Nursing Intervention at The Geriatric Consultation of HPV-CHLN: A Challenge, A Reality
The professional commitment of nursing to the elderly population today is the result of several generations of nurses who have always provided care to individuals and their families. Accordingly, gerontological nursing is an area of intervention specialising in the care of the elderly and their families, represented by a group of qualified and skilled professionals who, with their knowledge, are able to carry out a set of effective and relevant interventions in care.
Working with the elderly population requires professionals to possess complex and unique characteristics, for which reason their approach should be conducted in a holistic manner and as part of a multidisciplinary team. According to Berger (1995:14) “the philosophy of the intervention that supports all these functions is respect for the elder person in all his uniqueness, the wholeness of his being”. In the same fashion, Hesbeen (2001:42) states that “caring for someone constitutes a coherent and indivisible whole in which all components are interconnected, interrelated and in which what is important and what is secondary depends on the perception of the person who is being looked after, in the light of the meaning that this whole has in the uniqueness of his life”.
Nowadays, caring for the elderly should be based on the principles of individuality and respect for the human being as an unique individual, taking into account his opinion and wishes in choosing his behaviour and way of living.
The major demographic changes, which have become more accentuated over the last 50 years and resulted in the modification, even reversal, of the demographic pyramid, reflect the ageing of the population. This fact, associated with increased life expectancy and with a significant decrease in birth rate, alongside structural changes in social and family behaviours, has led to the emergence of new needs in health. This presents major challenges for health systems, society in general and for professional groups in healthcare.
Hence, in an attempt to provide answers to the needs of the elderly population and as part of the National Programme for the Health of the Elderly (DGS, 2004), the Geriatric Consultation was set up in March 2011 at the Pulido Valente Hospital – Northern Lisbon Hospital Centre. This consultation service is pioneer in Portugal as it is organised according to the international model of care for elderly outpatients and uses the Comprehensive Geriatric Assessment (CGA), in addition to home care service.
The Geriatric Consultation takes place every Thursday. It is coordinated by Professor Gorjão Clara and comprises a multidisciplinary team of doctors, nurses, a social worker, pharmacists, psychologists, physiotherapists, a physical therapist, and nutritionists/dieticians. Home visits take place on Wednesdays, and are carried out mostly by nurses and the social worker. This multidisciplinary intervention in geriatrics allows bringing together the results of all these specialities, and offers a global approach to the elderly and their families.
It should be noted that specific care in geriatrics exists not just due to the growing number of elderly people, but mostly as a result of the fact that the illnesses of the elderly have specificities and characteristics that are conditioned by ageing and which require a specialised approach.
Nursing Intervention in Geriatric Consultation
The provision of nursing care, taking into account the specificities of its target population, aims to contribute to the empowerment of users and families/caregivers in the protection of their health against any physical, mental and psychological eventual changes, to ensure they remain active and autonomous for as long as possible. To this end, the objectives of Geriatric Consultation are: contribute to the quality of life of the elderly; increase diagnostic accuracy; improve assessment of the mental condition and functioning of the elderly; reduce mortality and co-morbidity; reduce admission to nursing homes, and decrease hospitalisation.
Thus, and in accordance with the CGA, the nursing team is responsible for conducting the Functional Capacity Evaluation, the Functional Emotional Assessment, the Cognitive Function Assessment, and the Evaluation of Nutritional Risk and Status. The CGA uses various assessment tools in the specific areas to be assessed, and each takes approximately 30-40 minutes to perform (Folstein Mini-Mental Status Examination, the Yesavage 15-item Geriatric Depression Scale, the Mini Nutritional Status Examination, Katz Index, Lawton Scale). This assessment by nursing staff allows identifying the patients who will afterwards be referred to specialists (psychologists and nutritionists/dieticians).
