Nursing work in gerontological wards involves many responsibilities and competencies that health care personnel should consider providing quality care for targeted patients. Interaction with older adults requires following specific guidelines due to distinctive therapeutic patterns and unique rehabilitation regimens. In this regard, gerontological nursing is associated with a number of professional objectives that are essential to meet to create an effective nursing environment. This paper is aimed at describing eight common objectives and presenting the corresponding scenarios and rationale supporting specific concepts and decision-making approaches. Personal reflection is a tool to assess the value of these goals as applied to individual nursing practice. The older adult population, as a target audience in gerontology, needs increased attention and care, and productive nurse-patient interactions include a wide range of concepts and competencies to take into account.
Client-Centered and Culturally Competent Care
Gerontological nursing is an individual industry and involves different methods of care. Sanerma et al. (2020) offer to pay attention to the practices promoted by medical personnel and mention the principles of self-care, family members’ participation, communication to build partnership relationships, and evidence-based service principles. Each of these methods has unique approaches to engagement, but they are all based on a client-centered strategy. For instance, as Pakkonen et al. (2021) note, self-care is an important part of nursing procedures as it educates target patients and raises their clinical awareness. Engaging third parties, particularly family members, is a more common practice because, unlike self-care and evidence-based service, this care method includes additional psychological support (Sanerma et al., 2020). An equally important criterion is the adherence to cultural competencies in gerontological nursing. According to Mauk et al. (2018), cultural awareness is a crucial feature of a gerontological nurse, and such factors as diversity and potential health disparities are crucial to address. These aspects of cultural competence are indispensable in the implementation of client-oriented care.
Meeting these objectives is critical to my nursing practice because professional development depends on the ability to interact with patients and address their needs competently. I intend to adhere to a client-centered approach as this principle allows maintaining communication with the target audience as closely as possible, increasing the success of nursing interventions. Following the aspects of cultural competence carries significance to me as an integral working guideline, reflecting my nursing qualities, such as compassion, impartiality, and professionalism.
Interaction with older patients requires not only professionalism and respect for cultural competence but also continuous professional development to enhance the principles of nursing care. In this regard, the concept of intentional learning appears as a significant aspect of work in the gerontological field. Boscart et al. (2020) describe this phenomenon as an ongoing effort to share knowledge and expand professional competencies to improve senior care. The authors also mention some concepts related to this definition and highlight “professional learning and mentoring environment” and “intentional exposure to skills and behaviors” (Boscart et al., 2020, p. 464). The first one reflects an environment where a nurse can receive educational support from senior colleagues and look forward to participating in relevant academic programs related to professional development. The second concept is related to behavioral factors and involves adaptation to specific working conditions based on the needs of the target audience. Both concepts are valuable and contribute to improving individual competencies as part of a continuous workflow.
Following the intentional learning, the approach can help me self-develop professionally and establish sustainable and productive communication with my colleagues. In addition, in my practice, I will be able to constantly expand the range of skills through continuous learning, which aligns with the principle of professional nursing growth. An opportunity to draw valuable experiences from the current workflow is a significant prospect, and working in an environment where there are conditions for increasing individual knowledge is a valuable perspective for me.
Evidence-based activities are extremely important in gerontological nursing, given the need to provide comprehensive and qualified care to targeted patients. Appropriate concepts used in practice make it possible to justify specific interventions and rule out errors, which is crucial for older people due to their fragile health. One of such concepts is reminiscence therapy, which involves interacting with patients through their past experiences to create an effective communication environment. Scales et al. (2018) confirm that this approach is relevant to gerontological nursing and may increase patients’ psychological well-being. The authors also mention “the concept of honoring the feelings,” which refers to the principle of person-centered care (Scales et al., 2018, S95). Gerontology staff should treat patients concerning not only meeting their needs but also using adequate assistance algorithms that do not contradict their moral and ethical beliefs and are consistent with evidence-based care principles.
In my personal practice, using the aforementioned concepts can help me build productive communication with patients and gain their trust. I know that older people tend to be suspicious of health employees, especially younger ones. By utilizing evidence-based concepts, I will be able to convince target patients of the relevance of appropriate nursing steps and help them adapt to the treatment environment. In addition, these concepts will help me better understand people’s individual needs, strengthening patient-centered interventions.
Decision-making skills in gerontological nursing are important and require adherence to evidence-based concepts, including clinical reasoning. An example of work requiring adequate analysis and timely action is pressure ulcer prevention activities. Buh et al. (2021) address this problem and note that decision-making, in this case, should be based on specific protocols that are designed to address the difficulties of immobility among older patients and to prevent skin damage. Nurses should assess patients’ conditions and analyze the predisposition to such a problem by assessing different risk factors. The same goes for the practice of preventing falls among the elderly. Decisions are to be based on a multi-dimensional view of risk factors and cannot be biased (Meyer et al., 2019). As a result, clinical reasoning manifests itself through a comprehensive analysis of the accompanying circumstances and an adequate assessment of all possible impacts.
I happened to take part in the work related to the two aforementioned scenarios. I studied the methods of caring for patients with pressure ulcers and learned how to timely determine their predisposition to this problem. This, in turn, helped me reduce the number of people with such problems in my department as I adhered to the guidelines prescribed in the special protocols. With regard to the problem of falls, I was also involved in the team responsible for the development of the program to minimize this issue. After reviewing relevant literature and evidence-based concepts, I implemented appropriate surveillance methods for patients at risk. This paid off and helped me develop valuable skills in critically evaluating all risk factors.
