Chapter 1:
Introduction to
Gerontological Nursing
Learning Objectives
• Define important terms related to nursing and the
aging process.
• Outline significant landmarks that have influenced
the development of gerontological nursing as a
specialty.
• Identify several subfields of gerontological nursing.
• Develop the beginnings of a personal philosophy of
aging.
• Describe the unique roles of the gerontological
nurse.
Learning Objectives (cont’d)
• Discuss the scope and standards of gerontological
nursing practice.
• Examine core competencies in gerontological
nursing practice.
• Compare the nine essentials of baccalaureate
nursing education with the core competencies in
gerontological nursing.
• Distinguish among the educational preparation,
practice roles, and certification requirements of the
various levels of gerontological nursing practice.
History of
Gerontological Nursing
• 1960s: ANA forms gerontological nursing
specialty
• 1970s: Veterans Administration (VA) funds
Geriatric Research Education and Clinical Centers
• 1980s: The National Gerontological Nursing
Association (NGNA) established
• 1990s: Hartford Foundation Institute for
Geriatric Nursing established at NYU
• 21st century: “baby boomers” begin turning 65;
growing interest in gerontological care
Attitudes towards Aging
• Television, Media, Newspapers, Film
industry, Commercials in magazines and on
TV, Greeting card/birthday cards
• Observation of family members, friends,
neighbors, and your own experience with
older adults.
• Examine myths and realities, separate fact
from fiction.
• Ageism: negative attitude toward aging or
older adults.
Three major misconceptions
about aging
1. Disease in old age is normal
2. Older adults have no future and therefore
health promotion efforts are wasted
3. Damage to health from poor diet and
inactivity is irreversible
Definitions of “old”
• Chronological age
– young-old: 65 - 74
– middle-old: 75 - 84
– old-old (frail elderly): 85+
• Biological age
* Among individuals, vast differences exist
between biological and chronological aging.
Youth is not a time of life; it is a state of mind; it is
not a matter of rosy cheeks, red lips and supple
knees; it is a matter of the will,…. Years may
wrinkle the skin, but to give up enthusiasm
wrinkles the soul….. When the aerials are down,
and your spirit is covered with snows of cynicism
and the ice of pessimism, then you are grown old,
even at twenty, but as long as your aerials are up,
to catch the waves of optimism, there is hope you
may die young at eighty.
(Samuel Ullman “Youth”)
Definitions
• Gerontology: study of aging and/or the
aged.
• Geriatrics: medical care of the aged.
• Gerontological nursing: discipline of nursing
practice includes all older adults from the
time of “old age” until death.
• Subfields of gerontology: geriatrics, social
gerontology, geropsychology, geropharmacology,
gerontological nursing, gerontological
rehabilitation nursing.
Roles of the
Gerontological Nurse
•
•
•
•
•
Direct-care provider
Teacher
Leader
Advocate
Evidence-based clinician
Certifications
• Generalist Certification
• Entry level
• diploma in nursing, or an associate or bachelor of
science degree in nursing
• 2 years nursing experience
• Advanced Practice Certification
• Clinical specialist in gerontological nursing (GCNSBC)
• Gerontological nurse practitioner (GNP-BC)
Scope & Standards of Practice
• Scope of nursing practice
– defined by state regulation
– influenced by the complex and multifaceted needs of
the population being served
– depends on the setting in which the nurse practices
• Standards of nursing practice
– developed by the nursing profession
– These standards are divided into clinical care and the
role of the professional nurse
– There are six standards: assessment, diagnosis,
outcome identification, planning, implementation,
evaluation
AACN/Hartford Competencies
• Gerocompetencies
– 9 Essentials of Baccalaureate Education for Professional
Nursing Practice:
I. Liberal Education for Baccalaureate Generalist Nursing Practice
II. Basic Organizational and Systems Leadership for Quality Care and Patient
Safety
III. Scholarship for Evidence-Based Practice
IV. Information Management and Application of Patient Care Technology
V. Healthcare Policy, Finance, and Regulatory Environment
VI. Interprofessional Communication and Collaboration for Improving Patient
Health Outcomes
VII.Clinical Prevention and Population Health
VIII.Professionalism and Professional Values
IX. Baccalaureate Generalist Nursing Practice
AACN/Hartford Competencies
1. Incorporate professional attitudes, values, and expectations about
physical and mental aging in the provision of patient-centered care for
older adults and their families. (Essential VIII)
2. Assess barriers for older adults in receiving, understanding, and giving
of information. (Essentials IV & IX)
3. Use valid and reliable assessment tools to guide nursing practice for
older adults. (Essential IX)
4. Assess the living environment as it relates to functional, physical,
cognitive, psychological, and social needs of older adults. (Essential IX)
5. Intervene to assist older adults and their support network to achieve
personal goals, based on the analysis of the living environment and
availability of community resources. (Essential VII)
AACN/Hartford Competencies
6.