This assessment process is followed by the Nursing Care Plan, which is established according to the specific needs of each elderly person and his family, and involves the prevention, recovery and rehabilitation of the patient, contributing to increased autonomy. Examples of specific intervention with regard to the most frequent educational needs include: accident prevention; management of therapeutic regimes; identification and control of symptoms; self-control and self monitoring of health; healthy lifestyles; and knowledge of one’s own health/disease process, among others.
The home visits that are part of the geriatric consultation and which follow specific referral criteria are another form of intervention in the provision of care. Some of the advantages of this type of visit include the possibility of individualising the planned interventions according to the specific needs of each elderly person and his family. It provides a more welcoming and less stressful environment, enabling the classification of questions, concerns or needs. During the visit, nurses also identify the needs that may lead to referral to other members of the multidisciplinary team.
Thus, the main objectives of nursing care offered to the elderly and their families as part of the geriatric consultation include: to protect and promote health; to prevent complications inherent to the ageing process and any associated pathologies; to meet the health needs that the elderly and their families have identified, perceived and expressed; to facilitate the maintenance of identity and autonomy of the elderly; to prevent social detachment; to avert deterioration of personality; to reduce intellectual, physical and social inactivity; to give the elderly person the chance to take responsibility for himself to the extent of his possibilities; to help the elderly to develop new skills; to encourage the elderly to participate in activities connected to their environment; to contribute to the creation of a means of facilitating their involvement in the community; to collaborate with the providers of formal and informal care to the elderly in the clarification of doubts and suitability of the care provided; to contribute to the development of research in nursing care with the aim of promoting programmes in this area.
Final Remarks
Nursing care for the elderly and their families is directly linked to the educational needs of health. As members of the multidisciplinary team, nurses carry out their autonomous interventions to maximize health, minimizing losses and limitations, thus facilitating the establishment of nursing diagnoses and planning of interventions. Since this is an experience that is still in its infancy, it is driven by the enthusiasm and commitment of the entire multidisciplinary team involved in the process and especially by the extremely positive feedback from the elderly and their families who have been the target of our care.
Looking at other international successful experiences that have adopted similar intervention methodologies with the elderly population, the entire team hopes that this pioneer initiative will be replicated in future in other contexts and health institutions. The focus on the empowerment of the elderly should be seen as a priority health strategy, aiming to maintain their autonomy and independence through the use of their skills and subsequent improvement in their quality of life and their health.
BIBLIOGRAPHY
BERGER, L.; MAILLOUX-POIRIER, D. – Pessoas idosas: uma abordagem global. Lisboa: Lusodidacta, 1995. ISBN: 972-95399-8-7.
COSTA, M. – Cuidar idosos: formação, práticas e competências dos enfermeiros. Coimbra: Formasau, 2002. ISBN 972-8485-24-7.
GOMES, I. – O Doente idoso como parceiro no processo de cuidados de enfermagem. Enfermagem. Lisboa. ISSN 0871-0775. Nº 35/36 (2004), p. 23-31.
HESBEEN, W. – Qualidade em enfermagem: pensamento e acção na perspectiva do cuidar. Loures: Lusociência, 2001. ISBN 972-8383-20-7.
