Unit 10: Guidelines for Effective Documentation

Introduction.

Documentation is a vital part of the course of treatment

because:

 it assures the quality of service rendered

 the continuity of care
 the quality of service
 protection of the client and the practitioner.

Nursing documentation is
significant for excellent
clinical communication.
Appropriate documentation
provides:

 an accurate reflection of nursing assessments

 changes in clinical state
 care provided
 pertinent patient information to support the
multidisciplinary team to deliver excellent care.

This module is divided into four (4) lessons:

Lesson 1 Importance of Documentation

Lesson 2 Privacy and accountability
Lesson 3 Methods and formats
Lesson 4 Principles of good documentation

Objective:
Upon completion of this module, the student may to:
1. Design functional, user-friendly process documentation that allows and
enhances access to documentation.
2. Develop innovative documentation education programs
3. Evaluate the quality and efficiency of documentation requirements
4. regularly
5. Design necessary improvements to the documentation of policies,
procedures, and systems
6. Explain to patients and other third party’s information about the availability,
use, and dissemination of the system; provide and patient-specific
information, records, and data
Lesson 10.1_ Importance of Documentation

Introduction.

Why is documentation so significant in healthcare?

 It was necessary for good clinical communication.

 It provides an accurate reflection of nursing assessments, changes in clinical
state, care provided, and pertinent patient information to support the
multidisciplinary team to deliver excellent care.
 It helps in the continuity of care.
 Clear and concise medical record documentation is critical to:
o providing patients with quality care
o ensuring accurate and timely payment for the services furnished
o mitigating malpractice risks
o helping healthcare providers evaluate and plan the patient's treatment
and maintain the continuum of care.
 It helps ensure consent and expectations. It helps to tell the narrative for
decisions made and how yourself or the client responded to different
situations.
 It is important to record information that can help support the proper treatment
plan and the reasoning for such services.
 It also serves proof of any complaints and can also be used in court as
legalities are needed.
 It helps to determine if the treatment produces successful outcomes.
 It helps in teamwork among other team members. It also can be used
as an endorsement to other health care workers in your absence.
 It is beneficial to track down the progress of the improvement of your
patient.
 Documentation of nurses' work is critical for effective communication
with each other and with other disciplines. It is how nurses create a
record of their services for use by payors, the legal system,
government agencies, accrediting bodies, researchers, and other
groups and individuals directly or indirectly involved with health care.
  It also provides a basis for demonstrating and understanding nursing's
contributions both to patient care outcomes and to the viability and
effectiveness of the organizations that provide and support quality
patient care.

 Documentation is sometimes viewed as burdensome and even as a

distraction from patient care but, high-quality documentation is a
necessary and integral aspect of the work of registered nurses in all
roles and settings.

 Nurses should be provided with sufficient time and resources to

support documentation activities.

 At a time when accessing, generating, and sharing information in

health care is rapidly changing, it is particularly important to articulate
and reinforce principles that are basic to useful documentation of
nursing services.

 The pace of innovation and adoption of the digital technologies of such

documentation requires to include:
o issues of accuracy
o confidentiality
o security of patient documentation

http://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-
nursing-documentation.pdf

The Uses of Nursing Documentation Nurses document their work and

outcomes for several reasons:

Communication within the Health Care Team

 Nurses and other health care providers aim to share information about
patients and organizational functions that is accurate, timely, contemporary,
concise, thorough, organized, and confidential.

Credentialing Nursing documentation

 such as patient care documents, assessments of processes, and outcome
measures across organizational settings, serve to monitor the performance of
health care practitioners' and the health care facility's compliance with
standards governing the profession and provision of health care.

Legal
Legal Patient clinical reports, providers’ documentation, administrators’ records, and
other documents related to patients and organizations providing and supporting
patient care are vital evidence in legal matters.
Regulation and legislation
Audits of reports and clinical documentation provide a method to evaluate and
improve the quality of patient care, maintain current standards of care, or provide
evaluative evidence when standards require modification in command to achieve the
goals, legislative mandates, or address quality initiatives.

Reimbursement
Documentation is applied to determine the severity of illness, the intensity of
services, and the quality of care provided upon which payment or reimbursement of
health care services remains established.

Research
Data from documentation provides information about patient characteristics and care
outcomes. Evaluation and analysis of documentation data are essential for attaining
the goals of evidence-based practice in nursing and quality health care.

Quality process and performance improvement

Documentation is the primary source of evidence used to continuously measure
performance outcomes against predetermined standards of individual nurses, health
care team members, groups of health care providers (such as units or code teams),
and organizations. The data from such analytic activities inform quality improvement
activities and evaluations of organizational effectiveness.

nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nursing-
documentation.pdf
Title Lesson 10.2_Privacy and accountability
Duration: one (1) hour

CONCEPTS AND VALUE OF PRIVACY

Definitions
 Privacy refers to the right to control access to oneself and includes physical
privacy, such as ensuring curtains are closed during physical examinations.

 It is a restriction put by an individual on access to his/her bodily and mental

integrity

 The concept of privacy does not have a widely accepted definition. It is

typically known as a fundamental human need and a human right.

 Privacy has been well-defined as the regulator of a situation, freedom of

choice, mutual interaction, avoidance of communication, and an unreachable
area.

 Privacy, aside from being a fundamental quality of human beings and bearing
an essential value in its own right, is an instrumental 'good' that enables
individuals to achieve other suitable deals.

 Autonomy is a fundamental value of being a human. If privacy constitutes

essential to independence and freedom cannot be understood without
privacy, then losing privacy poses a threat to our most fundamental values.

The Right to Privacy

 Private life or privacy generally refers to a sphere where individuals can
remain on their own, think and behave as they like, and decide themselves
personally where, when, and under which conditions to communicate and
have a relationship with others and the right to control this sphere.

 The right to privacy means equal to the right of an individual to be left on their
own. The general law guarantees individuals' right to determine to which
extent they communicate feelings and ideas.
  The right to privacy or confidentiality, characterized by the right to self-
determination, provides individuals with moral authority about their
characteristics.

 Privacy is the right to autonomy and comprises the right to be left alone. It
provides individuals with the right to control the information related to them,
including the restriction of access to this information.

 It also involves the right to keep secrets confidential and share them only in
private conversations.

Patients' Right to Privacy

 A patient's right to privacy involves the confidentiality of information related to
the patient and the bodily privacy of the patient

 Confidentiality and privacy are vital for establishing and maintaining a

significant and respectful clinical relationship.

 The right to privacy constitutes social merit as it encourages the explicit

discussion of health-related problems between clinicians and patients.

 Privacy requires physicians to keep confidential information that patients

provide or obtain in their professional interaction with patients.

 Privacy is vital as it provides a secure environment for patients where they

receive medical care and provide complete and accurate information, and
which reinforces confidence in health care and emphasizes the importance of
respect for patient autonomy.

Accountability
 Health service providers are accountable to the criminal and civil courts to
ensure their activities meet legal requirements.

 The employees are accountable to their employer to follow their contract of

duty.

 Registered practitioners are also accountable to regulatory bodies in terms of

standards of practice and patient care.

 Registered nurses and midwives are professionally accountable to the

Nursing and Midwifery Council (NMC).

 The law imposes a duty of care on practitioners, whether HCAs, APs,

students, registered nurses, doctors, or others.

 The duty of care applies whether they perform specific activities such as
bathing patients or undertaking complex surgery.

 All practitioners must ensure that they perform competently and that they don't
work beyond their level of competence.
  They must inform a senior member of staff when they are unable to perform
competently.

 To be accountable through delegation and the policies and protocols of the

organization, practitioners must:

o have the ability to perform the activity or intervention

o accept responsibility for doing the activity
o have the authority to perform the activity

cn.org.uk/professional-development/accountability-and-delegation

Confidentiality
 Nurses are legally and ethically obligated to keep all patient information
confidential.
 Nurses are responsible for protecting records from all unauthorized readers.
o Only the members who are directly involved with patient care have
legitimate access to medical records.
o Be mindful of what's on your screen and what people can see - HIPPA
requires that disclosure regarding health information be limited to the
minimum necessary.
o Be very precise; don't give more information than what people need.
o Review records on a need to know basis only.

Privacy, Confidentiality, and Security Mechanisms

 Electronic documentation has legal risk - Most security mechanisms for
computerized information systems use logical and physical restrictions to
protect information.
o Prioritized protection of computer systems.
o Must have an IT group who goes around to check
o Be careful with access codes and passwords
 Physical security measures include placing computers or file servers in
restricted areas or using privacy filters for computer screens visible to visitors
or others without access.
o If you have patient information, make specific identifiers detached
from documents, mostly if you leave the form.
o Identifiers can include where the patient works, address, the reason
for admission or treatment.
 Title Lesson 10. 3_Methods and formats

Duration one (1) hour

You are now going to learn the different methods and formats of how you will write
your charting. But it depends on the institution what is their preferred formats.

Documentation of nursing care

Purpose:
1. Provides a written record of the history, care, and response of the client
while under the supervision of the health provider.
2. It is a guide for the reimbursement of care.
3. It serves as evidence of care in the court.
4. It shows the use of the nursing process.
5. It provides data for research studies.
6. It can serve as legal record evidence of events of treatments given.
7. It contains observations about the patients' conditions, cares, then treatment
set.
8. It will show progress toward expected outcomes.

