Chapter 01: Gerontological Nursing Across the Continuum of Care
Touhy: Toward Healthy Aging, 11th Edition
MULTIPLE CHOICE
1.When did serious and well-controlled research studies on aging first become available?
a.Only in the past 60 years.
b.Since the turn of the 20th century.
c.Following the Great Depression.
d.Since the year 2000.
ANS:A
Only in the past 60 years have serious and carefully controlled research studies flourished. Before that, anecdotal evidence was used to illustrate issues assumed to be universal, making all the remaining options incorrect.
DIF:Cognitive Level: Remembering TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
2.The son of a nursing home resident asks a nurse: “What is the significance of being certified in gerontology? I see that you are, but not all of the nurses are.” What response best answers the family member’s question?
a.“National certification as a gerontological nurse is a way to demonstrate special knowledge in caring for older adults.”
b.“National certification in gerontology is required for all nurses who have worked in this setting for 2 or more years.”
c.“National certification is only available to nurses who have a Baccalaureate degree
in nursing.”
d.“Only advanced practice nurses, like nurse practitioners, are certified in gerontology.”
ANS:A
National certification is a way to demonstrate special expertise in caring for older adults. It is not required for practice in any setting across the continuum of care, and it is not exclusive to nurses with Baccalaureate degrees. There is both a generalist and a specialist gerontological nursing certification. The generalist functions in a variety of settings providing care to older adults and their families. The specialist has advanced gerontological education at a master’s level.
DIF:Cognitive Level: Understanding
TOP:Integrated Process: Communication and Documentation
MSC:Client Needs: Management of Care
3.The major goal of the NICHE (Nurses Improving Care for Healthsystem Elders) program includes which of the following?
a.Improve outcomes for hospitalized older adults.
b.Increase the number of older adults cared for in hospitals.
c.Increase the number of iatrogenic complications that occur in hospitalized older adults.
d.Decrease 30-day readmission rates for hospitalized older adults. ANS:A
The goal of NICHE is to improve outcomes for hospitalized older adults. Although option D is a good outcome for hospitalized older adults, it is not one of the major goals of NICHE, which are broader. Options B and C are not goals that would improve care for older adults but would be negative outcomes themselves.
DIF:Cognitive Level: Understanding TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1.What is the impact of the Hospital Readmission Reduction Program (HRRP) on avoidable readmissions? (Select all that apply.)
a.Readmission rates for the selected conditions have dropped nationwide.
b.Many hospitals have instituted system-wide interventions to prevent readmissions.
c.Hospitals are keeping patients longer to avoid readmissions.
d.Potentially avoidable hospitalizations among nursing home residents is increasing.
e.Hospitals have a financial incentive to develop programs to reduce readmissions.
ANS:A, B, E
The Hospital Readmission Reduction Program (HRRP) was established as a provision in the Affordable Care Act (ACA) requiring Medicare to reduce payments to hospitals with relatively high readmission rates for selected conditions for patients in traditional Medicare. Since the HRRP, readmission rates for the selected conditions have dropped nationwide but estimates are that in 2018, about 80% of hospitals evaluated by CMS will face penalties totaling $564 million (Advisory Board, 2017). Additionally, the HRRP has been the impetus for many hospitals to institute system-wide interventions to prevent readmissions that have also contributed to the decline in readmission rates. The rate of potentially avoidable hospitalizations among SNF residents has fallen by nearly a third in recent years as a result of many quality improvement initiatives.
DIF:Cognitive Level: Understanding TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
2.Which of the following are true statements about the current health care workforce? (Select all that apply.)
a.Approximately 10% of registered nurses (RNs) are certified in gerontological nursing.
b.The number of geriatricians is expected to increase about 50% over the next 25 years.
c.The professions of social work, physical therapy, and psychiatry are demonstrating
the same trends as nursing.
d.The world’s older population is expected to grow to at least 1.3 billion in the next 20 years.
e.It is anticipated that there will be a need for approximately 3million additional direct care and professional health care workers by the year 2030.
