Student Work for Leading and Managing in Long Term Care Student Reactions to Virtual Long Term Care Facility Regarding Assessment In assessing the elderly patient, create a calming environment, by considering many factors, including good lighting, comfortable positioning, and whether or not hearing aids, glasses, or translators are needed. Speak slowly, clearly and patiently. You cannot conclude that a patient is non-verbal or forgetful because he did not respond to you. He may be hard of hearing, or understand limited English, or be distracted by his pain. From the first moment of the patient assessment, the nurse must show respect for the older adult and establish a relaxed atmosphere. The impression the nurse makes in the initial phase of the physical assessment establishes the basis for further cooperation and trust. For example, asking the patient how he prefers to be addressed or asking permission to call him by his first name, extending your hand for a handshake or gently touching his shoulder, are simple and powerful gestures for winning trust. When assessing the elderly patient, go very slowly and plan on more than one sitting. Focus on the problem area in your first assessment. Then do the other systems at a later time. Give them adequate time to answer questions. You have to keep some patients on track as the conversation can wander to illness-related stories. These patients do best with specific, focused questions. Rushing the assessment and speaking too quickly can upset and frustrate your elderly patient. Regarding Comatose Patient Before withdrawing artificial nutrition and hydration from this patient, the nurse and physician must have an in-depth talk with the family. They must make sure that the husband realizes the pros and cons of discontinuing the treatment, and reinforce that despite this withdrawal, the patient might linger. Include all disciplines, so the whole team can support the plan. I certainly would not want to be in a horrible situation like this unresponsive patient, with no quality of life. Remember that you must follow advance directives, if they are in place, because they represent a legally binding contract. You can't let your opinion and ethical beliefs get in the way, no matter how hard it is. If there are no advance directives, a family meeting including doctor and nurse must take place. Families often think that the patient will die immediately when care is withdrawn. However, even when only comfort measures are provided, the patient may linger for days. An example from my ICU nursing days stands out in my memory-care was withdrawn from a septic, intubated organ transplant patient. All expected this patient to die. I left that day for a week's vacation. When I returned the following week, this patient was sitting in a chair, complaining about her discomfort. None of us knows when it's our time to die. It's not possible to speed up the dying process. Comfort measures are exactly that, nothing more." Project Main Page | Geriatric Nursing Project | AACN Home Copyright © 2004 by the American Association of Colleges of Nursing. All rights reserved.