PORTUGAL. Direcção Geral de Saúde - Plano Nacional para a Saúde das Pessoas Idosas 2004-2010. [online] [quoted on 19/11/2011]. Available at: http://www.portaldasaude.pt/NR/rdonlyres/1C6DFF0E-9E74-4DED-94A9-F7EA0B3760AA/0/i006346.pdf
PORTUGAL. Ordem dos Enfermeiros – Cuidados de proximidade: os enfermeiros como recursos de saúde dos cidadãos [online]. [quoted in 2008/08/25]. Available at: http://www.ordemenfermeiros.pt/images/contents/uploaded/File/sedeforum/cuidadossaudeprimarios/7/7.pdf
Sílvia Matias
Candida Romão
Outpatient Consultation Service –
Pulido Valente Hospital / Northern Lisbon Hospital Centre
silviamatias27@gmail.com
The professional commitment of nursing to the elderly population today is the result of several generations of nurses who have always provided care to individuals and their families. Accordingly, gerontological nursing is an area of intervention specialising in the care of the elderly and their families, represented by a group of qualified and skilled professionals who, with their knowledge, are able to carry out a set of effective and relevant interventions in care.Working with the elderly population requires professionals to possess complex and unique characteristics, for which reason their approach should be conducted in a holistic manner and as part of a multidisciplinary team. According to Berger (1995:14) “the philosophy of the intervention that supports all these functions is respect for the elder person in all his uniqueness, the wholeness of his being”. In the same fashion, Hesbeen (2001:42) states that “caring for someone constitutes a coherent and indivisible whole in which all components are interconnected, interrelated and in which what is important and what is secondary depends on the perception of the person who is being looked after, in the light of the meaning that this whole has in the uniqueness of his life”.
Nowadays, caring for the elderly should be based on the principles of individuality and respect for the human being as an unique individual, taking into account his opinion and wishes in choosing his behaviour and way of living.
The major demographic changes, which have become more accentuated over the last 50 years and resulted in the modification, even reversal, of the demographic pyramid, reflect the ageing of the population. This fact, associated with increased life expectancy and with a significant decrease in birth rate, alongside structural changes in social and family behaviours, has led to the emergence of new needs in health. This presents major challenges for health systems, society in general and for professional groups in healthcare.
Hence, in an attempt to provide answers to the needs of the elderly population and as part of the National Programme for the Health of the Elderly (DGS, 2004), the Geriatric Consultation was set up in March 2011 at the Pulido Valente Hospital – Northern Lisbon Hospital Centre. This consultation service is pioneer in Portugal as it is organised according to the international model of care for elderly outpatients and uses the Comprehensive Geriatric Assessment (CGA), in addition to home care service.
The Geriatric Consultation takes place every Thursday. It is coordinated by Professor Gorjão Clara and comprises a multidisciplinary team of doctors, nurses, a social worker, pharmacists, psychologists, physiotherapists, a physical therapist, and nutritionists/dieticians. Home visits take place on Wednesdays, and are carried out mostly by nurses and the social worker. This multidisciplinary intervention in geriatrics allows bringing together the results of all these specialities, and offers a global approach to the elderly and their families.
It should be noted that specific care in geriatrics exists not just due to the growing number of elderly people, but mostly as a result of the fact that the illnesses of the elderly have specificities and characteristics that are conditioned by ageing and which require a specialised approach.
Nursing Intervention in Geriatric Consultation
The provision of nursing care, taking into account the specificities of its target population, aims to contribute to the empowerment of users and families/caregivers in the protection of their health against any physical, mental and psychological eventual changes, to ensure they remain active and autonomous for as long as possible. To this end, the objectives of Geriatric Consultation are: contribute to the quality of life of the elderly; increase diagnostic accuracy; improve assessment of the mental condition and functioning of the elderly; reduce mortality and co-morbidity; reduce admission to nursing homes, and decrease hospitalisation.
Thus, and in accordance with the CGA, the nursing team is responsible for conducting the Functional Capacity Evaluation, the Functional Emotional Assessment, the Cognitive Function Assessment, and the Evaluation of Nutritional Risk and Status. The CGA uses various assessment tools in the specific areas to be assessed, and each takes approximately 30-40 minutes to perform (Folstein Mini-Mental Status Examination, the Yesavage 15-item Geriatric Depression Scale, the Mini Nutritional Status Examination, Katz Index, Lawton Scale). This assessment by nursing staff allows identifying the patients who will afterwards be referred to specialists (psychologists and nutritionists/dieticians).
