Ebersole & Hess’ Toward Healthy Aging: Human Needs and Nursing Response

315 Pages·2015·44.3 MB·English

by  Theris A. Touhy

Ebersole and Hess' Toward
Healthy Aging
Human Needs and Nursing
Response
NINTH EDITION
Theris A. Touhy, DNP, CNS, DPNAP
Emeritus Professor, Christine E. Lynn College of Nursing, Florida Atlantic
University, Boca Raton, Florida
Kathleen Jett, PhD, GNP-BC
Gerontological Nurse Practitioner, Senior Care Clinic at Oak Hammock,
Department of Aging and Geriatric Research, University of Florida, College
of Medicine, Gainesville, Florida
To my three sons and daughters-in-law, thanks for surrounding me with love
and family. To my husband, just thanks for loving me for 47 years even
though it's not always easy!
To my beautiful grandchildren, Colin, Molly, and Auden Touhy. Being your
Grama TT makes growing older the best time of my life and I love you.
To all the students who read this book. I hope each of you will improve the
journey toward healthy aging through your competence and compassion.
To all of my students who have embraced gerontological nursing as their
specialty and are improving the lives of older people through their practice
and teaching.
To the wise and wonderful older people whom I have been privileged to
nurse, and to their caregivers. Thank you for making the words in this book
a reality for the elders for whom you care, and for teaching me how to be a
gerontological nurse.
Theris A. Touhy
To my patients and others who teach me every day about the highs and lows
of the furthest reaches of age and what really matters the most in life.
To my husband Steve, for his patience during the year I worked on this
edition, with little time for anything else.
To the staff at The Diner where I wrote and re-wrote for many hours in a
place with no distractions and a sunny window. They always kept my iced
tea glass full, knew what I wanted to eat, and how I liked it cooked!
I thank them.
And to Dr. Michael Johnson, who pushes me to grow and helps my soul
seek peace.
Kathleen Jett
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Theris A. Touhy, DNP, CNS, DPNAP, has been a clinical special long-term care, assisted living and hospice, researcher and
ist in gerontological nursing and a nurse practitioner for over teacher, and advanced practice as both a clinical nurse specialist
35 years. Her expertise is in the care of older adults in nursing and nurse practitioner. Dr. Jett received her bachelor's, master's,
homes and those with dementia. The majority of her practice as and doctoral degrees from the University of Florida, where
a clinical nurse specialist and nurse practitioner has been in the she also holds a graduate certificate in gerontology. In 2000 she
long-term care setting. She received her BSN degree from was selected as a Summer Scholar by the John A. Hartford
St. Xavier University in Chicago, a master's degree in care of the Foundation-Institute for Geriatric Nursing. In 2004 she
aged from Northern Illinois University, and a Doctor of Nursing completed a Fellowship in Ethno-Geriatrics through the Stan
Practice from Case Western Reserve University. Dr. Touhy is an ford Geriatric Education Center. Dr. Jett has received several
emeritus professor in the Christine E. Lynn College of Nursing awards, including recognition as an Inspirational Woman of
at Florida Atlantic University, where she has served as Assistant Pacific Lutheran University in 1998 and 2000 and for her excel
Dean of Undergraduate Programs and taught gerontological lence in undergraduate teaching in 2005 and Distinguished
nursing and long-term, rehabilitation, and palliative care nurs Teacher of the year within the Christine E. Lynn College of
ing in the undergraduate, graduate, and doctoral programs. Her Nursing at Florida Atlantic University. A board-certified geron
research is focused on spirituality in aging and at the end of life, tological nurse practitioner, Dr. Jett was inducted into the
caring for persons with dementia, caring in nursing homes, and National Academies of Practice in 2006. She has taught an array
nursing leadership in long-term care. Dr. Touhy was the recipi of courses including public health nursing, women's studies,
ent of the Geriatric Faculty Member Award from the John A. advanced practice gerontological nursing, and undergraduate
Hartford Foundation Institute for Geriatric Nursing in 2003, is courses in gerontology. She has coordinated two gerontological
a two-time recipient of the Distinguished Teacher of the Year in nurse practitioner graduate programs and an undergraduate
the Christine E. Lynn College of Nursing at Florida Atlantic interdisciplinary gerontology certificate program. The majority
University, and was awarded the Marie Haug Award for Excel of her research and practice funding has been in the area of re
lence in Aging Research from Case Western Reserve University. ducing health disparities experienced by older adults. The thread
Dr. Touhy was inducted into the National Academies of Practice that ties all of her work together has been a belief that nurses can
in 2007. She is co-author with Dr. Kathleen Jett of Gerontological make a difference in the lives of older adults. She is currently
Nursing and Healthy Aging and is co-author with Dr. Priscilla employed as a nurse practitioner at Oak Hammock, a life-care
Ebersole of Geriatric Nursing: Growth of a Specialty. community associated with the University of Florida, and pro
Kathleen Jett, PhD, GNP-BC, has been actively engaged in vides research consultation for the College of Nursing. In addi
gerontological nursing for over 30 years. Her clinical experience tion to her professional activities, Dr. Jett is actively engaged in
is broad, from her roots in public health to clinical leadership in the lives of her grandchildren in rural High Springs, Florida.
