19.2 Basic Concepts
Open Resources for Nursing (Open RN)
Ageism
Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of aging. There are many stereotypes and negative attitudes about aging adults that persist in the US and around the world. This bias can be linked to a general lack of knowledge about the aging process and misunderstandings about older adults. Because of these influences, many individuals have anxiety about aging that can lead to negative stereotypes of older individuals. This is known as ageism, which is the stereotyping and discrimination against individuals or groups on the basis of their age.[1]
Ageism among nurses and other health care professionals puts older people at risk. Research has demonstrated that ageism in health care negatively impacts older adults’ overall health, well-being, and quality of care received. Ageism results in increased risks of mortality, poor functional health, and slower recovery times from illness. Negative perceptions about aging can also lead to poor mental health and depression.[2] As you read this chapter, think about your own attitudes about aging and how these beliefs may impact the care you provide.
Read more at “What is Ageism in Healthcare and What Can We Do About It?” by GoodRx Health.
Integrity Versus Despair
Aging individuals must continually adjust to changes in health and physical strength, lifestyle changes as a result of retirement, the loss of significant others, and changing roles and relationships with family members and friends. As a result, older individuals may find it difficult to accept the changes associated with aging. Nurses can support older adults in maintaining a positive self-image and outlook by considering Erikson’s theory of development. Erikson’s theory of development describes the stage of older adulthood as “Integrity versus Despair.” This stage begins at approximately age 65 and ends at death. During this stage, older adults reflect on their accomplishments and the person they have become. If they feel they have led a successful life, they often feel satisfied and develop a sense of integrity. Conversely, individuals who feel unsuccessful or do not feel they achieved their life goals often feel unsatisfied and may experience hopelessness and despair that can lead to depression. Nurses can assist older adults in developing a sense of integrity by encouraging the client to reminiscence about previous positive life events and relationships and cultivate a positive mindset of guiding the next generation.[3]
Many older adults, especially those with declining health due to chronic disease, acknowledge that changes in their health status and mobility threaten the autonomy and independence they previously experienced throughout adulthood. As a result, many older adults strive to be autonomous, so they are not overly reliant on others for their daily care. They often engage in self-management activities in response to changes in their health and physical strength, ranging from simple daily tasks, such as medication management, to more complex tasks, such as relocating to new residences that are better suited to their changes in physical and mental health. Research has found that when older adults are faced with declines in their physical health and/or cognitive abilities, they often draw upon experiences and skills acquired in earlier adulthood for the purpose of self-managing their new conditions. They reflect on their resilience used to overcome significant challenges faced in earlier adulthood and then apply skills and knowledge gained through previously productive activities to managing their new health changes. However, not all older adults have sufficient personal and external resources to devote towards successful self-management of their health conditions. Nurses can assist older adults by personalizing health self-management strategies that emphasize their existing skill sets and knowledge.[4]
Other Considerations
Retirement
In addition to the physiological changes that occur with aging, older adults vary in their level of activity. For example, many older adults continue working into their seventies and beyond. Individuals may choose to continue to work because of their sense of purpose or because of a need for income. Some older individuals experience a loss of identity when they retire because their work role was an important aspect of their life. Retirement can bring a sense of freedom and adventure, as well as a need to find new identity and purpose.
Social Isolation
Retirement and the loss of daily interaction with coworkers, as well as death of family members and friends, can lead to social isolation in the aging population. Social support impacts a person’s health and quality of life and should be included as part of the assessment. It is helpful for nurses to be familiar with community resources that provide socialization opportunities and provide referrals for clients in need of additional services.
Modified Living Environment
Although many aging adults live in assisted living facilities or skilled nursing centers, many older adults prefer to live at home. Modifications may be needed to the home environment to promote safety and independence. For example, grab bars, elevated toilet seats, and other modifications may be needed in the bathroom, along with good lighting, minimization of clutter, and removal of rugs throughout the home. Assessment of the home environment for safety and ease of mobility is an important aspect of home care nursing.
If an older adult requires more care than family members are able to provide at home, nurses provide valuable information about available care options and make referrals to social workers and case managers. There are a wide variety of community-based resources to enhance care for older adults. Local aging and disability resource centers (ADRCs) can help facilitate referrals based on specific needs of the older adult. Examples of other resources include adult day centers, home health agencies that provide in-home personal care and nursing services, community-based residential facilities (CBRFs), and residential care apartment complexes (RCACs). If an older adult requires 24-hour nursing care, placement in a nursing home (also referred to as a skilled nursing facility) may be required. Use the following box to read more information about nursing home resources provided by the Centers for Medicare and Medicaid (CMS).
Learn more about nursing home resources by reviewing the Nursing Home Resource Center provided by the Centers for Medicare and Medicaid (CMS).
