Nurses Perception of

Vulnerability in
older adult and effect on
care outcome.
Presented by:

Bosede Adedire- FNPs

CONTENT OUTLINE
Background of the study
Definitions - Vulnerability
- Perception
Review of Literature
How do we assess vulnerability?
Roys Adaptation Framework & The Nursing Process
Future implication
Summary
Questions
Post-Presentation Quiz

BACKGROUND
Studies have estimated that 30% to 67% of
hospitalizations among nursing facility residents could
be prevented with well-targeted interventions (Jacobson,
et al., 2010; Dyer et al., 2010).
45%-65% of hospital admissions among Medicareenrollees receiving Medicare skilled nursing or
Medicaid nursing facility services could have been
avoided (CDC, 2011).
Projected estimate of twenty percent increase in the
population of people aged sixty-five and older by
2030(CDC, 2011).

WHAT IS PERCEPTION?
o Perception includes the five senses; touch,
sight, smell and taste
o Detecting stimuli in the environment to
actually taking action based on that
information.
o The ability to interpret and give meaning to
the interpretation of object in the
environment
o How does it apply to nursing?
Girard, B.R., & Murray T. (2010). Perceived control: a construct to guide patient care:
Journal of Cardiovascular Nursing; 20 (3): 18-26

WHAT IS VULNERABILITY
o Failure to engage in acts of selfcare that adequately regulate
safe and independent living.
o In the context of the older adult,
vulnerability refers to a subgroup of the
population who are more likely to
develop health problems as a result of
exposure to risk or to have worse
outcomes from these health problems
than the population as a whole.

Cassidy, R., Coverdale. J., Naik., & Nair. (2010). Assessing Safety Independent Living in

Vulnerable Older Adults. Journal of American Board of Family Medicine, 23(5).

TERATURE REVIEW
Sarvimaki, A., Stenbock-Hult., B. (2011). The
meaning of vulnerability to nurses caring for older
people. Nursing Ethics 18 (1) 31- 41, doi:
10.1177/0969733010385533
o Nurses experience a variety of consuming
emotions and stress.
o Analysis showed that vulnerability was a
resource as well as a burden.
o The more vulnerable a patient is the higher the
responsibility.

LITERATURE REVIEW CONT.

McCullough. L.B., Molinari, V., Workman., R.
(2010). Ethically justified clinical strategies for
promoting geriatric safety. Int J Geriatr
Psychiatry 2006;21:1517.
o It is ethically justifiable to address any form of vulnerable
state assessed during care interaction.
o Following a planned care path for individualized
care promote patient safety.
o Patient characteristics recognizable within
24 hours of admission can be used to
identify increased risk for adverse events
and 30-day readmission

TERATURE REVIEW CONT.

Girard, B.R., Murray T. (2010).
Perceived control: a construct to guide patient
care: Journal of Cardiovascular Nursing; 20 (3):
18-26

o Nurses perception play a huge factor in what is assessed

and how such assessments or findings are interpreted.

o Perception of patient care needs determines older adult re-hospitalization

within two weeks of earlier admission.

o Using clinical judgments and proper assessment tools, most older adult
hospitalizations or re-hospitalizations are preventable.

How do we assess
Vulnerability?

Adaptation Framework & The Nursing Process

1st level assessment: Assess Behaviors i.e. the what

2nd level assessment: Identify stimuli, i.e. the why

Diagnosis: What does it all mean?

Planning: What do you want to do?

Implementation: How are you going to do about it?

Evaluation: How did it work out, what do you need to

keep or change?

Jones., Patronis. (2010). Nursing Leadership and Management. Theories, Processes and
Practice Independent Publisher. A. Davis.

IMPLICATION FOR
NURSING PRACTICE

N SUMMARY Flawed clinical judgments in care delivery could increase

hospitalization or readmission
With proper admission and re-admission assessments, most older
adult hospitalization are preventable.
Nursing judgments are important in how patient needs are
perceived in care implemented.

QUESTIONS?

POST- PRESENTATION
QUIZ

References

Anderson, M. A. (2008). Nursing todays older adult holistically. Philadelphia: F.A. Davis
Research and Development Project (2011). The Vulnerable Elders Survey (VES-13): A Tool
for Identifying vulnerable Elders in the Community. Retrieved From:
http://www.rand.org/health/projects/acove/survey.html
Cassidy, R., Coverdale. J., Naik., & Nair. (2010). Assessing Safe and Independent Living in

Vulnerable Older Adults. Journal of American Board of Family Medicine, 23(5).

Center for Disease Control and Prevention (2011). National Geriatric Fact Sheet.
Retrieved From: http://www.ahrq.gov/qual/nurseshdbk
Dyer, C.B., Pickens S., & Burnett J. (2010). Vulnerable elders: when it is no longer safe to live

alone. Journal of American Medical Association; 29(8), 1448-50.

Frosch, D. L., Singer, K. J., & Timmermans, S. (2011). Conducting implementation research in
community-based primary care: a qualitative study on integrating patient decision support interventions
into routine practice. Health Expectations, 14(7), 3-84.
Gerber., L. (2012). Community health nursing: A partnership of care. American Journal of
Nursing: Volume 112 (1), 154-165.
Girard, B.R., & Murray T. (2010). Perceived control: a construct to guide patient care:
Journal of Cardiovascular Nursing; 20 (3): 18-26
Jones., Patronis. (2007). Nursing Leadership and Management. Theories, Processes and
Practice Independent Publisher. A. Davis.
Masotti, P., McColl, A., Green, M., (2010). Quality in elder care. International
Journal of Health Care 22 (2): 115-125.
McCullough. L.B., Molinari, V., & Workman., R.(2010). Ethically justified clinical strategies
for promoting geriatric safety. Int J Geriatr Psychiatry 6(21), 151-157.
Pauly., M., & Pagan., J. S (2010). Spillovers And Vulnerability: The Case Of Community
Uninsured Health Services Research. 26(5), 199-208.
Sarvimaki, A., & Stenbock-Hult., B. (2011). The meaning of vulnerability to nurses caring for

older people. Nursing Ethics 18 (1) 31- 41.

Skelton, K., Kunik, M., Regev, T., & Naik, A.D (2010). Determining if an older adult can make

and execute decisions to live independently: American Journal of Nursing

112 (1).
Saliba, S., Elliott, M., Rubenstein, LA., & Solomon, DH (2010). The Vulnerable Elders Survey:
A Tool for Identifying Vulnerable Elders in the Community
Journal of the American Geriatric Society; 49:1691-9.