Identify actual or potential mistreatment (physical, mental, or
financial abuse, and/or self-neglect) in older adults and refer
appropriately. (Essential V)
7.
Implement strategies and use online guidelines to prevent and/or
identify and manage geriatric syndromes. (Essentials IV & IX)
8.
Recognize and respect the variations of care, the increased
complexity, and the increased use of healthcare resources inherent in
caring for older adults. (Essentials IV & IX)
9.
Recognize the complex interaction of acute and chronic comorbid
physical and mental conditions and associated treatments common
to older adults. (Essential IX)
10. Compare models of care that promote safe, quality physical and
mental health care for older adults such as PACE, NICHE, Guided
Care, Culture Change, and Transitional Care Models. (Essential II)
AACN/Hartford Competencies
11. Facilitate ethical, noncoercive decision making by older adults and/or
families/caregivers for maintaining everyday living, receiving treatment,
initiating advance directives, and implementing end-of-life care.
(Essential VIII)
12. Promote adherence to the evidence-based practice of providing
restraint-free care (both physical and chemical restraints). (Essential II)
13. Integrate leadership and communication techniques that foster
discussion and reflection on the extent to which diversity (among
nurses, nurse assistive personnel, therapists, physicians, and patients)
has the potential to impact the care of older adults. (Essential VI)
14. Facilitate safe and effective transitions across levels of care, including
acute, community-based, and long-term care (e.g., home, assisted living,
hospice, nursing homes) for older adults and their families. (Essentials
IV & IX)
AACN/Hartford Competencies
15. Plan patient-centered care with consideration for mental and physical
health and well-being of informal and formal caregivers of older adults.
(Essential IX)
16. Advocate for timely and appropriate palliative and hospice care for
older adults with physical and cognitive impairments. (Essential IX)
17. Implement and monitor strategies to prevent risk and promote quality
and safety (e.g., falls, medication mismanagement, pressure ulcers) in
the nursing care of older adults with physical and cognitive needs.
(Essentials II & IV)
18. Utilize resources/programs to promote functional, physical, and mental
wellness in older adults. (Essential VII)
19. Integrate relevant theories and concepts included in a liberal education
into the delivery of patient-centered care for older adults. (Essential I)
Question
Which of the following is NOT performed
by gerontological nurses?
a)Maximize patient independence
b)Evaluate the effectiveness of their care
c)Identify the strengths and limitations of their
patients
d)Prescribe medications for common conditions
of aging
The AACN/John A. Hartford
Foundation Competencies are helpful
to nurses because they:
A. offer suggestions about how to gain
employment in geriatrics
B. provide a guideline for the knowledge that is
expected to provide quality care to older
adults
C. were designed to prepare nurses to pass the
State Board Exam
D. were written for nurses working on a
graduate degree in gerontology
Summary
• Gerontological nursing is a specialty practice
focusing on the unique needs of older adults and
their families.
• Caring for older adults is influenced by many
factors, including recognizing one’s own attitude
about aging.
• As the older population grows, more
gerontological nurses will be needed.