ConceptTheoryModel
Carol A Miler in Gerontic
Nursing
By Dr. Joni Haryanto, S.Kp., Ns., M.Si.
Disampaikan pada Kuliah dengan Metode Ceramah dan Evidence
Base Learning, F.Kp UA, Surabaya, September 2015
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The use of Functional
Consequences Theory
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Old Defined
Young old: 65 74
Middle old: 75 84
Old old: 85 and up
Only a guide as there is a vast
difference in biological and
chronological aging
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Roles of the Gero Nurse
Provider of care
Teacher
Manager
Advocate
Research Consumer
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Certification
Nurse certification is a formal process
by which a certifying agency validates a
nurses knowledge, skills, and
competencies through a written exam
in a specialty area of practice
Why certify?
Professional
accomplishment/Leadership
Commitment to profession
Provide higher quality of care
EBP and resource to others
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Background
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Growth in Home Care
Growth in Home Care 2002 - 2007
No. of No. of
service service
users hours Net Expenditure
millions
2001/02 67,211 452,758 208
2006/07 75,935 645,043 305
% Growth 11% 30% 32%
Source: Home Care Statistical Return H1 Source: LFR
Housing Support Services
2005/06
2005/06 - Community Care Groups 117,811 307
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Source: Supporting People Statistical Return
Age and gender of service users
Age, client group and gender of people receiving home care services,
2007*
Hous.
0-64 65-74 75-84 85+ Total Supp.
Male 47% 40% 30% 24% 33% 43%
Female 53% 60% 70% 76% 67% 57%
Total People -- Home
Care 20% 15% 35% 30% 100% 100%
Total People Hous.
Supp.10/24/2017 50% 14% 21%
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15% 9
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Care group of service users
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Demographic Time Bomb
More people are living
longer, with serious disease
and increased symptom
burdens
Almost double life
expectancy in 100 years
Increased complexity in
looking after patients with
advanced disease at the end
of their lives
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Why are we leaving it to luck?
Joanne Lynn
What will we need when we have to live with a
fatal disease?
We need reliability, We need a care system we can
count on- Doing RIGHT thing at RIGHT time
To make excellent care routine we must learn to do
routinely what we already know must be done
All that it takes is innovation, learning,
reorganisation and commitment
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Added Value 2: Caring for people with non-malignant
conditions and the frail elderly
Function
Function
High
High
Death
Death
Low
Time Low
Time
Organ failure
Function
GP has 20 High
deaths per 6 5
year
Death
2 7 Low
Other Time
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Key Factors with end of life
care of elderly
Multiple co-morbidities
Increasing memory loss/dementia
Difficulty predicting prognosis
Difficulty predicting dying phase
Complex social/ health factors
Need protection from over intervening - eg
DNAR, trolley deaths
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Place of death
Higginson I (2003) Priorities for End of Life Care in England Wales
and Scotland National Council
Place: Home Hospital Hospice CareHome
Preference 56% 11% 24% 4%
Cancer 25% 47% 17% 12%
All causes 20% 56% 4% 20%
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Gold Standards Framework
3 Programmes of work:
GSF in Primary Care
GSF in Care Homes
EOLC developments and support
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The Gold Standards Framework
A framework to deliver a
gold standard of care
for all people approaching
the end of their lives
A systematic approach to optimising
the care delivered by healthcare
professionals
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A good death for all
Our aim is that
every person
should be able to
live well and die
well in the place
and in the manner
of their choosing
But how?
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Gold Standards Framework in
Community Palliative Care
The Aim for Primary Care and Care
Home teams:
to develop a practice-based/care
home based system to improve
the organisation and quality of
care of patients/residents in the
last year/s of life in the
community/care home
So generalist better dovetail skills
with specialists
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Head Hands and Heart of
Community Palliative Care
HEAD HANDS
- knowledge - process/organisation
- clinical competence - systems
- what to do - how to do it
HEART
-compassion/care
-human dimension-why
- experience of care
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The Gold Standard of
end of life care
The care of ALL dying patients
is raised to the level of the best.