- Merz, C. C., Stark, S. L., Morrow-Howell, N. L., & Carpenter, B. D. (2016). When I'm 64: Effects of an interdisciplinary gerontology course on first-year undergraduates' perceptions of aging. Gerontology & Geriatrics Education, 39(1), 35-45. https://doi.org/10.1080/02701960.2016.1144600 ↵
- Burnes, D., Sheppard, C., Henderson, C. R., Wassel, M., Cope, R., Barber, C., & Pillemer, K. (2019). Interventions to reduce ageism against older adults: A systematic review and meta-analysis. American Journal of Public Health, 109(8), e1-e9. https://doi.org/10.2105/AJPH.2019.305123 ↵
- This work is a derivative of StatPearls by Orenstein and Lewis and is licensed under CC BY 4.0 ↵
- Perry, T. E., Ruggiano, N., Shtompel, N., & Hassevoort, L. (2014). Applying Erikson's wisdom to self-management practices of older adults: Findings from two field studies. Research on Aging, 37(3), 253-274. https://doi.org/10.1177/0164027514527974 ↵
Use the checklist below to review the steps for completion of “Primary IV Solution Administration.” Review the steps to safely administer all types of medication in the "Checklist for Oral Medication Administration" in the "Administration of Enteral Medications" chapter.
View an instructor demonstration of Primary IV Solution Administration[1]:
Steps
Disclaimer: Always review and follow agency policy regarding this specific skill.
- Gather supplies: IV fluid, primary tubing, tubing change label, and alcohol pads/scrub hubs.
- Verify the provider order with the medication administration record (eMAR/MAR).
- Perform the first check of the six rights of medication administration while withdrawing the IV fluids from the medication dispensing unit. Check expiration date and verify patient allergies.
- Remove the IV solution from the packaging and gently apply pressure to the bag while inspecting for tears or leaks.
- Check the color and clarity of the solution.
- Perform the second check of the six rights of medication administration.
- Perform safety steps:
- Perform hand hygiene.
- Check the room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain the process to the patient and ask if they have any questions.
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs (airway, breathing, and circulation).
- Perform the third check of the rights of medication administration at the patient's bedside.
- Remove the primary IV tubing from the packaging. If administering IV fluid by gravity, note the drip factor on the package and calculate drops/min. Perform the necessary calculations for the infusion rate.
- Move the roller clamp so that it is halfway up the tubing and clamp it.
- Remove the cover from the tubing port on the bag of IV fluid.
- Remove the cap from the insertion spike on the tubing. While maintaining sterility, insert the spike into the tubing port of the bag of IV fluid.
- Squeeze the drip chamber two or three times to fill the chamber halfway.
- Loosen the cap from the end of the IV tubing and open the clamp to prime the tubing over the sink:
- If using multiple port tubing, invert the ports to prime them and to prevent air accumulation in line.
- If the solution is an antibiotic, take care to not waste solution while priming the tubing to ensure the patient receives the correct dosage.
- Once primed, clamp the IV tubing and check the entire length of the tubing for air bubbles. Tap the tubing gently to remove any air.
- Replace or tighten the cap on the end of the tubing.
- Label the primary IV fluid bag with the date and time. Place the tubing label on the tubing near the drip chamber.
- Assess the patient’s venipuncture site for signs and symptoms of vein irritation or infiltration. Do not proceed with administering fluids at this site if there are any concerns.
- Based on agency policy, vigorously cleanse the catheter cap on the patient's IV port with an alcohol pad/scrub hub (or the agency required cleansing agent) for at least fifteen seconds and allow it to dry.[2]
- Assess IV site patency according to agency policy. Purge a prefilled normal saline syringe of air. Attach the syringe onto the saline lock cap. Undo the clamp on the extension tubing. Inject 3 to 5 mL of normal saline using a turbulent stop-start technique. If resistance is felt, do not force the flush and do not proceed with IV solution administration; follow up according to agency policy.
- Remove the syringe from the IV cap and then clamp the extension tubing.
- Vigorously cleanse the catheter cap on the patient's IV port with an alcohol pad/scrub hub (or the agency required cleansing agent) for at least five seconds and allow it to dry.
- Remove the protective cap from the end of the primary tubing and attach it to the IV port while maintaining sterility.
- Move the slide clamp on the saline lock to open the tubing.
- Set the infusion rate based on the provider order:
- For infusion pump: Set volume to be infused and rate (mL/hr) to be administered.
- For gravity: Calculate drop per minute.
- Assess the patient’s IV site for signs and symptoms of vein irritation or infiltration after infusion begins.
- Secure the tubing to the patient’s arm.
- Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
- Ensure safety measures when leaving the room:
- CALL LIGHT: Within reach
- BED: Low and locked (in lowest position and brakes on)
- SIDE RAILS: Secured
- TABLE: Within reach
- ROOM: Risk-free for falls (scan room and clear any obstacles)
- Perform hand hygiene.
- Document the procedure and related assessment findings. Report any concerns according to agency policy. Include IV fluids on patient's input/output documentation.
