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Ko and Song: Development and Application of a Nursing Assessment Tool for Senior Center Nurses
Original Article

Perspectives in Nursing Science 2016;13(2):96-109.

Published online: 19 October 2016

DOI: https://doi.org/10.16952/pns.2016.13.2.96

Development and Application of a Nursing Assessment Tool for Senior Center Nurses

Ha Na Ko1, Misoon Song2,

1Graduate Student, College of Nursing, Seoul National University, Seoul

2Professor, College of Nursing ․ The Research Institute of Nursing Science, Seoul National University, Seoul, Korea.

Corresponding author: Song, Misoon College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8826, Fax: +82-2-765-4103, E-mail: msong@snu.ac.kr

Received 19 August 2016       Revised 2 September 2016       Accepted 2 September 2016

Copyright © 2016 The Research Institute of Nursing Science, Seoul National University

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purposes of this study were to develop a nursing assessment tool for senior center nurses, and to test its feasibility and content validity. Methods: The study utilized a psychometric test design. Preliminary items were developed based on geriatric health needs and Gordon's 11 domains of functioning health. Initially, the tool was evaluated for content validity and feasibility. Then, it was administered among 195 older adults in a senior center by a gerontological nurse practitioner. Data were analyzed to describe the nursing problems of the senior center older adults. Results: The final version of the nursing assessment tool consisted of 27 items. The internal consistency, measured with the Cronbach's ⍺, was .74. The result of the assessment showed that senior center older adults had high nursing needs in the area of management of chronic diseases (hypertension, diabetes, and lipids), dental care, community relations, safety, elder abuse, health behaviors (such as drinking), mental health (depression, suicide, and cognitive function), and health consultations. Conclusion: The new tool was feasible for use with senior center participants, and it was evaluated as having high content validity by senior center nurses.

Keywords: Nursing assessment, Senior centers, Old adults

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Table 1.
The Senior Center Nursing Assessment Survey: Domains, Items, Content Validity Index, Reliability and Response Rate
Domain Item CVI∗ (N=14) Reliability† Response rate‡ (N=195, %)
1. Medical history 1-1 Current disease .94 .66 100
1-2 Family history .73   30
1-3 Number of medication .95   100
2. Nutrition 2-1 Nutrition risk .86 .29 100
2-2 Weight management .73   100
2-3 Number of health functional foods .48   100
3. Hygiene 3-1 Bath frequency .70 .34 100
3-2 Oral care .80   100
4. Activity and rest 4-1 ADL .79 .86 100
4-2 IADL .79   100
4-3 Frailty .82   100
4-4 Exercise .80   100
4-5 Sleep .82   100
5. Social activity 5-1 Family relations .75 .76 100
5-2 Friendship .73   100
5-3 Community relations .73   100
6. Safety 6-1 Safety awareness .86 .54 100
6-2 Safety precautions .84   100
7. Elder abuse 7-1 Elder abuse exposure .79 .61 100
8. Health habit 8-1 Smoking .73 .17 100
8-2 Alcohol .73   100
8-3 Drug abuse .80   100
9. Sexual function 9-1 Sex problem .61 .62 100
9-2 Sexual perceptions .63   100
10. Mental health 10-1 Depression .95 .61 100
10-2 Suicide .95   100
10-3 Cognitive function .93   100
11. Counseling 11-1 Health counseling needs .89 .53 100

∗ Senior center nurses;

† Cronbach ⍺;

‡ Senior center participating older adults; CVI=Content Validity Index.