ANS:C, D, E Less than 1% of RNs are certified in gerontological nursing. Geriatric medicine faces similar challenges with about 7000 prepared geriatricians, 1 for every 2546 older Americans; and this number is falling with the trend predicted to be less than 5000 by 2040 (IOM, 2008). By 2040 the number of older adults in the world will be at least 1.3 billion. Other professions such as social work, physical therapy, and psychiatry have similar shortages. It is estimated that by 2030 nearly 3 million additional health care professionals and direct care workers will be needed to meet the care needs of a growing older adult population. Healthy People 2030 has addressed this concern..
DIF:Cognitive Level: Understanding TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
3.Best practice recommendations for nursing education in relation to gerontology include which
of the following? (Select all that apply.)
a.Provision of a “stand-alone” course in gerontological nursing
b.Integration of gerontological content throughout the curriculum
c.Replacement of acute care pediatric clinical experiences with gerontological clinical experiences
d.Recruitment of nurses with Master and Doctoral degrees and a specialty in gerontology to faculty roles
e.Requiring all undergraduate nursing students to obtain gerontological certification as a requirement for graduation
ANS:A, B, D
Best practices include providing a stand-alone gerontological nursing course as well as integrating gerontology throughout the curriculum. Recruitment of nurses with a specialty in gerontology and a Master or Doctoral degree to faculty roles is a critical step in making sure that the next generation of nurses is prepared to care for older adults. Best practices do not recommend removing pediatric clinical experiences and replacing them with gerontological experiences. Nursing certification is only available to practicing nurses who meet specific education and practice requirements. It is not applicable to nursing students.
DIF:Cognitive Level: Understanding TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
4.What are the current initiatives being implemented to enhance the specialty of gerontological nursing? (Select all that apply.)
a.Mandating of a minimum of a Baccalaureate degree in nursing in order to care for older adults
b.Geriatric Nursing Leadership Academy (GNLA) project
c.Promotion of geriatric nursing to excellence to the nursing community
d.Requiring a nursing certification specifically required to long-term care
e.Offering scholarships for study and research in geriatric nursing
ANS:B, C, E The most significant influence in enhancing the specialty of gerontological nursing has been the work of The Hartford Institute for Geriatric Nursing, established in 1996 and funded by the John A. Hartford Foundation. Initiatives in nursing education, nursing practice, nursing research, and nursing policy have addressed enhancement of geriatrics in nursing education programs through curricular reform and faculty development, creation of the National Hartford Centers of Gerontological Nursing Excellence, predoctoral and postdoctoral scholarships for study and research in geriatric nursing, and clinical practice improvement projects to enhance care for older adults. . Mandating minimum nursing levels or certifications
to practice in long-term care are not current initiatives.
DIF:Cognitive Level: Understanding TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
5.A nurse discusses the “age in place” concept with an older adult client. The nurse would provide information related to which facility? (Select all that apply.)
a.Independent senior housing complexes.
b.A long-term care facility that is affiliated with the hospital.
c.Retirement communities.
d.Adult day health centers.
e.Assisted living facilities.
ANS:A, C, D, E
Community-based care occurs through home and hospice care provided in persons' homes, independent senior housing complexes, retirement communities, residential care facilities such as assisted living facilities, hospice facilities, and adult day health centers. Acute care hospitals and long-term care facilities are not considered community based care facilities.
DIF:Cognitive Level: Applying TOP:Integrated Process: N/A
MSC:Client Needs: Psychosocial Integrity
6.What are the significant factors contributing to the growth of community-based care?: (Select all that apply.)
a.A decrease in the number of available nursing home beds.
b.Rapidly escalating health care costs.
c.Older adults’ preferences to “age in place.”
d.Inadequate numbers of nurses with gerontological specialty education.
e.Decreasing numbers of family caregivers.
ANS:B, C
Care will continue to move out of hospitals and long-term care facilities because of rapidly escalating health care costs and individual preferences to “age in place.” There has not been a decrease in nursing home beds. Although there are inadequate numbers of nurses with gerontological specialty training, this is not a factor that has impacted the growth of community-based care. There is projected to be a decrease in the number of family caregivers as the caregivers themselves are aging; however, this does not contribute to the growth of community-based care.
DIF:Cognitive Level: Understanding TOP:Integrated Process: Teaching/Learning
MSC:Client Needs: Health Promotion and Maintenance