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CONTRIBUTORS REVIEWERS
Debra Hain, PhD, ARNP, ANP-BC, GNP-BC, FAANP Kathleen Koemig Blais, EdD, MSN, RN
Associate Professor/Lead Faculty AGNP Program Professor Emerita
Christine E. Lynn College of Nursing Florida International University
Florida Atlantic University College of Nursing and Health Sciences
Boca Raton, Florida
Miami, Florida
Nurse Practitioner
Department of Hypertension/Nephrology
Sherri Shinn Cozzens, MS, RN, GRN
Cleveland Clinic Florida
Nursing Faculty
Weston, Florida
De Anza College Nursing Program
Maria de los Angeles Ord6iiez, DNP, ARNP/GNP-BC Cupertino, California
Director, Louis and Anne Green Memory and Wellness Center
Memory Disorder Clinic Coordinator Gail Potter, RN, BScN, M. Div., MN, CGNC(C)
Assistant Professor Christine E. Lynn College of Nursing Nursing Faculty
Assistant Professor of Clinical Biomedical Science (Secondary) Department of Health and Human Services
Charles E. Schmidt College of Medicine Selkirk College
Florida Atlantic University Castlegar, British Columbia, Canada
Boca Raton, Florida
P. Janine Ray, RN, CR.RN, MSN, PhD(c)
Lisa Burroughs Phipps, PharmD, PhD
Assistant Professor of Nursing
Assistant Professor
Department of Nursing
Virginia Commonwealth University
Angelo State University
Academic Learning Transformation Lab
Member, Texas Tech University System
Richmond, Virginia
San Angelo, Texas
Jo Lynne Robins, PhD, RN, ANP-BC, AHN-C, FAANP
Assistant Professor Ann Christy Seckman, DNP, MSN-FNP, RN
Virginia Commonwealth University Associate Professor
School of Nursing Goldfarb School of Nursing
Department of Family and Community Health Barnes-Jewish College
Richmond, Virginia St. Louis, Missouri
JoAnn Swanson, MSN, RN-BC, ONC
Assistant Professor
BSN Program Director
Bellin College School of Nursing
Green Bay, Wisconsin
vi
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In 1981, Dr. Priscilla Ebersole and Dr. Patricia Hess published ORGANIZATION OF THE TEXT
the first edition of Toward Healthy Aging: Human Needs and
Toward Healthy Aging has 36 chapters, organized into 5 sections.
Nursing Response, which has been used in nursing schools
Section 1 introduces the theoretical model on which the text
around the globe. Their foresight in developing a textbook that
is based and discusses the concepts of health and wellness in
focuses on health, wholeness, beauty, and potential in aging has
aging and the roles and responsibilities of gerontological nurses
made this book an enduring classic and the model for geronto
to provide optimal and informed caring. It includes a discus
logical nursing textbooks. In 1981, few nurses chose this spe
sion of the changing population dynamics around the globe as
cialty, few schools of nursing included content related to the
more and more persons live longer and longer.
care of elders, and the focus of care was on illness and problems.
