Case Scenario:
Mr. Allen is an 84-year-old man recently admitted to a skilled nursing facility after a hospitalization for pneumonia. He has moderate hearing loss, early-stage Alzheimer’s disease, a history of diabetes, and lives far from his family. He is alert but often confused in the evenings. He reports feeling weak and "not steady" when walking. The staff note that he has refused meals twice and appears withdrawn.
Your Task:
Write a 750–1000 word case analysis responding to the prompts below. Use your learning from Weeks 4–6 to guide your work.
Part 1: Application and Evaluation of a Care Model
Identify one gerontological care model (e.g., PACE, NICHE, Transitional Care) and explain how it applies to Mr. Allen’s situation.
Evaluate one strength and one limitation of this model when used with patients like Mr. Allen.
Part 2: Geriatric Assessment and Protocols
Identify two screening tools (e.g., CAM, Braden Scale, Mini-Cog, GDS) you would use and explain why.
Describe two risks or concerns the tools might help you identify.
Identify one geriatric treatment protocol relevant to Mr. Allen’s case and describe how you would apply it.
Part 3: Prioritizing Nursing Care
Based on your assessment, what are Mr. Allen’s two most urgent care priorities?
Propose two nursing diagnoses and corresponding interventions that align with those priorities.
Briefly explain how you evaluated and prioritized his needs based on assessment findings.
Part 1: Application and Evaluation of a Care Model
The NICHE (Nurses Improving Care for Healthsystem Elders) care model is highly applicable to Mr. Allen’s situation. NICHE is an evidence-based program designed to improve the quality of care for hospitalized older adults, but its principles and protocols are easily transferable to a skilled nursing facility (SNF). The core of the NICHE model is to empower nurses with the knowledge and tools to provide a higher level of care to geriatric patients. It focuses on recognizing geriatric syndromes, implementing best practices, and creating a supportive, elder-friendly environment.
In Mr. Allen's case, the NICHE model would guide the nursing staff to address his specific needs holistically. Instead of simply treating his pneumonia and hoping for the best, a NICHE-trained team would recognize that his cognitive impairment, hearing loss, and feelings of weakness are not just isolated issues but interconnected geriatric syndromes that require targeted interventions. The model would prompt nurses to use specific protocols for managing his confusion, especially in the evenings, and to implement fall prevention strategies. It also encourages a focus on emotional and psychological well-being, which is crucial given his social isolation and withdrawn behavior. The NICHE philosophy helps the entire care team see Mr. Allen not just as a patient with a list of diagnoses, but as a unique individual with specific vulnerabilities.
A significant strength of the NICHE model is its emphasis on geriatric-specific nursing education. By equipping nurses with specialized knowledge, the model directly addresses the complex needs of patients like Mr. Allen. This specialized training leads to more accurate assessments and more effective, proactive interventions, which can prevent adverse events such as falls, delirium, and functional decline. The NICHE framework provides a structured approach, ensuring that all aspects of Mr. Allen’s care are considered, from his physical safety to his mental and emotional state.
However, a limitation of the NICHE model in this context is its reliance on a high level of staff training and commitment. Implementing the model requires significant institutional investment in education and a willingness from staff to embrace new protocols. In a busy SNF, which may have staffing shortages and high turnover, it can be challenging to ensure that all nurses are consistently trained and adhering to the model's principles. If the staff are not fully engaged or educated, the NICHE model's effectiveness is diminished, and Mr. Allen may not receive the comprehensive, specialized care he needs.
Sample Answer
Case Analysis: Gerontological Care for Mr. Allen
Mr. Allen's case presents a complex and multi-faceted care challenge, highlighting the need for a comprehensive, person-centered approach to gerontological nursing. His recent hospitalization, multiple comorbidities, cognitive decline, and social isolation all contribute to a heightened risk of further health complications and a diminished quality of life. A strategic care plan must therefore integrate a robust care model, precise assessment tools, and a clear set of nursing priorities to address his immediate needs and promote his long-term well-being.