Methods of Documentation (Charting)

A. A source-oriented (narrative) charting
B. Problem-oriented medical record (POMR) charting
C. Focus charting
D. Charting by Exception
E. Computer-assisted charting
F. Case management system charting

Source oriented / narrative Charting

 Organized according to the source of information
 Separate forms for nurses, physicians, and other health
care professionals to document assessment findings and
plan patient care.
  Narrative charting requires documentation of patient care
in chronologic order

Advantages
 Information in chronologic order
 Documents the patient's baseline condition for each shift
 Indicates aspects of all steps of the nursing process

Disadvantages
 Documents all finding: makes it difficult to separate
pertinent from irrelevant information
 Requires extensive charting time by the staff
 Discourages physicians and other health teams from
reading.
o Example of narrative charting

Problem-oriented medical record charting (POMR)

 Focuses on patient status rather than on medical or
nursing care
 Basic parts:
o Database
o Problem list
o Plan
o Progress notes
o Discharge summary

Advantages:
 Focus on patients' problems
 Promotes a problem-solving approach to care
 Improves continuity of care by writing relevant data
 Allows easy audit on patients record in evaluating staff performance or quality
patient care
 Constant evaluation and revision of care plan - Reinforces application of the
nursing process

Disadvantages
 Results in loss of chronologic charting
 More challenging to tract trends in patient status
 Fragments data because more flow sheets are required.
PIE charting
P- Problem identification
I - Interventions
E – Evaluation
  Follows the nursing process and uses nursing diagnoses while placing the
plan of care within the nurse's progress notes

Example of pie charting

Focus Charting

 They are focus on nursing diagnosis, patient problem, concern, sign,

symptom, or event.
 Components:
a. D: date A: action R: response (DAR)
b. D: data A: action E: evaluation (DAE)

Advantages
 Compatible with the use of the nursing process
 Shortens charting time, many flow sheets, checklist

Disadvantages
 If the database insufficient, patient problems missed
 It doesn't adhere to charting with the focus on nursing diagnoses and
expected outcomes.
o Example of focus charting

Charting by Exception
 Based on the assumption that all standards of practice are carried out and
met with a typical or expected response unless documented.
 A longhand note appears when the standardized statement on the form has
encountered

Advantages
 Highlights abnormal data and patients' trends - Decrease narrative charting
time - Eliminates duplication of charting

Disadvantages
 Requires detailed protocols and standards - Requires staff to use unfamiliar
methods of record-keeping and recording
 Nurses so used not to chart that necessary data sometimes omitted.

Computer – Assisted charting

 Electronic health record (HER)
 Computerized form of patient's history and care across all facilities and
admissions
 Automated provider entry (CPOE)
 Provides efficient workflow
 Automatically routs orders to appropriate clinical areas
 Documentation did as interventions and performed using bedside computers
 Variations depending on the system
  Some produce flow sheets with nursing interventions and the expected
outcome

Advantages
 Date and time of the notation automatically recorded - Notes always legible
and easy to read
 Quick communication among departments about patient needs
 Many providers have access to patient's information at one time
 Electronic records can be retrieved very quickly
 Reimbursements for services rendered is faster and complete
 Can provide a full description of the patient's medical history
 Can reduce errors

Disadvantages
 A sophisticated security system is needed to prevent unauthorized personnel
from accessing records.
 The initial cost is considerable
 Implementation can take a long time
 High price and time to train staff to use the system
 Computer downtime can create problems of input, access, transfer of
information

Case management System Charting

 A method of organizing patient care through an episode of illness, so clinical
outcomes are attained within the expected timeframe and at a predictable
cost
 A clinical pathway or interdisciplinary care plan takes the place of the nursing
care plan.

Accuracy in Charting
 Be specific and definite in using words or phrases that convey your wish to
express
 Terms that have ambiguous in meaning and slang should not remain used in
charting

Brevity in charting
 Sentences not necessary
 Articles (a, an, the) must be absent
 The word 'patient" omitted when the subject of the sentence
 Abbreviations, acronyms, symbols acceptable to the agency used to save
time and space
 Choose which behavior and observations are noteworthy

Legibility and Completeness in Charting

 If writing not legible, misperceptions can occur
 Record information about the patients needs and problems and specify
nursing care given for those needs or problems
The Kardex
 Not a part of the permanent medical record
 A quick reference for current information about the patient and ordered
treatments
 Typically consist of a folded card for each patient in a folder that can remain
quickly flipped from one patient to another
Information on the Kardex
1. Room number, patient name, age, readmitting diagnoses, physicians name
2. Date of surgery
3. Diet
4. Scheduled test or procedures
5. Level of activity permitted
6. Notations on tubes, machines
7. Nursing orders for assistive or comfort measures
8. List of medications prescribe
9. IV fluids ordered

Sample Kardex

1. A Kardex maintain for all patients cared for by the college of nursing students. It
fills up when a patient assigns to a student for the first time.
2. It is check and revised as needed, before giving care and daily after doctors
rounds.
Ink for all recordings except the following.
a. A pencil for the recording of:
 Bed no.
 Diagnosis
 Bath type
 T.P.R & B.P. frequency and method
 Diet
 Nursing care plan
 Treatments
 b. Using red ink indicates the time of administration of medications from 7
p.m. to 7 a.m. Black ink suggests administering orders from 7 a.m. to 7
p.m.
3. Only standard abbreviations in writing orders on the Kardex is allowed. Do not
abbreviate the name of the medications.
4. Drawing a red line through the order and writing the date and the initials of the
person canceling the hierarchy above the line will cancel the charges.
5. The medication order should not be scrubbed or overwritten.

METHOD OF FILLING IN KARDEX CARD:

I. Identification Data:
 Use capital letters to record.
 Name – copy accurately and entirely from the admission record
 Diagnosis – Record provisional diagnosis.
 Any change in the working diagnosis should note.
 A scheduled surgical procedure has done as expected.

II. Medication:
a) Write the date, form, and the name of the medication, frequency of
administration in 24 hours, route of administration if other than oral and
specific instructions concerning administration in the column marked
“medication.”
b) In the column marked “Dosage,” Write the amount to be administered at the
time of each administration.
c) In the column marked “time,” write the hours of administration.
d) Stat, P.R.N., and S.O.S. medication orders should not appear in the Kardex
card, but the medicine card should be prepared and inserted in the Kardex.
e) Mark and record medications with the pencil the due dates for three
consecutive dosages.

III. Treatments:
a) In the column marked “treatment,” write the date and name of the treatment,
Example I/V, irrigation, diet, therapy, external applications, baking, frequency
in 24 hours. And if applicable, site, duration, temperature or strength of
solutions, and any special instructions.

IV. Nursing Care Plan

1. Write order relating to needed nursing care plan of the patient such as
Hygienic care
Special Mouth care
 Shampoo
 Posture and position – Frequency in 24 hours
 Activity, rest, and exercise
 Control of pain
 Need for health teaching or nursing care following discharge.
 Need for maintenance of emotions or mental attitudes.
 Food or Fluid – Intake
 Type
 Amount
 Frequency
 Elimination
 Use of comfort devices and safety measures.
 Recreation and diversion.
 Plan to meet the spiritual needs
 In the “time,” column indicate the specific hours for carrying out nursing
care if applicable.
 Bath – Record if bed bath or shower, frequency, and if not daily, the
specific days of the week given the bath care.
 T.P.R. – Record the method of taking if other than oral
 Diet – Record the type of diet ordered, supplementary feedings if ordered.
Limitation of food or fluid, if applicable.
 Health education of;
o Disease
o General
o Family Planning
o Prevention of disease etc.,
Title: Lesson 10.4_Principles of good documentation

Duration: one (1) hour

ANA's Principles for Nursing Documentation identifies six essential principles to

guide nurses in this necessary and integral aspect of the work of registered nurses in
all roles and settings.
 Clear
 Accurate
 accessible documentation is an essential element of:
o safe
o quality
o evidence-based nursing practice.

Documentation must be consistent with the agency's standard, complete, accurate,

concise, factual, organized, and timely, lengthy, prudent, and confidential.

1. Date and time

 Document the date and time of each recording
 Avoid recording in advance.

2. Legibility
Entries must be legible and easy to read
 writing must be clear
 it is vital in recording numbers and medical terms

3. Correct spelling
 Essential for accuracy
 If unsure, use a dictionary or other resource book.
4. Permanence
 Entries must be in dark ink.
 It helps to identify changes and allows duplication.

5. Accepted terminology
 Use commonly accepted abbreviations, symbols, and terms that are
specified by the agency.

6. Factual
 Descriptive objective information about what nurses noticed/professed
hears feels, and smells.
 The use of inference without supporting data is not acceptable.
 Vague terms like appears seem, or apparently, I not accepted.
 Include objective signs of problems.
 Subjective data appear in records exactly how the client's verbalized exact
words within quotation marks.

7. Accurate
 Use of exact measurements.
 E.g., 450 ml amount of water than an adequate amount of water
 Clients' names and identifying information printed on each page.
 Chart only your observations and actions.
 If mistakes occur, draw a line and write your initials
 Do not erase, blot, or use correction fluids.
 Follow agency policies while making computerized charting.
 Write on every line but not in between lines.
 Mark the blank spaces to prevent additional information.

8. Sequence
 Document events in order of occurrence
 Update or delete problems as needed.

9. Appropriateness
 Record only information's regarding patient's health problems and cares
only.
 Avoid inappropriate personal information.

10. Completeness
 Document all necessary information's
 Give a clear picture of what took place.
 Complete pertinent assessment data such as vital signs wound drainage,
client's complaints, who was informed, and what interventions are
approved out, should all be recorded.

The information is recorded in the chart.

1. New changed of information
2. Signs and symptoms
 3. Client behavior
4. Nursing interventions
5. Medications
6. Physicians orders carried out
7. Client teachings
8. Clients response
9. Current
 Timely entries
 Keep record at the bedside facilitates immediate documentation
10. Concise
 Brief and complete
 Use acceptable abbreviation
11. Organized
 Logical manner.
 E.g., Describe pain, nurse's assessment, intervention, and response
 Easy to read.
12. Signature
 The nurse signs each pages.
 name and title of the signatories.
13. Confidentiality
 All clients record are confidential files
 All personal information in the chart is unique and legal.
 The record must not borrow without the permission of the client.
 The nurse should not allow any outsiders to verify the client record.