Section 2 provides the reader with the basic information
Today, gerontological nursing is a strong and evolving specialty
needed to perform the day-to-day activities of gerontological
with a solid theoretical base and practice grounded in evidence
nursing such as assessment, communication, and interpretation
based research. Dr. Ebersole and Dr. Hess set the standards for
of laboratory tests.
the competencies required for gerontological nursing education
Section 3 explores concerns that may affect functional abilities
and the promotion of healthy aging. Many nurses, including us,
in aging such as vision, hearing, elimination, sleep, physical activ
have been shaped by their words, their wisdom, and their pas
ity, and safety and security. Nursing interventions to enhance
sion for care of elders. We thank these two wonderful pioneers
wellness, maintain optimal function, and prevent unnecessary
and mentors for the opportunity to build on such a solid foun
disability are presented.
dation in the three editions of this book we have co-authored.
Section 4 goes into more depth regarding the chronic disor
We hope that we have kept the heart and spirit of their work, for
ders covered in just one chapter in previous editions. Among
that is truly what has inspired us, and so many others, to care
these are chapters on mental health and neurodegenerative
with competence and compassion.
We believe that Toward Healthy Aging is the most compre disorders such as Alzheimer's and Parkinson's diseases.
Section 5 moves beyond illness and functional limitations that
hensive gerontological nursing text available. Within the covers,
may occur in aging and focuses on psychosocial, legal, and ethical
the reader will find the latest evidence-based gerontological
issues that affect elders and their families/significant others. Content
nursing protocols to be used in providing the highest level of
ranges from the economics of health care to sexuality and palliative
care to adults in settings across the continuum. The content is
care. Aging is presented as a time of accomplishing life's tasks,
consistent with the Recommended Baccalaureate Competencies
developing and sharing unique gifts, and reflecting on the meaning
and Curricular Guidelines for the Nursing Care of Older Adults
of life. Wisdom, self-actualization, creativity, spirituality, transcen
and the Hartford Institute for Geriatric Nursing Best Practices
dence, and legacies are discussed. The unique and important
in Nursing Care to Older Adults. The text has been on the list of
contributions of elders to society, and to each of us, calls for nurses
recommended reading for the ANCC Advanced Practice Exam
to foster appreciation of each older person, no matter how frail.
for many years and is recommended as a core text by geronto
logical nursing experts. Toward Healthy Aging is an appropriate
text for both undergraduate and graduate students and is an KEY COMPONENTS OF THE TEXT
excellent reference for nurses' libraries. This edition makes an
A Student Speaks/An Elder Speaks: Introduces every chapter
ideal supplement to health assessment, medical-surgical, com
to provide perspectives of older people and nursing students on
munity, and psychiatric and mental health textbooks in pro
chapter content
grams that do not have a freestanding gerontological nursing
Learning Objectives: Presents important chapter content and
course.
student outcomes
Information about evidence-based practice is presented
where available. A holistic approach, addressing body, mind, Promoting Healthy Aging: Implications for Gerontological
Nursing: Special headings detailing pertinent assessment and
and spirit, along a continuum of wellness, and grounded in car
interventions for practice applications of chapter content
ing and respect for person, provides the framework for the text.
Key Concepts: Concise review of important chapter points
The ninth edition has been totally revised to facilitate student
Nursing Studies: Practice examples designed to assist students
learning. Several new chapters have been added to expand and
in assessment, planning, interventions, and outcomes to pro
update content areas from previous editions. We present aging
mote healthy aging
within a cultural and global context in recognition of diversity
Critical Thinking Questions and Activities: Assist students in
of all kinds and health inequities which persist. We hope to
developing critical thinking skills related to chapter and nursing
encourage readers to develop a world view of aging challenges
study content and include suggestions for in-classroom activi
and possibilities and the significant role of nursing in promot
ties to enhance learning
ing healthy aging.
