Exploring Adult Nursing and Its Scope

This paper explores the scope of adult nursing, covering major areas such as roles, relationships with other specialties, and insights into caring for patients with ill-health. It discusses the importance of practicing healthy life behaviors to promote patient health and provides a comprehensive overview of adult nursing, including its challenges and applications in real-world scenarios.

The Scope of Aged Care Nursing
ROLE OF THE ADULT NURSE IN A VARIETY OF SETTINGS AND INSIGHT
INTO ADULTS’ EXPERIENCES OF ILL HEALTH
Author
Name of The Class
Name of The Professor
School
City and State
Date

The Scope of Older Adults Nursing 1
Introduction
The most significant priority of healthcare models is to improve and enhance the
quality of care among adults. The role of the advanced practice nursing (APN) is to take
this immediate priority and maximize their specialized skills in nursing knowledge to
handle the customers’ needs within their sphere. Older people in the society are faced
with various chronic conditions and different functionality problems. With this, The
society turns to adult nursing as the main solution to such dilemmas. The paper is
focused on analyzing the role of the adult nurse in a variety of settings and insight into
adults’ experiences of ill health.
.
The Scope of Adult Nursing Role
According to (Castledine and Close, 2009), adult nursing is a health practice that
is carried out across all institutional settings as named above. Adult nursing is a broad
term that that simply refers to the general nursing care except for children care. Also, it
has a particular grouping that deals with older people (geriatric nursing) (Adams, 2010).
However, where care for senior adults focuses primarily on physical health and well-
being, such nursing care would fall within the responsibilities of adult nurses. On the
other hand, where attention falls towards mental health conditions of an adult, the same
would fall within the scope of mental health. For instance, the care for patients of
dementia falls within adult nursing even though the deteriorated cases sometimes have
much to do with mental problem.
One of the main areas or ill-health in adult nursing includes taking care of
patients of dementia. Given the high and still rising cases of dementia, there demands

The Scope of Older Adults Nursing 2
to apply relevant models of care that help in identifying specific patient’s needs. The
main role of adult nurse involves assessing the patient’s conditions by the application of
methods that are explained in the nursing theories (Potter et al., 2016). These methods
allow the nurse to identify the exact patient needs and demonstrate effective
communication that aids in the interaction between the nurse and the patient (Cherry
and Jacob, 2013, p.81). Nurses are expected to apply the appropriate theory that would
cater for the patient needs. The theory applied is expected to the provide a solution for
the recognized patient’s problems and assess how level in which the procedure would
be successful. One of these theories is the Orem's Self-Care Deficit theory that was
suggested by Dorothy (Hartweg, 1991).
The self-care deficit theory suggested by Orem features three theories. These
are the self-care, self-care deficit and the nursing systems. In the self-care theory,
(Hartweg, 1991) explains these are the activities the patient undertakes to maintain his
health. In this theory, self-care agency is one’s assimilated ability to execute self-care
needs which also depends with the condition’s factors i.e gender, age, family,
healthcare, etc. Therapeutic self-care needs are the totality of the self-care measures
needed. The better performance of self-care determines the fulfillment of the self-care
requisites (Katherine Renpenning and Susan Gebhardt Taylor, 2003, p.104). There
three types of self-care requisites are the universal, developmental and health deviation
(Katherine Renpenning and Susan Gebhardt Taylor, 2003, p.218).
The deficit theory involves the nurse role in patient assessment to identify the
needs. Once they are identified, the nurse next step is to choose the appropriate
nursing systems of care (Katherine Renpenning and Susan Gebhardt Taylor, 2003,

