EXCELLENT.

{Student}  “This ends the formalized interview process.  Do you have any questions for me that you would like to discuss?  I would like to thank you for helping me with my project.  It has been very helpful and useful to me to learn your perspectives on health.  Thank you again for such a positive experience.  I wish you a year filled with much health.”

          

(Student:  You are to direct the following questions only to a community site where you are completing your project.)

Community Assessment (2 points)

  • Community (Residential) Facility Name: ________________________________________
  • What are the community-specific objectives in providing services to older adults?
  • What are the kinds of activities/services that are provided in this community?
  • What activities/services are categorized as health-promoting, health maintaining, and health restoring?
  • What are the eligibility requirements necessary to participate in the community?
  • How do your potential members qualify for becoming a participant in the community?

NURSING EVALUATION:  IN 5 SENTENCES OR LESS, HOW WOULD YOU EVALUATE THE SCOPE OF SERVICES AVAILABLE FOR THE OLDER CLIENT?  USE THE SCALE OF 1 FOR NOT WELL MATCHED TO 5 WELL MATCHED.

Summary Evaluation (6 points)

  • (2 points)
  1. What is this older adult’s primary health strength?
  2. Identify from Maslow’s hierarchy of needs, the area that matches the older adult’s strength.
  3. Document one nursing implication to promote this older adult’s health strength.
  • (2 points)
  1. What is this older adult’s primary health need?
  2. Identify from Maslow’s hierarchy of needs, the area that matches the older adult’s need.
  3. Document one nursing implication to promote the older adult’s health need.
  • (1 point)

Using Maslow’s hierarchy of needs, evaluate how well this client’s needs are currently being met.

(1 point)

What one evidence-based content area will be helpful in your role as the RN with the geriatric client?

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Introduction

Leadership consists of
various qualities, skills and aspects relating to the action of leading an
organization or a group of individuals (Ennis et al, 2013). The focal point of
the NHS is to enable cultures that provide safe, compassionate and high-quality
care (West et al, 2015). Furthermore, leadership has an impact on a number of
different aspects such as mortality levels, patient satisfaction, staff
well-being, financial performance and generally, the quality of care (West et
al, 2015). The Francis report discussed the importance of distributed
leadership, whereby all healthcare professionals are enabled to think freely,
make decisions and take control themselves. It leads to the provision of
high-quality care (Francis, 2013). This piece of work will assess effective
leadership and why it is a necessity within nursing practice.

Communication

Ennis et al (2013) implemented
a study in order to assess the communication characteristics needed for good
leadership within nursing. Interviews were carried out, outlining how effective
communication is key in order to provide high quality care, develop as a
professional and to harbor working relationships (Ennis et al, 2013). The study
produced the following themes: choice of language, listening skills, relevance,
non-verbal communication and relationships. Participants outlined that good
leaders have the knowledge to choose the type of language used and can adapt it
to any scenario that they are faced with. In addition, they suggest that an
effective leader considers the outcome and consequence of each conversation
(for example, whether further support was needed) (Ennis et al, 2013). When
leadership is successful, it enables excellence and ethical and
patient-centered care (Ennis et al, 2013).

Furthermore, it was
noted that good leaders needed to be able to listen, be affable and have
patience (Ennis et al, 2013). One participant outlined that listening should be
first and foremost, valuing its importance and showing great interest in what
the patient has to say (Ennis et al, 2013). Respondents noted the need for
effective communication across all aspects of nursing; with junior staff,
between healthcare professions and when directly caring (Ennis et al, 2013).
Good clinical leaders need to be able to communicate to a high level, adapting
to enable all patients to understand, noting body language, non-verbal cues and
avoiding medically complex terms as much as possible (Ennis et al, 2013). The
study notes the link between effective communication and the amount of
influence that leader has, the team’s performance and their development of
staff member relations (Ennis et al, 2013). Guidelines by NICE also emphasize
the importance of effective communication to enable high quality care (NICE,
2016). Non-verbal communication is also key; effective leaders need to note
their body language and level of eye contact, assessing not only their own
non-verbal cues, but also those of the patient or fellow professional (Ennis et
al, 2013). This will enable them to judge the scenario and to foresee any
issues that may arise (Ennis et al, 2013). Within the study by Ennis et al,
(2013) respondents outlined that good leaders had excellent people skills,
building a good rapport with everyone. To do so, respect and treating each
person as an individual is key (Ennis et al, 2013). It is also vital to ensure
that no judgements are made and that support is offered when needed (Ennis et
al, 2013). Effective leaderships can only be implemented when these areas are
adhered to, building work relationships and providing high quality,
patient-centered care (Ennis et al, 2013).