Activities/findings recorded at the time of occurrence

1. Vital signs
2. Drug administration
3. Diagnostic test and surgeries time of preparation
4. Change of client's health status documented
5. Admission, transfer, discharge, or death of a client
6. Emergency treatment for the sudden change in the client's status is
applicable.

A precise written record listing all aspects of patient monitoring is essential. It forms
an integral part of the provision of care or nursing management of the patient. Still, it
also contributes to the circulation of information among the different teams involved
in the patients' treatment or care.

Documentation and record-keeping are there for the protection of the nurse or health
care professional.

Documentation ensures a matter of professionalism and proof of the improvement of

practices.

Type of Record-keeping used in Healthcare

 Hand-written records
 Electronic
  Computer-based system
 employers will use a combination of both.

Points to consider in record keeping

 ensure that you are up to date on the information systems and tools in the
workplace, including:
o security
o confidentiality
o appropriate usage
 Protect any passwords or details assigned to you to enable your access to
any systems;
 Ensure the safety of written records, including any electronic systems or
displays.
 Ensure that an entry is made in the patient’s medical record whenever a
health professional sees a patient.

Components of a patient’s records:

 Medical records
 Nursing records/progress notes
 Medication charts
 Laboratory orders and reports
 Vital signs/observation charts
 Handover sheets and admission
 Discharge and transfer checklist/letters
 Patients’ assessment forms, such as:
o Nutrition
o Pressure area care

Principles of Good Record Keeping

 Be factual, consistent, and accurate
 Be updated for any recordable event;
 Provide current information on the care and condition of the patient;
 The document clearly the doctors order made through text;
 Be consecutive and accurately dated, timed and all entries signed including
any alterations;
 All original entries should be legible. Draw a line through any changes and
sign and date;
 Avoid usage of abbreviations which is not standard, slang or jargon because
not all workplace or organizations are using the same terminology;
 Records must be stored securely following the local policy;
 Refrain from using a meaningless phrase, speculation, and offensive
subjective statements/insulting or derogatory language;
 Identify the patient by recording a patient’s name, date of birth, and hospital
number on each page of the record based on local policies on identifying the
patient’s history.
 Be legible if photocopied or scanned.
Common Deficiencies in Record Keeping
 An absence of clarity
 Inaccuracies
 Spelling mistakes
 Missing information
 Failure to record unavoidable action.
Benefits of Good Record Keeping
 Record keeping is a tool for professional practice and one that should help the
care process.
 All patient’s procedures should be recorded as soon as possible after the
patient.
 It is essential that an accurate description is made in the patient’s notes and
should include interventions and any response to the interventions.

The importance of good record keeping are:

 Record keeping makes the continuity of care more accessible.
 Record keeping promotes better communication and dissemination of
information between members of the multi-professional team;
 Helps to address complaints or legal processes;
 Supports clinical audit, research, allocation of resources, and performance
planning;
 It helps to identify risks and enables the early detection of complications;
 It supports patient care and patient-centered communication;
 It supports practical clinical judgment;
 It supports the delivery of services;
 It helps improve accountability;
 It shows detailed decisions relating to the patient’s care.

Legal Issues in Record Keeping

 Accept a comprehensive nursing assessment of the patient to include delivery
of care planned.
 The duty of care to the patient has been providing and that no acts or
omissions have compromised a patient’s safety;
 Arrangements have been complete for the ongoing care of the patient.

Delegation and countersigning

As with any delegated activity, registered nurses should:
 Provide supervision until the team member is competent at undertaking the
activity alone, and then that it is in the patient’s best interest to have record
keeping duties delegated;
 Only countersigned if they have witnessed activity or can validate that it took
place;
 Always follow local policies around record-keeping, delegation, and
countersigning.

UNIT 11: ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER

 PERSONS
Duration: 1 hour
Introduction
Older people have an advantage over other age groups. They probably have had
more experience with coping, problem- solving, and managing crises by the years they have
lived. Older persons have few delusions regarding what they are or what they are going to
be. They know where they have been, what take been through, and who they are.
Such experiences have provided them with a unique strength that should be appreciated.
However, acknowledging this strength does not imply that psychiatric illness is not a
problem among the older population. More people than ever survive to old age, and many
bring to their later years the mental health problems they have possessed throughout their
lifetimes. Besides, the many losses and challenges of late-life may exceed the physical,
emotional, and social resources of some persons and promote mental illness. By promoting
mental health, detecting problems early, and minimizing the impact of existing psychiatric
issues, nurses can help older people achieve optimal satisfaction and function.

OBJECTIVE
1. Recognize that aging changes are partially dependent upon an individual’s health
behaviors and preventive health measures.
2. List thee resources at the international, national, regional, and local levels to assist
older persons.

This module is divided into (3) three lessons

Lesson 1 Geriatric Health care Team
Lesson 2 Support Services and Advocacy for an older person
Lesson 3 Mental health programs

Lesson 11. 1 Geriatric Health care Team

Geriatric care usually consists of a team-based approach. This team evaluates

medical, social, and emotional needs, emphasizing common problems in older adults, such
as memory problems, falls, incontinence, and multiple medications. The goal of this care
team is to help older adults age gracefully.
 Geriatrician
 Gerontological nurse
 Physician assistant
 Social worker
 Pharmacist
 Nutritionist
 Physical therapist
 Occupational therapist
 Speech therapist health or help to treat the health issue they are experiencing.
 Adhere to departmental policies, procedures and objectives, ongoing quality
improvement objectives and safety, environmental, and infection control standards.
  Maintain patient confidentiality.
 Record complete, timely, and legible medical records.

Social workers are concerned with assisting persons and their families, the groups, and
communities to improve the individual and collective well-being. The goals are to help
people develop their skills and their ability to use their resources and those of the
community to resolve problems.
 They receive services by telephone and in-person in assisting the clients.
 They are involved in beneficial activities for the clients.
 They assess and gather pertinent data.
 They offer information and supporting clients and their families.
 They are contacting and making referrals to other agencies and services.
 Maintaining accurate records and preparing reports.
 They are participating in training, supervision, and meetings.
 Watch for signs of child abuse.
 Provide crisis intervention.

A pharmacist is a person professionally qualified to prepare and dispense medicinal drugs.

 Dispense Prescriptions
 is the "filling, licking and sticking
 Communicate with Prescribers
 they confirm the dosage and formulation (e.g., liquid or tablet) and
 Ensure Patients' Safety
 They check each patients’ medication record every time he or she gets a new
or refill prescription filled.
 Counsel Patients
 they train patients the dosages, follow up with patients to see if medications
are working, minimize side effects, and listen to their concerns.
 Working with clients on Over-all Strength
 To maintain health requirements and take the prescribed medication,
help patients heal and avoid getting sick by sharing advice on using
nonprescription remedies, taking health supplements such as vitamins,
using herbal and natural health products, exercising, and maintaining a
good diet
 Dealing with the Insurance Companies
 Pharmacists working in a chain and independent pharmacies have to
submit insurance claims and work with private insurance companies.
 Perform Administrative Tasks
 Everyone in a pharmacy has some responsibilities for keeping patient files
up to date, making sure products and required reports get generated and
filed.
 Educate Health Provider Colleagues
 The doctors, nurses, and other healthcare providers follow the new
medications and drug therapy protocols
 Nutritionist - a person who studies or is an expert in nutrition.
  Advise and present a balanced nutritional strategy
 Discussing and advising on weight-management plans
 Assisting clients with nutritional goals and offering a sound dietary plan for
optimizing health
 Recognize appropriate behavioral-change modifications and nutritional
approaches for different ages and populations
 Physical therapists are the movement experts who improve quality of life through
prescribed exercise, hands-on care, and patient education.
 Physical therapists manage individuals of all ages, from newborns to people at the
end of life.
 Consulting with patients to learn about their physical condition and symptoms
 Diagnosing movement dysfunction and developing a treatment plan
 Teaching patients how to use therapeutic exercise techniques properly
 Providing stimulation or massage to promote healing
 Assisting patients with the use of equipment such as wheelchairs or walkers
 Maintaining patient records and keeping track of goals and progress
 Advising the patient and family about in-home treatment options and exercises
8. Occupational therapist is a branch of health care that helps people of all ages who have
physical, sensory, or cognitive problems.

Occupational therapists
 help with barriers that affect a person's emotional, social, and physical needs. To do
this, they use everyday activities, exercises, and other therapies.
 Conducting physical and psychological assessments of clients and developing or
following a treatment plan.
 Assessing home and work environments of clients and deciding what adjustments
are needed.
 They are advising on adaptive equipment to help clients with daily activities.
 They are developing physical rehabilitation programs to help clients regain lost skills.
 They are preparing clients for a return to work.
 They are educating caregivers and family members of clients on patient care.
 They are evaluating the results and progress of occupational therapy on clients.
 They are maintaining professional knowledge and the technical progress to provide
clients with the best treatment program available.
 They are complying with certification requirements.
 They are evaluating patient conditions regarding physical and primary mental health.

Speech Therapists - are professionals who work with people of all ages to improve
communication techniques and treat swallowing disorders.
 Undertaking assessments.
 Planning and providing appropriate treatment.
 They were giving advice and support to patients, family members, and teachers.
 They are writing reports.
 They are maintaining records and case notes.
  They are liaising with doctors, physiotherapists, teachers, family members, and
careers.
 Other functions of Gerontological nurse
 The main objective of gerontological nursing is to improve the quality of life of older
adults.