This assessment process is followed by the Nursing Care Plan, which is established according to the specific needs of each elderly person and his family, and involves the prevention, recovery and rehabilitation of the patient, contributing to increased autonomy. Examples of specific intervention with regard to the most frequent educational needs include: accident prevention; management of therapeutic regimes; identification and control of symptoms; self-control and self monitoring of health; healthy lifestyles; and knowledge of one’s own health/disease process, among others.
The home visits that are part of the geriatric consultation and which follow specific referral criteria are another form of intervention in the provision of care. Some of the advantages of this type of visit include the possibility of individualising the planned interventions according to the specific needs of each elderly person and his family. It provides a more welcoming and less stressful environment, enabling the classification of questions, concerns or needs. During the visit, nurses also identify the needs that may lead to referral to other members of the multidisciplinary team.
Thus, the main objectives of nursing care offered to the elderly and their families as part of the geriatric consultation include: to protect and promote health; to prevent complications inherent to the ageing process and any associated pathologies; to meet the health needs that the elderly and their families have identified, perceived and expressed; to facilitate the maintenance of identity and autonomy of the elderly; to prevent social detachment; to avert deterioration of personality; to reduce intellectual, physical and social inactivity; to give the elderly person the chance to take responsibility for himself to the extent of his possibilities; to help the elderly to develop new skills; to encourage the elderly to participate in activities connected to their environment; to contribute to the creation of a means of facilitating their involvement in the community; to collaborate with the providers of formal and informal care to the elderly in the clarification of doubts and suitability of the care provided; to contribute to the development of research in nursing care with the aim of promoting programmes in this area.
Final Remarks
Nursing care for the elderly and their families is directly linked to the educational needs of health. As members of the multidisciplinary team, nurses carry out their autonomous interventions to maximize health, minimizing losses and limitations, thus facilitating the establishment of nursing diagnoses and planning of interventions. Since this is an experience that is still in its infancy, it is driven by the enthusiasm and commitment of the entire multidisciplinary team involved in the process and especially by the extremely positive feedback from the elderly and their families who have been the target of our care.
Looking at other international successful experiences that have adopted similar intervention methodologies with the elderly population, the entire team hopes that this pioneer initiative will be replicated in future in other contexts and health institutions. The focus on the empowerment of the elderly should be seen as a priority health strategy, aiming to maintain their autonomy and independence through the use of their skills and subsequent improvement in their quality of life and their health.
BIBLIOGRAPHY
BERGER, L.; MAILLOUX-POIRIER, D. – Pessoas idosas: uma abordagem global. Lisboa: Lusodidacta, 1995. ISBN: 972-95399-8-7.
COSTA, M. – Cuidar idosos: formação, práticas e competências dos enfermeiros. Coimbra: Formasau, 2002. ISBN 972-8485-24-7.
GOMES, I. – O Doente idoso como parceiro no processo de cuidados de enfermagem. Enfermagem. Lisboa. ISSN 0871-0775. Nº 35/36 (2004), p. 23-31.
HESBEEN, W. – Qualidade em enfermagem: pensamento e acção na perspectiva do cuidar. Loures: Lusociência, 2001. ISBN 972-8383-20-7.
PORTUGAL. Direcção Geral de Saúde - Plano Nacional para a Saúde das Pessoas Idosas 2004-2010. [online] [quoted on 19/11/2011]. Available at: http://www.portaldasaude.pt/NR/rdonlyres/1C6DFF0E-9E74-4DED-94A9-F7EA0B3760AA/0/i006346.pdf
PORTUGAL. Ordem dos Enfermeiros – Cuidados de proximidade: os enfermeiros como recursos de saúde dos cidadãos [online]. [quoted in 2008/08/25]. Available at: http://www.ordemenfermeiros.pt/images/contents/uploaded/File/sedeforum/cuidadossaudeprimarios/7/7.pdf
Sílvia Matias
Candida Romão
Outpatient Consultation Service –
Pulido Valente Hospital / Northern Lisbon Hospital Centre
silviamatias27@gmail.com