The Scope of Older Adults Nursing 3
p.218). The care is provided as per the level of the patient deficits. After identifying the
care, procedures and the system, the last part involves evaluating the care to find out
whether it met the specific needs. Thus, this theory was the one successful for our
practice in assisting our patient.
The case I encountered was for a male adult patient, 75 years old suffering from
dementia. For the sake of patient’s confidentiality, this paper will refer to the patient as
Mr. White, and the caregiver (daughter) Ms. X. Mr. White came was presented to the
orthopaedic emergency ward department in pain from a broken fractured Neck of Femur
(NOF) which he had sustain from a fall. Mr. White was accompanied by her daughter X
who also acted as his caregiver. Ms. X stated that Mr. White was 75 years old and he
lived with him together with the rest of the family members. Mr. White is a retired
teacher and had a good memory before his retirement. Ms. X presented a clinical note
from a district nurse (DN) revealing the diagnosis of Mr. White with Alzheimer, a
common type of dementia. The note showed that he had been diagnosed with the
disease for five years ago. Ms. X and other family members have been taking care of
him ever since. Mr. White wife had passed 20 years ago.
In applying the orem’s theory, we started with filling the patient profile, then we
moved to data collection where we collected the basic information regarding the
condition. I.e. age, gender, female, health state, development state, sociocultural
orientation, health care system, family system, patterns of living .etc. We then collected
information regarding the patient universal selfcare prerequisites such as the how he
was breathing, fluid intake, food, elimination, activities (pain/rest) bone fracture and
deformity, social interaction, communicates etc. We also assessed the developmental

The Scope of Older Adults Nursing 4
self-care requisites and health deviation self-care requisites such as cooperation with
medical regime, adjustment to health changes, perception of the physical therapy
approaches etc.
In overall, the areas that needs assistance were food and nutrition interventions,
education for the disease management was required, life style to include medical
regimen, hazard prevention such as falls, maintenance of health status, maintain a
developmental environment, adherence to the medical regimen, solitude/ Interaction,
Activities and rest, supportive educative, preoperative education, surgery, and post-
operative education.
On examination, Mr. White had sustained a non-ST-segment elevation
myocardial infarction (NSTEMI) which was also linked to his fall. An anesthetic review
showed that he was at another risk of unstable cardiac, which also suggested high
chances of an intraoperative mortality. There was a recommendation for a delay of
anesthetic from 24 to 72 to allow operative fixation. The purpose of this approach was to
monitor optimize cardiac status if need be. In addition, there was a palliative care which
was highly monitored for controlling his pain, which at some point it was necessary to
use a continuous intravenous infusion of fentanyl. After about 3 days, Mr. White got a
transthoracic echocardiogram which showed that his left ventricular had a normal size
and was functioning well. After another anesthetic review, the patient was found fit to
undergo a surgery though there still remained a high anesthetic risk. Since the daughter
was supporting the idea of operation, she was just given the consent form which she
signed, and the dynamic hip screw was inserted. There were no problems with the
postoperative recovery. The patient just moved well except for a time when there was

The Scope of Older Adults Nursing 5
and pneumonia and anemia complications. All of them were taken care of and the
conditions improved. Due to the few perioperative symptomatic conditions of delirium
and some pain, the palliative care was ongoing for the management of those symptoms,
and the move facilitated successful recovery by the 7th day of his admission.
.
Role of Other Professionals
(i) Nutritionists and Dieticians
While identifying the therapeutic selfcare demands of Mr. White’s deficient areas
under Orem’s model, the nursing diagnosis showed that the patient had inabilities to
maintain an ideal nutrition or inadequate food intake. The two professionals were to
focus on assessing Mr. White’s diets and nutrition during the palliative care. Besides, it
has been noted that this problem of diets and nutrition is common among dementia
patients as they hardly maintain steady body weight and regularly have feeding-related
challenges (Jansen et al., 2015). For instance, Mr. White’s had a body mass index
(BMI) of 14.9. Their role of nutritionists and dieticians in Mr. White’s case was to develop
nutritional care approaches to prevent cases that can complicate Mr. White’s condition
due to underweight. From the study of (Ye et al., 2016), underweight can cause
deterioration of dementia.
(ii) Orthopaedic Surgeon
The role of this professional in Mr.White’s case was to perform the operation.
According to (Riemen and Hutchison, 2016), a multidisciplinary hip fracture approach is
composed of seven components. These are the orthogeriatric assessment, the rapid
optimization in the preparation for the surgery, early identification the patient’s goals