A. Health assessment:
Daily activities of living. Activities related to the use of equipment or procedure (telephone,
bank account, food preparation)
A. Health screening
B. Promoting good nutrition
C. Promoting activity & exercise.

Preventive care of elderly

A. Physical & mental safety is essential.
Gerontological nurse & caregiver should pay special attention to the following safety
measures:
A. Protection from an unhealthy environment.
B. Protection from mental tensions.

Special care of personal health

A. Protection from physical & mental injuries, threats & fatigue
B. They are providing rehabilitation services.
C. They are providing psychological support.

Title Lesson 2: Support services and advocacy for an older person

Duration: 1 hour
What is Advocacy? Advocacy is the process of standing beside someone and supporting
them to:
 understand and exercise their rights
 has their voice heard on the issues that are important to them?

An advocate:
 It takes the time to listen and understand your views and wishes
 Informs you of your rights and responsibilities
 Assists you in exploring your options and making informed decisions
 Supports you to raise your concerns and work towards a resolution
 Provides practical assistance such as help to write a letter or raise your concerns at a
meeting
 Speaks for you in situations where you don’t feel able to speak for yourself
 Increases your capacity to self-advocate
Home Care Services for Seniors
 While it may be hard to accept, most of us will require some type of care assistance
after 65.
 You may be used to handling everything yourself, dividing up duties with your
spouse, or relying on family members for little help around the home.
 But as you get older and your circumstances change, getting around and taking care
of yourself can become more and more difficult.
 If the idea of moving to a retirement community, assisted living facility, or nursing
home doesn’t appeal, home care services may be able to help keep you living in your
own home for longer.

Home care services include:

1. Household maintenance.
 Keeping a household dashing takes a lot of work. If you’re finding it hard to
keep up, you can look into the laundry, shopping, gardening, housekeeping,
and handyman services. If you’re having trouble staying on top of bills and
appointments, financial and healthcare management may also be helpful.

2. Transportation.
 Transportation is a vital issue for older adults. Maybe you’re finding it hard to
drive or don’t like to go at night. Having access to trains, buses, rideshare
apps, reduced fare taxis, and senior transportation services can help prolong
your independence and maintain your social network.

3. Home modifications.
 If your mobility is becoming limited, home modifications can go a long way
towards keeping your existing residence comfortable and accessible.
Personal care.
 Help with the activities of daily living such as dressing, bathing, or meal
preparation, is called personal or custodial care. Home health aides can
provide personal care services that range from a few hours a day to around-
the-clock live-in care.

4. Health care
 Home service is provided at home by a trained individual such as
occupational therapists, social workers, or home health nurses
 Hospice care at home.

5. Day programs.
 Day programs or adult day care can help you keep busy with activities and
socialization during the day while providing a break for your caregivers.
Title: Lesson 3 Mental health programs

Duration: 1 hour

 The mental healthcare in the Philippines faces continued challenges, including

underinvestment, lack of mental health professionals, and vulnerable community
mental health services.

 The recent Mental Health Act legislation has – for the first time, provided a legal
framework for delivering comprehensive mental healthcare; economic restrictions
preventing people from accessing mental healthcare should be considered to enable
the population to access appropriate care when required equitably

 Increased investment is urgently needed to improve the training and recruitment of

psychiatrists, nurses, psychologists, social workers, and other multidisciplinary team
members, particularly as large numbers of skilled professionals continue to emigrate.

 National information on mental health services in the Philippines indicates

substantial gaps and inconsistencies in the delivery of mental healthcare.

 The recently enacted Mental Health Act legislation provides a platform for delivering
comprehensive and integrated mental health services. There remain many
challenges in the provision of accessible and affordable mental healthcare.

 The Philippines has recently passed its first Mental Health Act (Republic Act no.
11036). The Act seeks to establish access to comprehensive and integrated mental
health services while protecting the rights of people with mental disorders and their
family members (Lally et al., 2019).

 The mental health remains poorly resourced: only 3–5% of the total health budget
expended on mental health, and 70% of this spent on hospital care (WHO &
Department of Health, 2006).

 The majority of mental healthcare provided in hospital settings, and there are
underdeveloped community mental health services. The National Center for Mental
Health was previously estimated to account for 67% of the available psychiatric beds
nationally (Conde, 2004).

 More recent data indicate that there are 1.08 mental health beds in general
hospitals and 4.95 beds in psychiatric hospitals per 100 000 population (WHO, 2014).
There are 46 outpatient facilities (0.05/100 000 people) and four community
residential facilities (0.02/100 000) (WHO, 2014).

 There are only two tertiary care psychiatric hospitals: the National Center for Mental
Health in Mandaluyong City, Metro Manila (4200 beds), and the Mariveles Mental
 Hospital in Bataan, Luzon (500 beds). There are 12 smaller satellite hospitals
affiliated with the National Center for Mental Health, located throughout the
country.

 Overcrowding, poorly functioning units, chronic staff shortages, and funding

constraints are ongoing problems, particularly in peripheral facilities. There are no
dedicated forensic hospitals, although forensic beds locate at the National Center for
Mental Health.

 There is one doctor for every 80 000 Filipinos (WHO & Department of Health, 2012);
the emigration of trained specialists to other countries, mainly English-speaking
countries, contributes to this scarcity. The in psychiatry, where, nationally, there are
a little over 500 psychiatrists in practice. The ratio of mental health workers per
population in the Philippines is low, at 2–3 per 100 000 people (WHO & Department
of Health, 2006). This ratio is lower than in other Western Pacific Rim countries with
similar economic status, for example, Malaysia (4.9 mental health workers per 100
000 population) and Indonesia (3.1 per 100 000 people).

 Data indicate that there are 0.52 psychiatrists (Isaac et al., 2018) and 0.07
psychologists per 100 000 inhabitants, and 0.49 mental health nurses per 100 000 of
the population (a reduction from 0.72 per 100 000 in 2011) (WHO, 2014). The
burden of mental disorders in the Philippines There is little epidemiological evidence
on mental disorders in the Philippines; however, some important data are available.
14% of a population of 1.4 million Filipinos with disabilities have a mental illness
(Philippines Statistics Authority, 2010).

 The National Statistics Office identified that mental illness is the third most prevalent
form of morbidity. 0.4% had a diagnosis of schizophrenia, 14% of Recent data from
the Philippine Health Information System on Mental Health identified that (from 14
public and private hospitals surveyed from 2014 to 2016) 42% of the 2562 surveyed
patients for schizophrenia and from 0.12 to 1.09 per 100 000 in females (Redaniel et
al., 2011). The most recent data from 2016 identified an overall suicide rate of
3.2/100 000, with a higher rate in males (4.3/100 000) than females (2.0/100 000)
(WHO, 2018).

Access to treatment
 Prohibitive economic conditions and the inaccessibility of mental health services
limit access to mental healthcare in the Philippines. Further, perceived or
internalized stigma is a barrier to help-seeking behavior in Filipinos (Tuliao &
Velasquez, 2014), just as is the case in Western populations (Lally et al., 2013).

 There is a cultural drive to ‘save face’ when there is a threat to or loss of one's social
position, and as such, Filipinos may have difficulty in admitting to mental health
problems or seeking help. There is a strong sense of family in the Philippines.
  When issues are socially related, Filipinos will turn to family and peer networks
before seeking medical help (Tuliao, 2014). There are little data on prescription rates
and the use of psychotropic medications in treating mental disorders.

 2005 WHO Health Survey indicated that only a third of people with a diagnosis of
schizophrenia were receiving treatment or screening (although antipsychotic
medication was as the treatment)

The Philippines Department of Health Medication Access Program for Mental Health list of
essential psychotropic medications
 First-generation/typical antipsychotics → chlorpromazine, haloperidol (oral and long-
acting injectable), fluphenazine decanoate
 Second-generation/atypical antipsychotics → clozapine, olanzapine, quetiapine,
risperidone
 Antidepressants → fluoxetine, sertraline, escitalopram
 Mood stabilizers → lithium carbonate, valproic acid, carbamazepine, lamotrigine
 Anticholinergics → biperiden, diphenhydramine
 Benzodiazepine → clonazepam
 Cholinesterase inhibitor → donepezil
 NMDA receptor antagonist → memantine

MENTAL HEALTH PROGRAM (DOH)

Description
 Mental health and well-being is a concern of all. Addressing concerns related to MNS
contributes to the attainment of the SDGs. Through a comprehensive mental health
program that includes a wide range of promotive, preventive, treatment, and
rehabilitative services; that is for all individuals across the life course, especially
those at risk of and suffering from MNS disorders; integrated into various treatment
settings from the community to facilitate implemented from the national to the
barangay level; and backed with institutional support mechanisms from different
government agencies and CSOs, we hope to attain the highest possible level of
health for the nation because there is no Universal Health Care without mental
health

Vision
 A society that promotes the well-being of all Filipinos, supported by transformative
multi-sectoral partnerships, comprehensive mental health policies and programs,
and a responsive service delivery network

Mission
 To prevent mental, psychosocial, and neurologic disorders, substance abuse, and
other forms of addiction, and reduce the burden of disease by improving access to
quality care and recovery to attain the highest possible level of health to participate
fully in society.
Objectives
1. To promote participatory governance and leadership in mental health
2. To strengthen coverage of mental health services through multi-sectoral partnership
to provide high-quality service aiming at the best patient experience in a responsive
service delivery network
3. To harness the capacities of LGUs and organized groups to implement promotive and
preventive interventions on mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services

Program Components
1. Wellness of Daily Living
 All health/social/poverty reduction/safety and security programs and the like
are protective factors in general for the entire population
 Promotion of Healthy Lifestyle, Prevention, and Control of Diseases, Family
wellness programs, etc.
 School and workplace health and wellness programs 2. Extreme Life
Experience
2. Provision of mental health and psychosocial support (MHPSS) during personal and
community-wide disasters
3. Mental Disorder
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction
 Provision of mental, neurologic, and substance use disorders at the primary level
from assessment, treatment, and management to referral; and provision of
psychotropic drugs provided for free.
 Enhancement of mental health facilities under HFEP

