Geriatric Nursing: Interview with Karen San Diego-De Guzman, RN, BSN

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Geriatric Nursing: Interview with Karen San Diego-De Guzman, RN, BSN

Innovations include loaning iPads to seniors for electronic visits

By Keith Carlson, RN, BSN, CPC, NC-BC
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Where are you employed and what is your position?

I’m currently employed at UC Irvine Medical Center as a clinical nurse in the outpatient department of the Senior Health Center.

What are your responsibilities?

I’m responsible for overseeing patient flow within the clinic, answering triage messages, performing walk-in triage, reviewing lab results on behalf of the doctors, delegating tasks and supervising medical assistants. We also assist the doctors in completing various forms for our geriatric patients, including paperwork for adult daycare, DMV placards, in-home support and other services. I coordinate hospital admissions, ER transfers and home health referrals. We also manage the usual RN tasks in the clinic, including catheter insertions, IV hydration, blood draws and medication administration.

How long have you worked in geriatrics?

For almost two years. Since 2001, I have worked in various specialty areas. I’ve been employed at this facility for six years. Prior to working specifically in geriatrics, I worked with adults and seniors in both the inpatient and outpatient settings.

What attracted you to geriatrics as a specialty?

The way specialized care is delivered in order to meet the very specific healthcare needs of older patients. It’s very satisfying to see my patients recover their health and resume normal lives. The good that we do for our patients is very fulfilling, especially considering that each of us and our loved ones will be in the same position someday.

Have you had personal experiences with elders in your life that have impacted your work as a nurse?

I grew up with my grandmothers — six of them — and I was raised to interact properly with my elders. My family and I took care of our elders until their very last breaths, attending to all of their needs.

I was raised in Catholic schools where the nuns exposed us to an environment of sharing and caring for others. That too is deeply rooted in me. While pursuing excellence in this profession, I’ll never forget that my true purpose is to love and care for others, especially those who are sick.

We understand that you are involved in some special initiatives. Can you tell us about them?

There are several:

    • Patient-Centered Medical Home
    Currently, we are preparing to become the first accredited patient-centered medical home (PCMH) in Orange County. This is a promising outpatient, nonresidential model where patients receive continuity of care through one facility.  The clinic coordinates the management of chronic diseases, including dementia, congestive heart failure (CHF) and diabetes. The care includes wellness visits and ready availability of same-day appointments. The PCMH also has access to the medical records of area hospitals in order to avoid having to call hospitals to request labs, notes and other information.

    • iPad Initiative
    Some of our patients who are frequently in the ER or who have recently been discharged from the hospital are loaned an iPad as a free service. The iPads are used to schedule electronic visits with a nurse. The goal is to allow us to follow up in hopes of preventing readmission. While the patient cannot call the nurse via the iPad, we schedule iPad visits at regular intervals that meet patients’ individual needs. These electronic visits are like a replacement for having a home health nurse. I’m able to make an assessment and take action to prevent rehospitalization. I can also discuss medications and reiterate discharge instructions.

For example, a patient with CHF was recently loaned an iPad so that we could follow up regarding his condition. During each iPad visit, I ask the patient to show me his legs, hands and face in order to evaluate for edema and assess the effects of prescribed diuretics. Using the iPad, I can also see if the patient is distressed, pale or short of breath.

Every day, the nurses receive a list of patients from the SeniorHealth Center who have been admitted to the hospital. We use that list to determine whether each patient qualifies to go home with an iPad. The devices are usually loaned for 30 days, since that is the most critical period post-discharge.

    • Telemonitoring Carts
    We use telemonitoring carts that are connected electronically to several local skilled nursing facilities in Orange County. This technology enables doctors to consult remotely on non-urgent patient issues. It also includes special features like a stethoscope that can allow a doctor to hear the lung and heart sounds of a patient who is 10 miles away.

    • Health Assessment Program
    We offer a health assessment program for seniors (HAPS), a service for elders who have medical, psychological and social challenges. The assessment involves an evaluation by a geriatrician, neuropsychologist, pharmacist, nutritionist, social worker and occupational therapist. We then review any recommendations with patients and their families to assist them in making decisions regarding treatment and living arrangements.

Other services we offer include a memory assessment by a geriatrician or neuropsychologist and a medication consultation with a pharmacist who specializes in specific issues related to older adults and medications.

How do you feel the aging of the population will change the delivery of healthcare in the United States in the years to come?

Older adults will have to deal with more chronic diseases and there will be an increased need for geriatricians as well as nurses, physical therapists, dentists and other caregivers. There will also be a greater need for durable medical equipment and other services.

Do you feel that the U.S. healthcare system offers elders the care that they need? If not, what’s missing?

