Gerontology Nursing: A Personal Gerontological

Gerontology Nursing: A Personal Gerontological Nursing Framework

The environment, the elderly person, and health are all interrelated as this work in writing will clearly demonstrate and moreover, the nursing professional relates to and is related to by all of these factors in the course of their professional service provision. The role of the gerontological nurse is one that is differentiated from other nursing positions in that the elderly person more than other less vulnerable age groups are impacted greatly by the environment and health factors all of which are incidentally directly related one to the other insofar as impacting upon the elderly person's health. The nurse serves as a mediator to the elderly person in navigating the present environment which surrounds them and as it specifically relates to the elderly individual's health.

Personal Gerontological Nursing Framework

Person-centered health care based on autonomy and support and mediation on the part of the professional nurse forms the basis for the personal gerontological nursing framework present in this work in writing. The following illustration depicts the interaction between the environment, the elderly person and health and additionally depicts the mutual interactions between nurses and each of these factors in the healthcare environment.

Figure 1

Legend

Mediator between environment and elderly persons/Mediator between health and elderly persons.

Impacting Elderly Persons

The work of McCormack (2003) entitled: "A Conceptual Framework for Person-Centered Practice with Older People" reports the development of a framework with the guidance of "hermeneutic philosophy and integrated process of conversation analysis and reflection conversation in data collection and analysis." (p.1)

McCormack states that the research findings indicate that nurses "...need to be able to particularize the person that the patient is, the relationship that exists between them and the patient, and the understandings and expectations implicit in the relationship. From these findings a conceptual framework for person-centered practice was developed. In the framework, person-centeredness is premised on the concept of authentic consciousness..." (p.1)

II. Person/Patient/Client Centered Care & Nursing Interaction Characteristics

The work of Law, Baptiste and Mills (1995) reports that client-centered care is "...an approach to service "…which embraces a philosophy of respect for, and a partnership with people receiving services" (Law, Baptiste and Mills, 1995 in: ) Collaborative efforts are stated in the work of Lutz and Bowers (2000) to consist of "…patients, patients' families, friends, the doctors and other health professionals & #8230;" (Lutz and Bowers, 2000).

Characteristics of the nursing professional's interactions with elderly patients are those as follows:

(1) Respect - (for older persons, for their values, needs and preferences);

(2) Partnership and collaboration - (between the older person (and their family) and the professional care team); and (3) Patient/person/client being at the centre - (health services revolving around the service user rather than around funders and/or professionals) (McCormack, 2003, p.1)

It can therefore be understood that person centered care involves collaboration and respect and ultimately "…a partnership between the service provider and the service user" and McCormack states that will involve the following:

(1) Getting to know the service user as a person

(2) Sharing of power and responsibility between the service user and service provider

(3) Accessibility and flexibility of both the service provider as a person and of the services provided

(4) Coordination and integration of care for the service user; and (5) Having an environment that is conducive to person-centred care both for service providers and service users. (2003, p.1)

In fact, McCormack (2003) states that it is indicated by evidence as follows:

(1) Communication between physician and patient (asking questions about the patient's understanding, expectations and feelings and showing support and empathy) can make a positive difference to patient health outcomes;

(2) Person-centred education for both staff and patients has been found to be beneficial.

(3) Person-centred care can lead to:

(a) Improved client and carer satisfaction;

(b) Improved pain management;

(c) Improved adherence to intervention recommendations; and (d) Improved sense of professional worth. (McCormack, 2003, p.1)

III. Five Dimensions to Health Care that is Person Centered

Mead et al. (2000) is stated to have proposed five dimensions to health care that is 'person-centered' including those as follows based on criticism of the bio-medical model:

(1) Bio-psycho-social perspective;

(2) Patient as a person;

(3) Sharing power and responsibility;

(4) Therapeutic alliance; and (5) Doctor as a person. (McCormack, 2003, p.1)

IV. Person-Centered Health Care Values

Values that are stated to be related to person centered health care in the work of McCormack and colleagues are those as follows:

(1) Assumption that human freedom/autonomy can be retained in the presence of debilitating illness and disability through partnership with nurses; and (2) Partnership is obtained via:

(a) getting close to the person";

(b) Providing care that is consistent with the person's values;

(c) Biographical approach to assessment; and (d) Focus on ability rather than dependency. (McCormack, 2003, p.1)

V. Seven Concepts that are 'Key' to Client Centered Practice

The work of Law et al. (1995) relates seven concepts that are stated to be 'key to client centered practice' as follows:

(1) Autonomy and Choice

(2) Partnership & Responsibility

(3) Enablement

(4) Contextual Congruence

(5) Accessibility

(6) Flexibility

(7) Respect for diversity. (McCormack, 2003, p.1)

VI. Patient and Informal Expertise and Knowledge

The work of Loeb, et al. (2003) entitled: "Supporting Older Adults with Multiple Chronic Conditions" states that nurses "have studied the experience of chronic illness within relational and social contexts, depicting persons who live with chronic illnesses as active agents of their own health." (p.3) This view involves the individual as "active agents of their own health…" who "develop expertise both in awareness of their bodily responses and in managing the self-care required by their unique types of chronicity." (Loeb, et al., 2003, p.4) It is stated that the patient's expertise "often reaches a level that exceeds that of their professional health care provider." (Loeb, et al., 2003, p.3)

According to Loeb, et al. "engaging in life…" is a strategy that can be effectively used in diverting the individual's attention "away from the challenges of chronicity toward a life filled with purposeful, activities." (2003, p.4) Loeb et al. states that findings in the study include "a number of coping strategies used to mediate the effects of multiple chronic conditions." Some of those strategies are the following:

(1) need for formal expertise of healthcare providers who have a 'critically evaluative attitude.'

(2) the experiential process of living with multiple chronic conditions was identified as a means of acquisition of informal expertise.

(3) Information gained through peers was preferred to information provided by professional health care workers;

(4) however, individuals did desire a partnered relationship with members of the health care team;

(5) A desire existed among participants to make informed health care decisions because it promoted their personal sense of empowerment.

(6) Finally, the need for health care workers to acknowledge the informal knowledge and expertise of patients. (Loeb, 2003, p.5)

McCormack (2003, p.5) states that health care provision which is based upon autonomy and choice is of the nature that makes the assumption that the opinion of the patient will be sought, that the patient's values will be respected and that the patient's dignity will be maintained.