Partner Institutions
 NGOs (DOLE, DSWD, DepEd, Tesda, CHED, DILG), NGOs (WHO, PPA, PAP, PNA,
PLAE, AWIT Foundation, WAPR, NGF)
 Policies and Laws DOH Administrative Order No. 8 Series of 2001 The National
Mental Health Policy DOH Administrative Order No. 2016-0039
 Revised Operational Framework for a Comprehensive National Mental Health
Program Republic Act No. 11036 Mental Health Act

Strategies, Action Points and Timeline

 Governance
 Service coverage
 Advocacy
 Evidence
 Regulation

Program Accomplishments/Status
 1. Passage of the Republic Act No. 11036 dated June 20, 2018 "An Act Establishing a
National Mental Health Policy to enhance the Delivery of Integrated Mental Health
Services, Promote and Protecting the Rights of Persons Utilizing Psychiatric,
Neurologic and Psychosocial Health Services, Appropriating Funds Therefore and for
Other Purposes."
2. DOH Administrative Order No. 2016-0039 dated October 28, 2016 " Revised
Operational Framework for a Comprehensive National Mental Health Program."
3. National Mental Health Program Strategic Plan 2018-2022
4. Harmonized MHPPS Training Manual
5. Development of the Implementing Rules and Regulation of the RA No. 11036, also
known as The Mental Health Act
6. Conduct of the Advocacy Activities such as 2nd Public Health Convention on Mental
Health, Observance of the World Health Day, World Suicide Prevention Day, National
Mental Health Week, and Mental Health Fairs
7. Training on Mental Health Gap Action Programme
8. Conduct of The National Prevalence Survey on Mental Health
9. Establishment of the Medicine Access Program for Mental Health

In the Philippines
1. 2004 WHO study, up to 60% of people attending primary care clinics daily, is
estimated to have one or more MNS disorders.
2. 2000 Census of Population and Housing showed that mental illness and mental
retardation rank 3rd and 4th respectively among the types of disabilities in the
country (88/100,000
3. Data from the Philippine General Hospital in 2014 show that epilepsy accounts for
33.44% of adults and 66.20% of pediatric neurologic outpatient visits per year.
4. Drug use prevalence among Filipinos aged 10 to 69 years old is at 2.3%, or an
estimated 1.8 million users, according to the DDB 2015 Nationwide Survey on the
Nature and Extent of Drug Abuse in the Philippines
5. 2011 WHO Global School-Based Health Survey has shown that in the Philippines,
16% of students between 13-15 years old have ever seriously considered attempting
suicide, while 13% have attempted suicide one or more times during the past year.
6. The incidence of suicide in males increased (Redaniel, Dalida and Gunnell, 2011)
7. Intentional self-harm is the 9th leading cause of death among the 20-24 years old
(DOH, 2003).
8. A study conducted among government employees in Metro Manila revealed that
32% out of 327 respondents had experienced a mental health problem in their
lifetime (DOH 2006).
9. Based on Global Epidemiology on Kaplan and Sadock’s Synopsis of Psychiatry, 2015
and Kaufman’s Clinical Neurology for Psychiatrists, 7th edition, 2013
A. Schizophrenia ---1% .....1 Million B. Bipolar ---1% .... 1 Million C. Major Depressive
Disorder ---17% .... 17 M D. Dementia --- 5% (of older than 65) ..... E. Epilepsy
---0.06% .... 600,000
FINAL REQUIREMENT:
Make an NCP of a patient with Anxiety disorders.

Prescribed:
 Kristen L. Mauk Gerontological Nursing; Competencies for Care; Philippine Edition;
2nd Edition;

OTHER REFERENCES
 Janice L. Hinkle, Kerry H. Cheever Brunner & Suddath’s Textbook of Medical-Surgical
Nursing 14th Edition; Lippincott Williams and Wilkin’s The Lippincott Manual of
Nursing Practice 5th edition

Resources:
 American Association of Retired Persons (AARP) Elder Law Forum
 http://www.aarp.org/research/legal-advocacy/ American Bar Association Senior
Lawyers Division
 http://www.abanet.org/srlawyers/home.html Elder Justice Coalition
 http://www.elderjusticecoalition.com Hartford Institute for Geriatric Nursing
Mistreatment and Abuse Assessment.
 http://consultgerirn.org/uploads/File/trythis/try_this_15.pdf National Academy
of Elder Law Attorneys http://www.naela.com National Center on Elder Abuse
 http://www.ncea.aoa.gov National Senior Citizens Law Center
 http://www.nsclc.org Nursing Home Abuse/Elder Abuse Attorneys Referral
Network

Recommended Readings
Recommended readings associated with this chapter can be Visit
 http://thepoint.lww.com/Eliopoulos9e to access the list of recommended tasks and
additional resources related to this chapter.

UNIT 12: IMPLEMENTATION CONSIDERATIONS FOR TELEHEALTH

PROGRAMS

Introduction

Home telemedicine services are developing rapidly because of the demand.

As more patients retire, more families will need to depend on these services to care
for their elderly loved ones.

This module is divided into four (4) lessons:

 Lesson 12.1 Telehealth and the Older Person
 Lesson 12.2 Entrepreneurial Opportunities
 Lesson 12.3 Home Health Agencies
  Lesson 12.4 Visiting Nurse Groups

Objectives:

Upon completion of the topic, the student will:

1. Discuss the relationship between telehealth and the older person.
2. Discuss the entrepreneurial opportunities in health care.
3. Explain the purpose of home health agencies
4. Explain the roles and responsibilities of visiting nurse groups
12.1: Telehealth and the Older Person
Duration: One (1) hour

Lesson Proper

What is Telehealth?

By using technologies, health and human services can reach as far as to our
rural areas.

 “The use of electronic information and telecommunications technologies to

support and promote long-distance clinical healthcare, patient and
professional health-related education, public health, and health
administration.”
 “A collection of means or methods for enhancing healthcare, public health,
and health education delivery and support using telecommunications
technologies.”

What is the difference between telehealth and telemedicine?

Telehealth can reach to deliver a broad range of medical care,

education, and public health services.

Telemedicine typically focuses on exchanging medical information and

providing diagnosis and treatment.

There are “seven deadly barriers” for telemedicine:

1. Money
 Reimbursement is the main barrier to telemedicine.
2. Regulations
 Licensing was a minor issue because as most healthcare providers
move into a national system, licensure is becoming a bigger barrier.
3. Hype
 studies and all the beautiful things that telemedicine can do, but
many reviews show that some applications of telemedicine do not
work or cost too much.
4. Adoption
 Health care providers sometimes resist innovation in telemedicine
because it creates competition.
5. Technology
 Technology has been the focus of telemedicine for a long time.
 Telemedicine is really about the services and how they change
people’s lives and not about the uniqueness of the newest piece of
technology.
 The implementation of multiple technologies may create massive
data flows that are not useful or easily maintained (e.g., continuous
 monitoring of temperature and blood pressure).
6. Evidence
 Some applications of telemedicine show tremendous progress, but
other areas lack extensive studies or require synthesis of existing
studies to evaluate their value.
7. Success
 Telemedicine is becoming part of the business plan of many.

Telehealth used to care for and manage the following conditions

and diseases:

 Palliative Care: At-home caregivers can use telehealth to report on

the condition of their loved one as their health continues to
deteriorate while receiving valuable feedback and advice from
healthcare professionals.

 Transitional Care for Heart Failure: At-home caregivers can use

telehealth to stay on top of their loved one’s treatment regimen
following an episode of heart failure, including dispensing
medications, diet, physical activity, and managing stress levels.

 Chronic Disease Management: Telehealth helps at-home

caregivers report on the condition of their loved one, giving
healthcare providers insight into how their disease is progressing
over time. Caregivers can use telehealth to stay on top of
medications, dietary information, and mental and physical
changes.

 Primary Care for Frail Individuals: Patients that have trouble

moving or leaving the house can use telehealth to consult with
healthcare professionals on a variety of primary healthcare issues
and concerns, including joint pain, muscle stiffness, medications,
and accident management and prevention.
Lesson 12.2: Entrepreneurial Opportunities
Duration: One (1) hour

Lesson Proper

Entrepreneurial opportunities are situations where products and services can

at a price more significant than the cost of their production. An 'entrepreneurial
opportunity thus, is a situation where entrepreneurs can take action to make a
profit.

Elder Care Business Ideas

1. Seniors' Needs Service

Not all older adults are looked after by friends and family, and many
of them could use companionship regularly. If you’re passionate
about this, then this could be the elderly care business idea for you.

2. In-Home Care Service

Elderly loved ones often want to remain at home but may need
assistance due to a disability or activity restrictions. If this sounds like
something you would like to do, then this could be the elder care
business for you.

3. Mobile Beauty Services

Many senior people prefer to have services provided in their homes.

You can launch a mobile beauty service that offers various beauty and
massage treatments to elderly customers.

4. Products For Easier Home Maintenance

If you’re inventive and enjoy making products to increase

convenience, this is a business opportunity for you. Before you start to
come up with helpful inventions to assist elderly customers, here is an
example of an elderly business.

5. Elderly Medical Assistance

Older people have a great need for medical services like

physiotherapy, massage therapy, and orthopedics. If you have the
right skills, this could be the elderly care business idea for you.

6. Technical Support

Even though some senior citizens struggle with technology, they do

want to know how to use it so that they can connect with friends and
family. If you have the right skills and a passion for helping the
elderly with technology, this could be the elderly care business idea
for you.
 7. Concierge Services

Older adults need help running errands, dropping off and collecting
things, and personal shopping. If helping the elderly is a passion of
yours, this could be the elder care business idea for you.