vii
Preface
Research Highlights Box
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lips for Best Practice Box
Preface
Research Questions: Suggestions to stimulate thinking about unique case studies and class activities that can be shared with
ideas for nursing research related to chapter topics students
Boxes Students
Safety Alerts: QSEN competencies and safety issues related to Student Review Questions: Open-ended study questions cov
care of older adults ering nearly every element of each chapter
Research Highlights: Summary of pertinent current research Case Studies: Accompanying select chapters, these provide
related to chapter topics short case studies with questions to help students see content
Resources for Best Practice (New to the ninth edition): Sugges put into practical use
tions for further information for chapter topics and tools for
practice
ACKNOWLEDGEMENTS
Tips for Best Practice (New to the ninth edition): Summary of
evidence-based nursing interventions for practice This book would not have been possible without the support
Healthy People: Reference to the goals cited in Healthy and guidance of the staff at Elsevier. Especially Karen C. Turner,
People 2020 who listened to all of our suggestions and concerns and under
stood how important this work was to us and to nursing stu
EVOLVE ANCILLARIES dents. Special thanks also to Sandra Clark, Content Strategist
and Tracey Schriefer, Project Manager. We also acknowledge
Instructors
our reviewers and contributors, because without their efforts
Test Bank: Hundreds of questions with rationales to use in this edition would not have been possible. Finally, we acknowl
creating exams edge the past and future readers who, we hope, will provide us
PowerPoint: Lecture slides for each chapter, including with enough feedback to keep us honest in any future writing.
integrated audience response questions Theris A. Touhy
Teach for Nurses Lesson Plans: Detailed listing of resources Kathleen Jett
available to instructors for their lesson planning, and including
PART 1 Foundations of Healthy Aging 7 Health Assessment. 74
Kathleen Jett
1 Health and Wellness in an Aging Society, 1 The Health History, 75
Kathleen Jett and Theris A. Touhy Physical Assessment, 75
The Years Ahead, 2 Functional Assessment, 79
Aging,3 Function and Cognition, 81
A Wellness-Based Model, 6 Assessment of Mood, 82
Disease Prevention and Health Promotion Comprehensive Geriatric Assessment, 84
for Older Adults, 8
8 Laboratory Values and Diagnostics, 88
2 Gerontological Nursing: Past. Present, and Future, 13
Kathleen Jett
Theris A. Touhy Hematological Testing, 88
Care of Older Adults: A Nursing Imperative, 13 Measures of Inflammation, 91
Development of Gerontological Nursing, 14 Vitamins, 91
Gerontological Nursing Education, 18 Blood Chemistry Studies, 92
Organizations Devoted to Gerontology Uric Acid, 94
Research and Practice, 18 Prostate-Specific Antigen, 94
Research on Aging, 19 Laboratory Testing for Cardiac Health, 94
Gerontological Nursing Roles, 20 Testing for Body Proteins, 95
Transitions Across the Continuum: Laboratory Tests of Renal Health, 96
Role of Nursing, 23 Monitoring for Therapeutic Blood Levels, 96
Urine Studies, 97
Appendix 2-A Recommended Baccalaureate Competencies
and Curricular Guidelines 9 Geropharmacology, 101
for the Nursing Care of Older Adults, 29
Kathleen Jett
3 Theories of Aging, 31 Pharmacokinetics, 101
Pharmacodynarnics, 104
Kathleen Jett
Biological Theories of Aging, 31 Issues in Medication Use, 104
Psychosocial Theories of Aging, 35 Safe Medication Use, 111
4 Cross-Cultural Caring and Aging, 40 10 The Use of Herbs and Supplements, 115
Jo Lynne Robins and Lisa Burroughs Phipps
Kathleen Jett
Culture and Health Care, 40 Standards in Manufacturing, 116
Herb Forms, 116
Diversity, 41
Health Inequities and Disparities, 41 Select Commonly Used Teas, Herbs, and
Obstacles to Cross-Cultural Caring, 42 Supplements, 117
Use of Herbs and Supplements for Select
Providing Cross-Cultural Health Care, 43
Integrating Concepts, 50 Conditions, 121
Herb and Supplement Interactions with
5 Cognition and Learning, 54 Standardized Drugs, 122
Theris A. Touhy
Adult Cognition, 54
Learning in Later Life, 57 PART 3 Wellness and Function
Health Literacy, 60
11 Vision, 130
Theris A. Touhy
PART 2 -F-ou-n-da~tio~ns o.f. C.a.r.in;g= --------- Changes in Vision with Age, 130
Visual Impairment, 132
6 Communicating with Older Adults, 65
Diseases and Disorders of the Eye, 133
Theris A. Touhy
Ageism and Communication, 66 12 Hearing, 142
Therapeutic Communication with Older Adults, 67 Theris A. Touhy
The Life Story, 67 Hearing Impairment, 142
Communicating with Groups of Older Adults, 70 Interventions to Enhance Hearing, 144
Tinnitus, 149