Emotional intellect

Emotional intellect is
a key aspect to adhere to when managing situations and caring for patients
(Powell et al, 2015). Controlling emotions and self-awareness are both vital
components of emotional intellect (Powell et al, 2015). Doing so decreases the
risk of burnout and ensures that patients are receiving high quality care
(Powell et al, 2015). In addition, being aware of one’s emotions enables a
collaboration that is needed to meet the needs of individuals within the
complex and increasingly technical NHS system (Powell et al, 2015).

The qualities of a leader

The main traits of a
good leader were assessed by Yukl (2013). They consist of a high level of
energy, stress coping mechanisms, confidence, control, maturity, integrity, as
well as being a high achiever, with low needs for affiliation. Nursing leaders
need to be empowering, promote independence, encourage a critical and effective
work environment and remain positive (Jukes, 2013). They should enable fellow
healthcare professionals to build resilience, enabling them to make their own
decisions yet providing protection when needed (Jukes, 2013). In order to
achieve structural change for the provision of high-quality care, the following
should be adhered to: promoting inclusive team work, maintaining trust, seeking
contribution, using personal authenticity, valuing relationships, enabling
learning and challenging any issues that arise (Cleary et al, 2011). Patients
need support and care which cannot be carried out without effective leadership
(Cleary et al, 2011). If a nurse does not show effective leadership skills,
they often retreat towards more traditional methods of behavior (more
documentation and relying on medicine), instead of promoting patient-centered
care (Jukes, 2013). Furthermore, leaders need to support any professionals that
they are responsible for in following the nursing and midwifery code at all
times (Nursing and Midwifery Code, 2015: 18).

The qualities of a manager

Managers oversee a
certain area, supervising fellow staff and ensuring that patient care is
upheld, in addition to administrative aspects (Jukes, 2013). Concerns are
addressed through their specialized nursing experience, good communication and
the ability to take the lead (Jukes, 2013). Good communication is key when
assessing any risks, managing plans, delegating work and ensuring the effective
and safe provision of resources (Jukes, 2013). Delegating work is an integral
part of effectively leading, encouraging active learning, whilst freeing up
more time for aspects that cannot be delegated (Weir-Hughes, 2011). Delegation
is a necessity, especially when staff numbers reduce and pressures rise
(Griffin, 2016). Managers also demonstrate excellent leadership skills by
improving nurse confidence and upholding morale (Timmins, 2011). They need to
ensure that staff are communicating effectively, in order to provide high
quality, safe care (Timmins, 2011). This can be carried out by implementing an
open leadership style, listening to the nurses and involving the team when
making decision (Timmins, 2011). Gilmartin and D’Aunno (2007) outline how nurses prefer managers who are
emotionally intelligent, facilitate change and who actively participate.
Further stating that this leads to cohesion, a sense of empowerment and reduces
stress and burnout (Gilmartin and D’Aunno,
2007). Management and leadership can only be improved by adhering to the
following: ensuring a good set of qualities and knowledge, a supportive environment,
an adequate number of managers and ensuring rewards or acknowledgement for good
practice (World Health Organization, 2007).

Ineffective leadership

Ineffective leadership
can lead to the unsafe provision of care (Nicolson et al, 2011). This was portrayed
during the 1990s, in which nurse Beverly Allitt
murdered children by injecting them with insulin. She was not supervised and
the deaths were not challenged by management (Nicolson et al, 2011). More
recently, the investigation into the Airedale NHS trust found nurse Anne
Grigg-Booth to be providing dangerous care. Many patients died under her care,
which was noted as an abundance of failures in which dangerous actions were not
acknowledged by management (Nicolson et al, 2011). Within the Mid Staffordshire
Foundation Trust, a lack of leadership and supervision detrimentally impacted
upon the lives of many, with high mortality rates (Nicolson et al, 2011). The
Francis Report identified various issues such as, call bells not being
answered, patients lying in their own urine and left without water or food
(Francis, 2013). Saving money was a priority and management preferred to meet
targets than deal with individual needs and thus leadership was poor (Nicolson
et al, 2011). Ineffective management has not only led to unsafe care but cost
more than £16m in legal fees and implementation costs (Calkin, 2013).