8. Window and Gutter Cleaning

Older adults find cleaning windows and gutters challenging,

especially if they still live in a double story home. If you have the
right experience, this could be the elder care business idea for
you.

9. Gardening Services for the Elderly

Although some elderly people enjoy gardening, it can be hazardous for

them, as many can get badly hurt falling. If you love gardening and
enjoy helping the elderly, this could be the elder care business idea for
you.

10. Handyman Services for the Elderly

If you’re good at doing home repairs and replacing fixtures and have
electrical and plumbing knowledge, you can start a handyman service
specifically for older adults. Before you launch your elder business,
here is an example of an elder company that can gain some insights.

Home-Based Business Ideas that Serve Senior Citizens

Here are fifteen senior-related, home-based business ideas that may have you
finding riches in these boomers’ golden years.

1. MEDICAL CLAIMS ASSISTANCE PROFESSIONAL

The background knowledge on marketing, services directly to small medical

offices, hospitals, senior centers, and networking with lawyers, bankers,
accountants, and other professionals can be of help for medical claims
assistance professionals whose clients may need your expertise.

2. SENIOR CARE CONSULTANT

Senior care consultants are nurses, social workers, gerontologists, and other
provide seniors, their adult children, or caregivers with information and
recommendations for long-term health-care and living arrangements that best
suit their

clients’ needs, finances, and preferences. They help ensure their clients will
have an on-going, optimum quality of life.

3. NUTRITION CONSULTANT
 With age, people often develop medical and physical conditions, such as
diabetes, heart disease, and other serious health concerns that require them
to follow specific diets. Nutritional consultants educate their clients about the
food and meal-planning regimens they need to follow while coordinating their
efforts with the clients’ caregivers and their health care professionals’
recommendations.

4. IN-HOME CARE (NON-MEDICAL) SERVICES

With the existence of in-home (non-medical) services that assist their clients
with cleaning, shopping, running errands, and transportation, many retirees
are opting to stay and live independently in their homes or apartments. In-
home care specialists work with social services, family members, or guardians
to develop individualized programs to manage best and monitor their clients’
daily needs.

5. DAILY MONEY MANAGERS

Seniors are often overwhelmed by the day-to-day money-managing tasks due

to age-related disabilities or illness, or because of the death of a spouse —
mostly if it was the one who primarily managed a couple’s expenses. Daily
money-managers supervise clients’ bill-paying tasks, balance their
checkbooks, sort mail, and refer their clients to professionals such as
accountants or tax preparers when needed. Managers will also help their
clients keep track of their scheduled appointments and engagements.

6. DAILY MONEY MANAGERS

Seniors are often overwhelmed by the day-to-day money-managing tasks due

to age-related disabilities or illness, or because of the death of a spouse —
mostly if it was the one who primarily managed a couple’s expenses. Daily
money-managers supervise clients’ bill-paying tasks, balance their
checkbooks, sort mail, and refer their clients to professionals such as
accountants or tax preparers when needed. Managers will also help their
clients keep track of their scheduled appointments and engagements.

7. SEAMSTRESS-TAILOR

Due to failing eyesight or loss of manual dexterity, seniors need experienced

sewers to help them with various sewing needs. If you are skilled with a
needle, you may do everything from alterations, sewing on buttons or zippers,
creating window treatments and upholstering furniture, sewing wedding
dresses, or christening gowns for grandchildren.

8. HANDY-PERSON FIX-IT SERVICES

Many seniors or their adult children will gladly pay someone to do simple
household jobs like painting and wallpapering, installing shelves and
household fixtures, replacing windowpanes. Other simple tasks they do not
have the time or no longer the ability to complete. Vocational schools often
 offer general home-maintenance courses if you need to brush-up your “fix-it”
skills for small repairs and installations.

9. FINANCIAL PLANNER

Financial planners assist clients in estate planning, choosing wise

investments, constructing budgets, and preparing money-management
strategies that will enable their clients to live comfortably in their retirement
years. Trading bitcoins helps them grow their savings. Go through the review
article at bitcoingrowthfund.com to learn how some smart software
applications help in trading bitcoins effectively.

10. HOME BUSINESS CONSULTANT

Many people in their fifties and sixties who do not want to retire to “play” want
to try their hand at entrepreneurship, but have no idea where to start. If you
have the credentials and the experience in operating a successful home-
based or small business, you might consider assisting others in choosing a
home venture that matches their skills and has good potential.

11. HOME DELIVERY SERVICES

You may find markets for specialized services such as transporting pets to
and from veterinarian and grooming appointments. One former business
executive quit his job and re-established successful milk and dairy delivery
service for customers in his urban neighborhood.

12. EXERCISE CONSULTANT

Many seniors participate in senior games and sports for fun and to reap the
health benefits. Some individuals exercise to improve medical conditions or
rehabilitative programs to help them maintain their regimens and remain
injury-free. Fitness experts work with senior physicians and therapists to
develop ongoing strength, conditioning, flexibility, and balance to enable their
clients to stay physically fit and active for as long as possible.

13. COMPUTER CONSULTING

Numerous mature adults, who were previously resistant to learning computer

technology, change their minds when they or their families move away and
realize that it is one of the best ways to keep in contact with their children,
grandchildren, and friends. As a computer consultant, the tasks are to teach
fundamental and advanced skills, select computer systems, and make home
visits for computer set-ups and troubleshooting.

14. ANTIQUES’ APPRAISALS

People need antiques and collectibles appraised for insurance coverage,

when they are moving or settling estates, or wish to liquidate some of their
prized possessions. They require honest evaluations of their items and
recommendations on where to sell their items for the best possible prices.
15. LAWN AND GARDEN CARE

With scores of mature adults selling their larger homes and moving to smaller
residences and retirement communities, they may not have the time or
capability to install or revamp garden spaces. Many, however, still wish to
pursue their gardening activities and need routine lawn and garden care and
continued property maintenance when they are traveling. You might also offer
to establish specialized gardens like those friendly to pets or those accessible
to individuals with disabilities.

16. TRANSCRIPTION and VIDEO SERVICES

Some older adults wish to leave a legacy of memories to loved ones or for the
public record about the experiences and accomplishments of their lives. In
this service, you would record, transcribe, and write and videotape clients’
memoirs.
Lesson 12.3: Home Health Agencies
Duration: One (1) hour

Lesson Proper

The impact is when older members of the family require assistance with daily
needs and care. Families are absorbing more complex responsibilities for
caregiving for more extended periods than ever before. With growing numbers of
people reaching the old–old years and the trend toward maintaining very ill older
individuals in the community, the burdens faced by family caregivers will likely
continue to grow. The increase of women in the workforce, mobility of families, and
complexity of family structures resulting from divorce and remarriage complicate
family relationships and caregiving. Nurses need to understand the various family
structures, roles, and affinities to virtually withholder adults and their caregivers.

REHABILITATIVE AND RESTORATIVE CARE

Rehabilitative care
 involves therapies developed by physicians and therapists focused on
returning individuals to their previous level of function.
 the need for rehabilitative services usually arises after a problem has
occurred that affected parts, such as a stroke, fracture, or prolonged
state of immobility.
 Skilled rehabilitative care involves services offered by physical,
occupational, and speech therapists, and is eligible for Medicare
reimbursement.

Restorative care
 is primarily offered by the nursing staff and does not require a medical
order. It can occur in any setting and includes efforts to help
individuals:
 Maintain their current level of function
 Improve their functional ability
 Prevent decline and complications
 Promote the highest possible quality of life
Frailty
 is a particular challenge to older persons that must be considered in
rehabilitative and restorative care.
 Although definitions of frailty can vary, it usually describes a clinical
state in which the person has poor endurance, fatigue, low activity
level, reduced speed in ambulation, weak grip strength, and increased
risk for adverse outcomes (Buckinx et al., 2015).

Nursing Home / Home health care defined:

A nursing home is a facility for the residential care of
elderly elderly or disabled people. Nursing homes may
also be referred to an as skilled nursing facility, long-
term care facilities, older adults's homes, care homes,
rest homes, convalescent homes or convalescent care.
Wikipedia

Nursing home is a place for people who don't need to be in a hospital

but can't be cared for at home. Most nursing homes have nursing
aides and skilled nurses on hand 24 hours a day. Some nursing
homes are set up like a hospital. The staff provides medical care, as
well as physical, speech and occupational therapy.

Homecare is health care or supportive care provided by a professional

caregiver in the individual home where the patient or client is living, as
opposed to care provided in group accommodations like clinics or
nursing homes. Homecare is also known as domiciliary care, social
care, or in-home care. Wikipedia

Home Health provides skilled services, including nursing care and

physical, occupational, speech, and respiratory therapy. A home
health care agency employs the healthcare professionals sent to
the home and must be licensed by the state.
What are the different types of home health care services?

 Doctor care. A doctor may visit a patient at home to

diagnose and treat the illness(es). He or she may also
periodically review the home health care needs.

 Nursing care. The most common form of home health

care is nursing care, depending on the person's needs.
Nursing care may include:
 ostomy care
 wound dressing
 intravenous therapy
 administering medication
 monitoring the general health of the patient
 pain control
 other health support.

 Physical, occupational, and/or speech therapy.

Some patients may need help relearning how to
perform daily duties or improve their vocabulary after an
illness or injury.

 Physical therapists can put together a plan of care to help

a patient regain or strengthen muscles and joints.

 Occupational therapists can help patients with physical,

 developmental, social, or emotional disabilities relearn
how to perform such daily functions as eating, bathing,
dressing, and more.

 Speech therapy can help a patient with impaired speech

regain the ability to communicate clearly.