The Scope of Older Adults Nursing 6
regarding multidisciplinary rehabilitation, continuous, coordination of orthogeriatric and
multidisciplinary analysis, liaising with other health services, governance structure in all
the stages and involvement in the palliative care. For the case of Mr.White, the
Orthopaedic Surgeon recognized these as his roles and also followed up with the
palliative care to ensure that the fracture did not trigger another problem.
(iii) Anesthetist
The role of anesthetist was to perform Mr. White’s assessments of his health to
advise on his status regarding anesthesia. The anesthetist also looked after him during
the surgery. For instance, the anesthetist carried out an assessment that showed that
Mr. White was at a risk of unstable cardiac, which also suggested high chances of an
intraoperative mortality. According to (Vanderweyde et al., 2010), dementia patients
develop a decline in cognitive ability as a post-operative outcome with most researchers
suspecting that it is caused by anesthesia. Therefore, with the presence of anesthetist,
such risks are reduced.
(iv) Orthogeriatric Team
The work of (De Rui et al., 2013) has enough evidence that the role of
orthogeriatric team go beyond the hospital settings especially to provide the services of
integral geriatric care. In our case, this team conducted weekly analysis to ensure that
the previous functional situations were improving hence signifying Mr. White’s maximum
recovery.
(v) Medical Doctor
This was a ward-based doctor who kept reviewing Mr. White’s daily basis.
According to (Hum et al., 2014), the management of cases of dementia falls within the

The Scope of Older Adults Nursing 7
role of the doctors who provide primary care for different medical conditions. In Mr.
White, the doctor helped in care coordination and the understanding of Mr. White social
and family background.
(vi) Neurologist
This is a physician with a specialty in the management and diagnosis of diseases
that affect the nervous system. In the cases of dementia, neurologists also advised on
the use of medications (Larner, 2014). In the case of Mr. White, the neurologist helped
in examining and interpreting algorithms that allowed an efficient and accurate
identification of neurodegenerative in addition to the vascular dementia. He guided in
the determination of the dementia and preventing the development of Alzheimer's
disease.
(vii) Occupational Therapist (OT)
The OT helped Mr.White to achieve independence in the performance of his daily
tasks such as meal preparation. According to (Gulanick and Myers, 2014), the OT ‘s
roles are to conduct assessments of functional capacity of a patient to care for himself.
In Mr.White, these assessments included the capacity to work on daily routines and use
of assistive equipment. OT also worked with the family members to provide trainings for
maximizing safety at home and patient independence.
(viii) Physiotherapist
The role of physiotherapist in Mr. White’s case was to assess him after the
surgery to enable him to recover his mobility. Th physiotherapist provided him with the
most suitable walking aids and provided a training to the carer in addition to the required
exercises. According to (Handley et al., 2017) physiotherapist help people affected by

The Scope of Older Adults Nursing 8
dementia with advises regarding exercise and assistive equipment especially if they
have a history or risks of fall that has impaired their mobility. Therefore, our
physiotherapist was highly beneficial to Mr.White.
(ix) Nursing and other Health Care staff
The roles of nurses in Mr. White were to take care of all his general needs and
care. These included training family member on medical regime, coping skills, follow up
with environmental care, etc. The roles of registered nurses are unlimited. According to
(Adams, 2010) the nurses assist in the assessment, care plan, provision and evaluation
of preventative and curative measures. Their wide range of operation also includes
rehabilitative care and coordination of care plan ordered by other professionals.
(x) Social Worker
Mr. White was also provided with the assistance of a social workers. Their roles
were to organise any assistance needed during his discharge from hospital. Like the
nurses, they also take a range of roles. For instance, the work of (Allen et al., 2012)
states that they provide support to consumers especially at stressing moments, during a
change, time of grief, adjustment, and counseling.
Conclusion
In a nursing career, adult nurses are nurse specialists whose aim is to help
communities in promoting health, preventing ill-health and enabling the society to
improve and maintain both their physical and mental health. In this role, an adult nurse
professional treats, offers support, and empowers families to care for their health by
practicing healthy life behaviors. This paper aimed to explore the scope of adult nursing.
The paper has covered different major areas like the roles of adult nursing and its