Transformational leadership

Transformational
leadership encourages nurses to provide a high level of care by making
influential changes (Cleary et al, 2011). It involves the following actions:
building trust with fellow healthcare professionals, showing integrity,
inspiring team members, offering intellectual inspiration, adhering to the
needs of each individual and providing support (Malloy and Penprase,
2010). With this leadership style, professionals provide clear aims and a
pathway for their work, prioritising mutual respect,
working together, gaining nurse autonomy and upholding staff morale (Cleary et
al, 2011). Doing so prevents burnout, improves job satisfaction and a sense of
commitment (Cleary et al, 2011). Transformational leadership can be contrasted
with the transactional style in which leaders focus upon meeting targets (it is
not creative, reflective and prevents emotional connection) (Cleary et al,
2011).

Support for the transformational leadership
style

A study was
implemented by Malloy and Penprase (2010) on 122
nurses in order to assess their supervisor’s leadership style. The following
leadership styles were analysed: transactional,
transformational, exceptional-active, exceptional-passive and laissez-faire
(Molloy and Penprase, 2010). The study concluded that
aspects of transformational leadership were connected with 17 out of 37 areas
within the working environment, as calculated by the Copenhagen Psychosocial
questionnaire (Molly and Penprase, 2010). Leaders
implementing the transactional style also made positive contributions, but
fewer than that of a transformational style (Molly and Penprase,
2010). In addition, the laissez-faire, exceptional-passive and
exceptional-active styles all negatively impacted the nursing environment
(Molly and Penprase, 2010). Corrigan et al (2002)
carried out a mental health study, consisting of 236 leaders who had
responsibility for 620 staff members. Leaders who noted themselves as high on
the transactional style, had staff outlining low transformational scores. In
comparison, leaders who noted high levels of inspirational and stimulatory
aspects were likely to have staff who felt that their style was transformative
(Corrigan et al, 2002). Lastly, staff members who stated that their leader has
a transformational style experienced less burnout, a better working environment
and support, adhering to conclusions by Malloy and Penprase
(2010). In a time of uncertainty, healthcare budget cuts, policy changes and
financial strain, transformational leadership is key (Cleary et al, 2011). It
encourages staff to treat patients with respect and dignity, promoting patient-centred care and upholding values (Cleary et al, 2011).
Many argue however, that there needs to be more evidence into whether
transformational leaderships enable better care, improved quality of life and
patient satisfaction (Holm and Severinsson, 2010).

NHS leadership review

The government
published findings in order to analyze leadership within the NHS (Department of
Health, 2015). It noted three main areas of concern: a lack of vision, poor
management and leadership and the need for clear pathways in regards to NHS
management careers (Department of Health, 2015). The key recommendations
include: refreshing the NHS graduate scheme, the transfer of NHS leadership
Academy to Health Education England as those responsible for training and
introducing a minimum term on some senior management contracts. In addition,
managers should be supported and have their knowledge updated regularly in
order to prevent ‘skill fade’ (Department of Health, 2015: 53). The report
concluded that, ‘the NHS as a whole, lacks a clear, consistent, view of what
‘good’ or ‘best’ leadership looks like’ (Department of Health, 2015: 20). The
recommendations focus upon training, management, support, performance
management and bureaucracy (Department of Health, 2015).

Conclusion

To conclude, effective
leadership is necessary in order to provide a high level of safe care. It leads
to patient-centered care, excellent communication skills and high quality care.
Leaders need to communication well, have emotional intelligence, distribute
work and implement a transformational style. Whereas poor leadership can lead
to death or severe harm, as took place in the independent investigation into
the Airedale NHS trust. Ineffective leadership was also a main aspect of why
the detrimental acts of Anne Grigg-Booth went undetected by managers (Nicolson
et al, 2011). To emphasise, leadership is a key area
of the NHS and so it is vitally important to ensure that behaviours,
communication skills, qualities, skills, leadership styles and strategies are
focused upon to improve (West et al, 2015). Without doing so, the lives of many
will be affected.

 

 

 

 

 

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