 Medical social services. Medical social workers

provide various services to the patient, including
counseling and locating community resources to help
the patient in his or her recovery. Some social workers
are also the patient's case manager--if the patient's
medical condition is very complex and requires the
coordination of many services.

 Care from home health aides. Home health aides can

help patients with their basic personal needs, such as
getting out of bed, walking, bathing, and dressing.
Some aides have received specialized training to assist
with more specialized care under the supervision of a
nurse.

 Homemaker or primary assistance care. While a

patient is physically be concerned for in the home, a
homemaker or person who helps with chores or tasks
can maintain the household with meal preparation,
laundry, grocery shopping, and other housekeeping
items.

 Companionship. Some patients who are home alone

may require a companion to provide comfort and
supervision. Some companions may also perform
household duties.

 Volunteer care. Volunteers from community

organizations can provide the necessary comfort to the
patient through companionship, helping with personal
care, providing transportation, emotional support, and
helping with paperwork.

 Nutritional support. Dietitians can come to a patient's

home to provide dietary assessments and guidance to
support the treatment plan.

 Laboratory and X-ray imaging. Certain laboratory

tests, such as blood and urine tests, can be performed
in the comfort of the patient's home. Also, portable X-
ray machines allow lab technicians to perform this
 service at home.

 Pharmaceutical services. Medicine and medical

equipment can be elated at home. If the patient needs
it, training on how to take medications or use of the
equipment, including intravenous therapy.

 Transportation. Some companies provide

transportation to patients who require transport to and
from a medical facility for treatment or physical exams.

 Home-delivered meals. Often called Meals-on-Wheels,

many communities offer this service to patients at home
who cannot cook for themselves. Depending on the
person's needs, hot meals can be delivered several
times a week.

Lesson 12.4: Visiting Nurse Groups

Duration: One (1) hour

Lesson Proper
Home visiting nurses (HVNs) have long been part of a home and community-
based care interventions designed to meet the needs of functionally declining
older adults.

Beginning in the 1960s, a variety of interventions have developed that aim to

meet better the needs of older persons whose physical or mental functioning
has declined. Yet, they desire to continue living in the community rather than
relocate to a nursing home or other institution.

What Is A Home Visit Nurse?

Home visit nurses are essentially traveling treatment providers, who may
attend to basic needs such as hygiene and nutrition, to more specialized
care like medications, infusions, and even emergency interventions. In the
public health sector, you may work in conjunction with community wellness
programs or available care facilities. This home visit can allow individuals in
the municipality to have access to the treatments and support they need for
wellness and a better quality of life.

Home visit nurses may work alone or as part of a larger team and would be
responsible for participating in the following duties:

 Visit individuals within the community to provide healthcare

services.
 Monitoring client vitals and recording changes in condition.
 Taking patient histories and organizing health records.
  Administering medications, ventilator, or IV therapies
 Attend to primary care needs.
 Report patient updates to supervisory staff members.
 Provide education for coping and management of conditions
to patients.

For you to become a home visit nurse, you should have the following
qualities:
 Organizational skills: - You will need to maintain
accountability for tasks and clients assigned to your care,
and ensure that your supplies are in order before setting out
each day.

 Punctuality and tasking: - While much of the job depends on

traveling to different residential locations, you will be
responsible for attending to public needs in a timely and
accountable manner.

 Recordkeeping requires the health care provider to take

patient notes and enter them accurately into facility
databases, as this will help communicate changes and
concerns in client needs.

 Basic nursing skills requires the health care provider a

comprehensive knowledge of nursing practices and scope of
treatments, whether you are an LPN or an RN.

 The interpersonal skills of the health care provider to have an interaction

with others will include the public, your clients, and fellow health team
members.

Nature of The Work

1. Provide clinical care in a residential setting.

 For this job, you will need to spend time at a healthcare facility for
scheduling, coordinating, and reporting to fellow health team members.

2. Engage in administrative and educational tasks.

 This can include reporting the benefits of home health care to the
municipal governing agencies and developing promotion and awareness
for these outreach services.

Education and Training

1. An LPN or an RN, so two year or four-year degrees in nursing, along

 with the required clinic rotations, would allow you to follow this career
path.

2. You will also need to have a valid nursing license for the state that you
work in, and a valid driver’s license for this position

Final Requirement 12

Technological advancement has been so imminent that it vastly influenced even the
healthcare delivery system as Telehealth worldwide emerges. As your final
requirement for this particular course unit, you are provided a video link that shows
Telehealth practices and your task is to make a reaction paper summarizing your
thoughts about the advantages and disadvantages of this evolving healthcare
practices local and abroad.

Your video link here – https://www.youtube.com/watch?v=-

YWez0BGa8I&feature=youtu.be&fbclid=IwAR10xzCwxTdZgZ6nMC2BncstD6-
rZUHDniu8SPG0pWGoCJ0yMSME6-DxHlo

Prepare the write up in an A4 size paper with the prescribed format of Arial font style,
12 font size and 1" margins in all borders. For the evaluation of this project please
refer to rubric for written output.

Unit 12 References
Berman A, Snyder S, Frandsen G. (2016). Kozier & Erb's Fundamentals of
Nursing. 10th Edition. Pearson Education Limited. England

Eliopoulus, C. (2017) Gerontological Nursing. Ninth Edition pp.48- Williams &

Wilkins

Hinckle, J., and Cheever, K. (2016). Brunner & Suddarth’s Textbook of Medical-
Surgical Nursing. 13th Edition. The Philippines. Wolters Kluwer Health/
Lippincott Williams & Wilkins

Miller, C (2012). Nursing for Wellness in Older Adults. Sixth Edition. Wolters
Kluwer Health | Lippincott Williams & Wilkins.

Potter, P (2016). Fundamentals of Nursing. 10th Edition. Elsevier Health Sciences

Weber, J. R., and Kelley, J. H. (2018). Health Assessment in Nursing, Sixth

Edition. C & E Publishing Inc.
Glossary

A durable power of attorney a formal legally endorsed document that identifies a

proxy decision-maker who can make decisions if the signer becomes incapacitated. 

Active memory is a memory that is currently the focus of consciousness or was

recently in awareness.

Activities of daily living is a term used to collectively describe fundamental skills

that are required to independently care for oneself, such as eating, bathing, and
mobility. Activities of daily living (ADLs) toileting, feeding, dressing, grooming,
bathing, and ambulating

Andropause or Viropause is a condition related to testosterone levels, which also

declines with age.

Anosmia is a loss of the sense of smell that can result in food tasting bland.

Aphasia is a condition that robs you of the ability to communicate. It can affect your
ability to speak, write, and understand language, both verbal and written. It typically
occurs suddenly after a stroke or a head injury.

Apraxia is a disorder of the brain and nervous system in which a person cannot
perform tasks or movements when asked, even though: The requestor command
willing to complete the job.
Assistive technology technological tools that enable a person to
maximize independence

Atrophy is the progressive degeneration or shrinkage of muscle or nerve tissue.

Autonomy is the authority to make decisions and the freedom to act under one's
professional knowledge base.

Baby boomers are a group of people born in the years following World War II when
there was a temporary marked increase in the birth rate. 

Background noise is an extraneous sound heard while listening to or monitoring

other sounds.

Beneficence It is an ethical principle that addresses the idea that a nurse's actions
should promote well. Doing good is thought of as doing what is best for the patient.

Biological aging refers to the physical changes that "slow us down" as we get into
our middle and older years, our arteries might clog up, or our lungs' problems might
make it more difficult for us to breathe.
Cataract Is a cloudy or opaque area in part of the lens or the entire lens that
interferes with the passage of light through the lens, causing problems with glare and
blurred vision. Cataracts usually develop gradually, without pain, redness, or tearing
in the eye.

Chronological age is the number of years since someone was born.

Cognition is the mental action or process of acquiring knowledge and understanding

through thought, experience, and the senses.

Communication Enhancement Model promotes health in old age by stressing

recognition of individualized cues, modifying communication to suit individual needs
and situations, appropriate assessment of the health/social problems, and
empowerment of both elders and providers.

Compensatory hypertrophy refers to the enlargement of a tissue or organ due to

the removal or damage remaining nephrons.

Conflict theory is a theory that society is perpetually conflicted because of

competition for limited resources.

Consent is the granting of permission to have the action in a procedure to perform. 

Declarative memory is a type of long-term memory that involves conscious

recollection of particular facts and events.

Diabetic retinopathy is pathological changes in the retina's blood vessels, resulting

in decreased vision or vision loss caused by hemorrhage and macular edema.
Disability inability to perform activities normally
Disability inability to perform activities normally

Dry eyes can occur when you're unable to produce enough tears.

Dysarthria occurs when the muscles you use for speech are weak, or you have
difficulty controlling them, often causes slurred or slow speech that can be difficult to
understand.

Elder abuse – the physical, emotional, or financial harm to an older person by one
or more of the individual's children, caregivers, or others; includes neglect. 

Elder law is a specialized legal practice area, covering estate planning, wills, trusts,
arrangements for care, social security and retirement benefits, protection against
elder abuse (physical, emotional, and financial), and older people.

Elder maltreatment refers to the seven types of abuse and neglect: physical abuse,
sexual abuse, emotional or psychological abuse, financial or material exploitation,
abandonment, neglect, and self-neglect. 
Elderspeak is a specialized speech style used by younger adults with older adults,
characterized by more straightforward vocabulary and sentence structure, filler
words, lexical fillers, overly-endearing terms, closed-ended questions, using the
collective "we," repetition, and speaking more slowly.

Episodic memory is a type of long-term memory that involves conscious

recollection of previous experiences and their context regarding time, place,
associated emotions, and more other feelings.