No, it does not offer the comprehensive programs that can fully meet the healthcare needs of elderly patients. What I feel is missing is continuity of care. This is why the patient-centered medical home is important. I worry particularly about the disabled elderly and isolated older adults. Our team approach ensures that there are positive outcomes for patients who have special needs, which is due to the fact that our team offers continuity of care. We aim to reduce hospital readmissions and pay more attention to transition of care.

It’s crucial to create a managed care system that truly assesses and serves the many needs of the elderly. We also need more medical personnel and caregivers who can communicate with elderly patients in their native languages and more social workers and home health nurses to coordinate patient care with clinic- or hospital-based physicians.

We must also address the issue of elderly patients who are often forced to choose between their basic needs and their health needs. Somehow, there has to be a system in which those living within a certain income bracket don’t have to contribute large premiums for additional coverage and services.

What opportunities for nurses do you see vis-à-vis the so-called “Silver Tsunami” — the aging of the population?

Between now and 2050, I see a growing demand for nurses as well as senior health centers that can take the lead in caring for this aging population. More training and expertise will be required for nurses and allied health for the system to cope.

What do you love about your work?

Seeing an elderly patient feeling well after an illness and being able to resume a normal life is very satisfying. Thank-you notes from patients and families mean a great deal.

I also appreciate when doctors take the time to acknowledge how our efforts have contributed to the achievement of our department’s goals and a job well done. The rapport among the staff and doctors is felt by the patients and can perhaps help to alleviate their worry and discomfort while also bringing about the best clinical outcomes. Overall, the things that mean the most are the commitment to delivering the best patient care and communicating it clearly to the patient.

How would you describe the greatest challenges of your work?

Dealing with a difficult patient. In those cases, we can hopefully make the patient understand that his or her concerns are being addressed and that his or her safety and well-being are of the utmost importance to us.

Also, being able to resolve a complicated case and attend to patients’ many concerns are the human factor of this job. Patients may request assistance with things that are outside of our normal responsibilities, but those things are often worthwhile, making the situation lighter and simpler for those patients.     

Do you have a special certification in geriatrics?

I don’t currently have a particular certification in geriatrics, but I regularly take part in lectures, seminars and online learning appropriate to the field. I do this to broaden my knowledge of the senior population and its care.

What are your future career plans?

Opportunities in geriatrics keep evolving and one must be well-informed in order to keep up with the challenges and changes. I foresee myself earning a master’s degree or perhaps another degree or specialization.  In the end, what really matters most is what you do for others. That says more about you than what you’ve achieved for yourself.   

Keith Carlson, RN, BSN,CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at http://www.nursekeith.com/.

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The Future of Aging is Digital

USC develops apps that identify elder abuse, calculate longevity and track pain levels


The USC Davis School of Gerontology recently established a new Center for Digital Aging whose mission is to develop high-tech tools to address the unique needs of older adults. 

Easy-to-Use Apps
One part of that mission is translating the school’s extensive research on aging into easy-to-use mobile apps that can help older adults manage their health, make lifestyle changes and even combat elder abuse. The apps are designed to be accessible to an older audience, with intuitive controls and easy-to-read typefaces.

Created by Grad Students
The first of the new apps, to be released sometime this year, will be GEAR-Up, intended to help “first responders” identify signs of elder abuse and find appropriate help. GEAR-Up is based on a proposal by doctoral candidate Marguerite DeLiema and graduate student Allyson Young, who developed the idea as part of a school contest.

Future apps may include a personalized longevity calculator and ManageMyPain, a digital tool proposed by doctoral candidate Jeff Laguna that would help patients and healthcare providers track pain levels between office visits.  “We found that older adults have an interest in learning new technology, especially if it’s intended to help their care,” says Laguna, “but there aren’t enough products for them yet.”  

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"Aging & Health in America 2013"

 Facts and figures from the Centers for Disease Control

• The first baby boomers reached age 65 in 2011, launching an unparalleled phenomenon in the United States. Since January 1, 2011, 10,000 Americans will turn 65 each day for 20 years!

• Americans are living longer than in previous decades. Many of the diseases that claimed our ancestors—including tuberculosis, diarrhea and enteritis, and syphilis—are no longer the threats they once were.

• Among healthcare costs for older Americans, 95% are for chronic diseases.

• Research has shown that people who do not use tobacco, who get regular physical activity, and who eat a healthy diet significantly decrease their risk of developing heart disease, cancer, diabetes, and other chronic conditions.

• In 2030, when the last baby boomer turns 65, one of every five Americans—about 72 million people—will be an older adult.

Excerpted from “Aging & Health in America 2013,” the excellent 60-page report published by the Centers for Disease Control. Download the free PDF here

This article is from workingnurse.com.

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