(NHS Cancer Plan 2000)
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Karakteristi Penduduk Dunia
Jumlah dan proporsi penduduk
Morbiditas dan mortalitas
Karakteristik sosial
Karakteristik kesehatan
Kondisi lansia yang menurun
Proses penuaan
Gerontophobia
Kompleksitas pelayanan kesehatan lansia
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Functional Consequences Theory
A guiding framework that would
address older adults with physical
impairment and disability
Nursings role is to minimize age-
associated disability in order to
enhance safety and quality of living
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Theory of Thriving
Based on the concept of failure to
thrive and application of thriving to
the experience of well-being among
frail elders living in nursing homes
Nurses identify and modify factors
that contribute to disharmony
among a person and his or her
physical environment and personal
relationships
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Carol A. Miller MSN RN-BC AHN-BC
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Concept The Functional
Consequences Theory
Terinspirasi dari teori Goal attainment
(1981)
Functional consequences
Hasil pengamatan efek tindakan, faktor
risiko, perubahan terkait usia yang
mempengaruhi kualitas hidup atau kegiatan
sehari-hari manusia dewasa tua
Negative functional consequences
Orang-orang yang terganggu tingkat
konsekuensi fungsionalnya atau kualitas
hidupya.
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Concept The Functional
Consequences Theory
Positive functional consequences
Sustu kondisi yg terbaik dan tingkat
ketergantungan yg terendah
Age-related changes:
Suatu perubahan yg tak terelakkan, yg
ireversibel dan progresif, terkait penambahan
umur dan pengaruh ekstrinsik dan kondisi
patolgis
Older adults:
Orang yang kemampuan fungsinya
dipengaruhi oleh akuisisi perubahan terkait
usia dan faktor risiko
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Concept The Functional
Consequences Theory
Risk factor
Kondisi peningkatan kerentanan lansia
menuju terjadinya NFC
Goals of gerontology nursing
Meminimalkan negatif efek thdp ARC and RF
& meningkatka PFC
Health:
Kemampuan lansia untuk berfungsi pada
capasity tertinggi, meskipun terjadi
perubahan terkait usia dan faktor risiko yg
ada.
Enviroment
Kondisi eksternal termasuk pelayanan
kesehatan yg mempengaruhi fungsi lansia
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Paradigm FCT
Person
Lansia sebagai manusia unik yg berinteraksi
dg lingkungan dan manusia di sekelilingnya.
Nursing
Aktivitas keperawatan yg berupa pengaturan,
promosi, modifikasi, dan monitoring
hubungan pasien dg lingkungannya
Health
Pengalaman hidup dinamis manusia, yg selalu
beradaptasi thdp stressor dlm lingk internal &
eksternal melalui penggunaan sumber daya yg
optimal seseorang untuk mencapai potensi
maksimal untuk hidup sehari-hari
Enviroment
Batas yg terorganisir dr sistem peran sosial,
perilaku, dan perkembangan praktik.
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Theory FC
The functional consequences theory of
gerontological nursing is consistently used
in this text to explain nursing care of older
adults.
Fokus pada lansia
What is unique about the care needs of
older adults.
How can gerontological nurses effectively
care for older adults.
The rational for this exclusion is that
deseases proceses are not different in older
adults, but the impact of ARC and RF.
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Framework
Assessment
Age-Related Additional Positive
Negative Functional Functional
Interventions Consequences Consequences
Changes Risk Factors
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Format p. 490
Functional consequences assessment
Date PTA ADM DISCH
Personal Care
Bathing
Dressing
Mouth care
Hair care
Dietary intake
Mobility
Transfer
Ambulation
Bed
Mental Sta
Mental
5 Totally
4 Assist simple
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3 Assist complex
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THANK YOU!
We hope you enjoyed our presentation
By Joni Haryanto
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