The Scope of Older Adults Nursing 9
relationship with other nursing specialties. Finally, the paper has also looked at the
insights of adult nursing and ill-health.

The Scope of Older Adults Nursing 10
References
Adams, R. J. (2010) Improving health outcomes with better patient understanding and education.
Risk Management and Healthcare Policy. [Online] 361–72.
Allen, J. et al. (2012) Rehabilitation in Patients with Dementia Following Hip Fracture: A
Systematic Review. Physiotherapy Canada. [Online] 64 (2), 190–201.
Castledine, G. & Close, A. (2009) Oxford Handbook of Adult Nursing. Oxford handbooks in
nursing. 1st edition. New York: Oxford University Press.
Cherry, B. & Jacob, S. R. (2013) Contemporary Nursing,Issues, Trends, & Management,6:
Contemporary Nursing. Elsevier.
De Rui, M. et al. (2013) Role of comprehensive geriatric assessment in the management of
osteoporotic hip fracture in the elderly: an overview. Disability and Rehabilitation. [Online] 35
(9), 758–765.
Gulanick, M. & Myers, J. L. (eds.) (2014) Nursing care plans: diagnoses, interventions, and
outcomes. 8th edition. St. Louis: Elsevier/Mosby.
Handley, M. et al. (2017) Dementia-friendly interventions to improve the care of people living
with dementia admitted to hospitals: a realist review. BMJ Open. [Online] 7 (7), e015257.
Hartweg, D. (1991) Dorothea Orem: Self-Care Deficit Theory. [Online]. 2455 Teller Road,
Thousand Oaks California 91320 United States: SAGE Publications, Inc.
Hum, S. et al. (2014) Role Expectations in Dementia Care Among Family Physicians and
Specialists. Canadian Geriatrics Journal. [Online] 17 (3), . [online]. Available from:
http://www.cgjonline.ca/index.php/cgj/article/view/110 (Accessed 20 May 2018).
Jansen, S. et al. (2015) Nutrition and dementia care: Informing dietetic practice. Nutrition &
Dietetics. [Online] 72 (1), 36–46.
Katherine Renpenning, M. S. N. & Susan Gebhardt Taylor, M. S. N. P. D. F. (2003) Self- Care
Theory in Nursing: Selected Papers of Dorothea Orem. Springer Publishing Company.
Larner, A. J. (2014) Dementia in Clinical Practice: A Neurological Perspective: Pragmatic
Studies in the Cognitive Function Clinic. 2nd edition. Springer London.
Potter, P. A. et al. (2016) Fundamentals of Nursing - E-Book. 9th edition. Elsevier Health
Sciences.
Riemen, A. H. K. & Hutchison, J. D. (2016) The multidisciplinary management of hip fractures
in older patients. Orthopaedics and Trauma. [Online] 30 (2), 117.

The Scope of Older Adults Nursing 11
Vanderweyde, T. et al. (2010) IATROGENIC RISK FACTORS FOR ALZHEIMER’S DISEASE:
SURGERY AND ANESTHESIA. Journal of Alzheimer’s disease : JAD. [Online] 22 (Suppl 3),
91–104.
Ye, B. S. et al. (2016) Unstable Body Mass Index and Progression to Probable Alzheimer’s
Disease Dementia in Patients with Amnestic Mild Cognitive Impairment. Journal of Alzheimer’s
disease: JAD. [Online] 49 (2), 483–491.