Exploitation is the illegal or improper use of an individual's resources

Financial or material abuse is illegal or improper exploitation or use of funds or

resources of the older person.
Frailty condition in which a person has low endurance and weakness

Functionalism describes that all aspects of a society serve a function and are
necessary for society's survival.

Geriatrics is the practice that focuses on the physiology, pathology, diagnosis, and
management of older adults' disorders and diseases.

Gerontologic nursing is related to assessing, planning, implementing and

evaluating older adults in all environments, including acute, intermediate, and skilled
care, and within the community.

Gerontology is the aging process that draws from the biological, psychological, and
sociological sciences—studying all aspects of aging and its consequences.

Glaucoma A slowly progressive increase in intraocular pressure that, if left

untreated, causes advanced pressure against the optic nerve, resulting in peripheral
vision loss, decreased visual acuity with difficulty adapting to darkness, and a halo
effect around lights.
Handicap limitation to fulfill a role

Hematopoiesis is the formation and maturation of blood cells from stem cells.
Occurs in the extravascular marrow spaces that contain endothelial cells, fibroblasts,
macrophages, and adipocytes (which provide growth factors, collagen, and cell
adhesion proteins)

Hyperlipidemia means your blood has too many lipids (or fats), such as cholesterol
and triglycerides. 
Immunity is a condition of resisting a particular disease primarily by preventing the
development of pathogenic microorganisms or counteracting the effects of its
products.
Impairment physical or psychological restriction
Impairment physical or psychological restriction
Instrumental activities of daily living (IADLs) tasks required for community living,
such as shopping, meal preparation, laundry, housekeeping, use of telephone,
money management, medication management

Instrumental daily living (IADLs) are complex skills needed for independent living,
such as shopping, cooking, managing finances, traveling by cars, or public
transportation. 

Justice states that there should be an element of fairness in all medical decisions:
fairness in decisions that burden and benefit, as well as equal distribution of scarce
resources and new treatments, and for medical practitioners to uphold applicable
laws and legislation when making choices.

Keratoconjunctivitis sicca is a common cause of decreased tear production

experienced in aging.

Lithogenic bile is bile that favors gallstone production associated with several
conditions: the most important is increased secretion of cholesterol in the bile

Macular degeneration is a condition in which the macula (the specialized portion of

the retina responsible for central vision) loses its ability to function efficiently. First
signs
Meniere's Disease

Menopause is the point in time when menstrual cycles permanently cease due to
the natural depletion of ovarian oocytes from aging.

Neglect Is the refusal or failure to fulfill a caregiving obligation.

Nonmaleficence means that nurses must not harm intentionally. Nurses must
provide a standard of care that avoids risk or minimizing it related to medical
competence. An example of nurses demonstrating this principle includes avoiding
the negligent care of a patient.

Osteoarthritis is the most common form of arthritis. It occurs when the protective
cartilage that cushions the ends of your bones wears down over time.

Osteoporosis a medical condition in which the bones become brittle and fragile
from loss

Otosclerosis is a hereditary disorder causing progressive deafness due to the

overgrowth of bone in the inner ear.

Physical abuse is the infliction of pain or injury, physical coercion, or physical or

drug-induced restraint.

Polypharmacy is an increase in the number of medicationsthan are medically

necessary. It is common in older ambulatory care, hospital, and nursing home
patients. Polypharmacy increases the risk of numerous adverse health
consequences in the elderly

Presbycusis is the loss of hearing that gradually occurs in most individuals as they
advanced in age.

Presbyopia is a gradual decline to accommodate or focus on close objects. The

individual is unable to see near objects.

Psychological abuse is a form of abuse characterized by a person subjecting or

exposing another person to behavior that may result in psychological trauma,
including anxiety, chronic depression, or post-traumatic stress disorder.

Psychological aging refers to the psychological changes, including those involving

mental functioning and personality that occur as we age. Some people who are 65,
for example, can look and act much younger than some who are 50.

Rehabilitative care therapies developed by physicians and therapists focused on

returning individuals to their previous level of function

Restorative care that assists people in maintaining or improving the current status
of the process, avoiding decline and complications, and achieving the highest
possible quality of life

Sarcopenia is the loss of muscle tissue as a natural part of the aging process.

Self-neglect is the person who chooses to avoid medical care or other services that
would promote optimal functioning.

Senescence refers to"the time-dependent accumulation of damage at the molecular

level that begins at fertilization and eventually expressed as nonspecific vulnerability,
impaired function, disease, and ultimately death."

Senior citizen is an older adult aged 60 who is retired and living on a pension. 

Sexual abuse is a non-consensual sexual contact of any kind with the older person.

Social aging refers to changes in a person's roles and relationships, both within
their networks of relatives and friends and informal organizations such as the
workplace and worship houses.

Symbolic interactionism is the view of social behavior that emphasizes linguistic or

gestural communication and its subjective understanding, especially the role of
language in forming the child as a social being.

Tinnitus Is the perception of noise or ringing in the ears

Verbal communication is exchanging information using speech. Your choice of
words and tone are essential.

Visceral hyperalgesia is the pain of the inner organs or viscera, which is more
intense than usual.

References

Berman A, Snyder S, Frandsen G. (2016). Kozier & Erb's Fundamentals of

Nursing. 10 Edition. Pearson Education Limited. England
th

Burke, A. (2020). Sensory and Perceptual Alterations: NCLEX-RN.

https://www.registerednursing.org/nclex/sensory-perceptual-alterations/

Cleveland Clinic (2015). How to Keep Your Body’s Defenses Strong After Age
65. https://health.clevelandclinic.org/5-tips-make-immune-system-stronger-
age/

Eliopoulus, C. (2017) Gerontological Nursing. Ninth Edition pp.48- Williams &

Wilkins

GeriatricNursing (2020). Physical care of the elderly.

http://geriatricnursing.org/physical-care-of-the-elderly/

Hall, K. Geriatric Medicine and Gerontology. Aging of the Gastrointestinal System.

https://accessmedicine.mhmedical.com/content.aspx?
bookid=1923&sectionid=144526242
Heiting, G. (2020). How vision changes as you age?
https://www.allaboutvision.com/over60/vision-changes.htm

Hinckle, J., and Cheever, K. (2016). Brunner & Suddarth’s Textbook of Medical-
Surgical Nursing. 13 Edition. The Philippines. Wolters Kluwer Health/
th

Lippincott Williams & Wilkins

Island Health (2015). Telehealth in Action: Geriatrics.

https://www.youtube.com/watch?v=-
YWez0BGa8I&feature=youtu.be&fbclid=IwAR10xzCwxTdZgZ6nMC2BncstD6-
rZUHDniu8SPG0pWGoCJ0yMSME6-DxHlo

Lueckenotte, A.G. (2000). Gerontologic Nursing. Theories of Aging. St Louis:

Mosby. https://ogg.osu.edu/media/documents/sage/handouts/SAGE
%20Theories%20of%20Aging%20geron%20nurs.pdf

Lumen Anatomy and Physiology (2020). Sensory Perception: Taste and

Olfaction. https://courses.lumenlearning.com/austincc-ap1/chapter/sensory-
perception/

Magtubo, C. (2017). Ageism: Elderly Filipinos discriminate against themselves.

https://today.mims.com/ageism--elderly-filipinos-discriminate-against-
themselves

Makofsky, N. (2012). How Does Caring for Aging Parents Affect Family Life?
https://mom.com/kids/4870-how-does-caring-aging-parents-affect-family-life

MedlinePlus (2019). Aging changes in the senses.

https://medlineplus.gov/ency/article/004013.htm

MedlinePlus (2020). Aging changes in the senses.

https://medlineplus.gov/ency/article/004013.htm

Miller, C (2012). Nursing for Wellness in Older Adults. Sixth Edition. Wolters
Kluwer Health | Lippincott Williams & Wilkins.

NurseKey (2016). Health Promotion, Health Maintenance, and Home Health

Considerations. https://nursekey.com/health-promotion-health-maintenance-
and-home-health-considerations/

Physiopedia (2017). Ageing and Genitourinary System. https://www.physio-

pedia.com/Ageing_and_Genitourinary_System

Potter, P (2016). Fundamentals of Nursing. 10th Edition. Elsevier Health Sciences

Robinson, L. et al (2019). Elder Abuse and Neglect.

https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm

Ruiz, A. (2019). Effects of Aging on the Digestive System.

https://www.msdmanuals.com/home/digestive-disorders/biology-of-the-
digestive-system/effects-of-aging-on-the-digestive-system

SeniorLifestyle (2019). 7 Best Exercises for Seniors (and a Few to Avoid!).

https://www.seniorlifestyle.com/resources/blog/7-best-exercises-for-seniors-
and-a-few-to-avoid/
The Gerontological Society of America (2020). Code of Ethics.
https://www.geron.org/code-of-ethics

United Nations. Principles for older persons.

https://www.un.org/development/desa/ageing/resources/international-year-of-
older-persons-1999/principles.html

University of Saint Mary (2020). The Impact of the Aging Population on Nursing.
https://online.stmary.edu/msn/resources/impact-of-aging-population-on-
nursing

Venus Zoleta (2020). Senior Citizen Discount and Benefits: Important Facts You
Might Not Know. https://www.moneymax.ph/government-
services/articles/senior-citizen-discount-philippines

Wayne, G. (2017). Acute Confusion Nursing Care Plan.

https://nurseslabs.com/acute-confusion/

Wayne, G. (2017). Chronic Confusion Nursing Care Plan.

https://nurseslabs.com/chronic-confusion/

Weber, J. R., and Kelley, J. H. (2018). Health Assessment in Nursing, Sixth

Edition. C & E Publishing Inc.

World Economic Forum (2020). These countries are aging the fastest - here’s
what it will mean. https://www.weforum.org/agenda/2020/02/ageing-global-
population/