Leadership in the Community
The relevance of sustainable and reasonable leadership in communities makes it possible for older patients to be involved and has a positive impact on their well-being. Locally, as Carver et al. (2018) argue, services to this population often lack adequate support due to limited resources or workforce. At the organizational level, patient involvement in the community improves health outcomes. Amagasa et al. (2017) note that, based on the research results, community involvement helps reduce stress among the elderly population, while ignoring this factor, conversely, may cause the development of psychological disorders. Globally, leadership in gerontology is based on recruiting patients from different cultural backgrounds (Carver et al., 2018). Involving this population in the community reduces health risks and, at the same time, increases the likelihood of successful care by communicating to these patients the importance of their well-being to medical personnel.
While involved in the senior citizen engagement program, I participated as a consultant for these citizens and served as a patient engagement officer in the community. This required me to know all the nuances of care since my task was to describe the prospects for such participation for older people. I learned that not all patients in this age group realized the value of being involved in the community, and I educated them about all the benefits. Our leadership encouraged the involvement of young employees, and this interaction was an important experience for me, which helped me hone my communication and consulting skills.
The quality of communication with target patients is one of the most important criteria reflecting the effectiveness of care and the productivity of nursing staff. In this regard, it is customary to distinguish between therapeutic and non-therapeutic types of communication. The first type involves creating a friendly environment in which compassion and respect for patients are promoted (Mpangane et al., 2021). This concept is positively associated with patient trust and does not imply bias on any criteria. The concept of non-therapeutic communication is opposite in its specificity and does not address the aforementioned factors. As Rababa et al. (2021) argue, this approach reflects negatively on older patient outcomes and is based on patronage rather than care. Unlike the first concept, this principle is ineffective in terms of establishing trusting relationships and can aggravate the psychological state of the elderly. Thus, the promotion of therapeutic communication is associated with more favorable patient outcomes and is consistent with the principle of person-centered care.
In my practice, I have always tried to promote therapeutic communication as the main approach to interacting with older patients. However, I have witnessed how some colleagues used the other practice. The main reason for this was accumulated fatigue and the lack of desire to give all the best, often due to professional burnout. I can understand their concerns, but I believe that regardless of personal factors, the task of a competent gerontological nurse implies full responsibility toward patients and the exertion of maximum effort. My belief in the need for therapeutic communication helped me find individual approaches for each patient, and the care regimen was not complicated by mistrust or other obstacles.
When caring for older patients, following culturally-competent practices is essential for several reasons. This population is morally and physically vulnerable, and any manifestations of unethical behavior on the part of nursing staff are fraught with deterioration in patient health outcomes. One of the concepts of safe care is the strategy of protective truthfulness, which, according to Periyakoil (2019), allows the protection of targeted patients from unwanted information that could worsen their condition. The author also suggests respect for individual autonomy as a concept that addresses the ethical aspects of the provider-patient interaction (Periyakoil, 2019). This approach also addresses the safety of the population as distinctive cultural practices specific to each case are to be respected in order for the patient to feel protected. From a cultural perspective, the concepts of distress should be considered as distinctive features of each patient individually. Respect for a personal background and the assessment of potential constraints, such as a language barrier, are important strategies to create a culturally-competent care environment.
When faced with a situation in which I would have to make a choice of whether to follow safety or cultural practice, I would assess all the attendant factors before making a specific decision. In some cases, the problem may be solved relatively easily, for instance, when the patient’s health literacy level is insufficient to understand all nursing prescriptions. Explaining the peculiarities of the care regimen in clear words can help avoid negative health outcomes and, at the same time, not offend the patient’s dignity. In more difficult cases, I would opt for safety since ignoring this criterion is fraught with more severe consequences than cultural omissions.
The team approach to caring for older patients is a mechanism to address the problems of the target population comprehensively by combining efforts and organizing an effective algorithm of interventions. Dham et al. (2017) give an example of collaborative care for patients with mental disorders. The authors’ findings relate to the specifics of such work, particularly the distribution of roles, joint discussions, and other features of team practice. Giuliante et al. (2018) give a similar example of working together in an interdisciplinary team, but their scenario is different from the previous one. Team members interact less frequently, and the emphasis is on personal contributions rather than collaborative efforts. The latter example may be characterized by weaker teamwork, but both approaches, nevertheless, carry a greater likelihood of successful interventions than outside the team. According to Giuliante et al. (2018), nurses individual of are associated with greater responsibility and more frequent mistakes, for instance, incorrect medication management, since there are no tips from colleagues. Therefore, team practice is important for improving older patient outcomes and as a safe strategy.
By studying readings on the team approach to care, I have expanded my knowledge about the value of collaborative practices and the mistakes that individual work is fraught with due to increased responsibilities. I have also evaluated different scenarios of interventions and found that when working as a team, nurses are more confident in their abilities and show a desire to make a personal contribution. Thus, I am confident that teamwork in gerontological nursing is no less important than in other areas.
Gerontological nursing objectives include a set of goals to follow and competencies to pursue while caring for older patients. The considered list of aims with specific scenarios and examples confirms the need to constantly improve personal nursing skills and enhance the quality of communication with the target population. The objectives influence different aspects of professional activities, and in the aggregate, they allow for achieving positive patient outcomes in case of successful work. In my nursing practice, these objectives are significant goals to pursue to increase my competencies and establish productive interaction with older patients needing constant care.
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