Table 2.
General Characteristics of the Subjects (N=195)
Characteristics Categories n (%) or M±SD
Gender Male 57 (29.2)
Female 138 (70.8)
Age (year)   77.5±6.28
65~74 61 (31.3)
75~84 108 (55.4)
≥85 26 (13.3)
Present employment Yes 35 (17.9)
No 160 (82.1)
Educational status ≤Elementary school 97 (49.7)
Middle & High school 71 (36.4)
≥College/University 27 (13.8)
Living situation Alone 88 (45.1)
With spouse 66 (33.8)
2 generation 28 (14.4)
3 generation 13 (6.7)
Economic status Good 4 (2.1)
Moderate 86 (44.1)
Poor 105 (53.8)
Table 3.
The Results of Nursing Assessment (N=195)
Domain Items Categories n (%) M±SD
1. Medical history Current disease Hypertension 123 (63.1) 2.36±1.36
Diabetics Dyslipidermia 64 (32.8) 50 (25.6)  
Dyslipidermia 50 (25.6)  
Arthritis 43 (22.1)  
Dysuresia 24 (12.3)  
Other disease 110 (56.4)  
Number of medication 0 25 (12.8) 1.92±0.42
1~5 160 (82.1)  
≥6 10 (5.1)  
2. Nutrition Nutritional risk Normal (0~2) 103 (52.8)  
Low risk (3~5) 89 (45.6)  
High risk (≥6) 3 (1.5)  
Weight management Very thin 10 (5.1)  
Thin 28 (14.4)  
Moderate 95 (48.7)  
Obese Very obese 56 (28.7) 6 (3.1)  
Very obese 6 (3.1)  
Number of health functional foods 0 122 (62.6) 0.64±0.99
1~4 74 (37.4)  
3. Hygiene Bath frequency Shower-day/week Hand washing 73 (37.4) 181 (92.8) 3.01±2.25
Hand washing 181 (92.8)  
Oral care Brushing 174 (89.2)  
Oral examination 116 (59.5)  
4. Activity and rest ADL 7~17   7.13±0.94
IADL 10~27   10.63±2.07
Frailty Normal (0~2) 100 (51.3)  
Low risk (3~4) 60 (30.8)  
High risk (≥5) 35 (17.9)  
Exercise Frequency (day/week)   4.78±2.15
Duration (min)   52.75±40.22
Sleep Length (hour/day) 6.97±1.57  
Quality - Good Quality - Poor 125 (64.1) 70 (35.9)  
Quality - Poor 70 (35.9)  
5. Social activity Family relations Inappropriate 110 (56.4)  
Friendship Inappropriate 31 (15.9)  
Community relations Inappropriate 36 (18.5)  
6. Safety Safety awareness Inappropriate 34 (17.4)  
Safety precautions Inappropriate 63 (32.3)  
7. Elder abuse Elder abuse exposure Yes 31 (15.9)  
8. Health habit Smoking Yes 4 (2.1)  
Alcohol Yes 48 (24.6)  
Drug abuse Yes 9 (4.6)  
9. Sexual function Sex problem None 176 (90.3)  
Sexual perceptions Poor 19 (9.7)  
10. Mental health Depression No depression (0~4) 86 (44.1)  
Major depression (5~9) 75 (38.5)  
Severe depression (10~15) 34 (17.4)  
Suicide Suicidal thoughts 57 (29.2)  
Suicide attempt 21 (10.8)  
Cognitive function (Dementia risk) Normal (≥24) 170 (87.2)  
Low risk (20~23) 22 (11.3)  
High risk (below 19) 3 (1.5)  
11. Counseling Health counseling needs Yes 126 (64.6)  
    No 69 (35.4)  
Table 4.
Comments from Senior Center Nurses regarding Nursing Assessment Tools (N=14)
Domain Comments
1. Medical history “The management and assessment of the elderly's health status is a basic part of the senior center nurses’ role.” (Nurse 4)
“It's a basic part of the nursing assessment, and a very important one; it will help provide basic information in case of emergency situations." (Nurse 10)
2. Nutrition “Nutrition is the foundation of physical and cognitive health, both of which are required in order to change someone's life. The prevalence of health supplements among the elderly is high. We aren’t able to make recommendations about these supplements, so don’t need to assess this, although it should be managed.” (Nurse 4)
“It is important to assess lifestyle. We can assess the risk factors of obesity through assessments, and promote health through disease prevention programs for those at risk and the obese.” (Nurse 10)
3. Hygiene “Generally, senior center users are typically independent, with relatively good functional activity levels, so they do not have a problem with bathing and outdoor activities. Hygiene is not important. There are many senior centers that have bathing facilities. Oral care is a more important issue.” (Nurse 12)
4. Activity and rest “Because senior center users have relatively good functional health, the ADL is not meaningful. Nurses use their intuition when deciding if someone needs it or not.” (Nurse 4)
“Exercise and sleep are considered very important factors in health. They are also related to quality of life.” (Nurse 12)
5. Social activity “It's mainly used for living alone and national basic living security older adults counseling.” (Nurse 4)
“It's essential to assess mental health. Active participation in social activities is considered to be very important to health.” (Nurse 10)
6. Safety “We conducted fire safety education. Safety awareness is essential in the use of multiple facilities.” (Nurse 4)
“This domain is important in identifying a person's physical condition so that safety education can be tailored specifically for them.” (Nurse 12)
7. Elder abuse “Human rights education programs for elderly abuse, and psychological counseling, are going on. They are highly exposed to potential abuse because they are physically weak. I actually think that there are many older adults exposed to abuse.” (Nurse 12)
8. Health habit “There is a lot of need for a health program about smoking and drug problems.” (Nurse 4)
“Drug abuse is a very serious issue in older adults. It is necessary to assess and manage it because drug dependency among the elderly is high, and drugs, alcohol, and smoking are highly addictive.” (Nurse 11)
9. Sexual function “There are no special requirements for sexual function. This domain is hard to assess.” (Nurse 4, 11)
“It will help determine quality of life. Especially if they remain physically and mentally in the past, sexual issues seem to require constant training.” (Nurse 10)
“Sexual issues are not easy to access, and it's difficult to ask about because I can’t help them.” (Nurse 13)
10. Mental health “We are cooperating with a mental health center, and a dementia center, for health screening and case management in older adults. We knew mental health is important for older adults, as is their need for mental health programs. However, a survey is too difficult for them. Also there are almost no mental health programs at our senior center.” (Nurse 4)
“The older adults thought negatively that natural part of aging. For the management of mental health, an assessment needs to be carried out carefully, and a customized patient-centered education program is required.” (Nurse 12)
11. Counseling “Sometimes, part-time doctors and nurses provide health counseling, depending on the older adult's health conditions.” (Nurse 4)
“For health counselling, we need to ask for more details. I think that is the main task for senior center
Appendix 1.
Nursing Assessment Tool
조 사항목 조사내용
1. 질환력 1~1 개인병력 지난 1년간 질병을 앓았거나 병원 진료를 받은 사항을 기재하여 주시기 바랍니다 (치료내용은 질환명 치료내용
‘완치/치료중/관찰중’ 으로 구분).
1~2 가족력 가족 중 질환으로 치료를 받거나 진단 받은 사람이 있으면 기재하여 주시기 바랍니다. 질환명 나와의 관계
1~3 투약력 지난 1달 동안 사용한 약물에 대해 기재하여 주시기 바랍니다. 약물명
2. 식생활 2~1 영양관리 내용 예 아니오
질병 때문에 음식의 양이나 종류를 바꾸고 있다.
하루에 식사를 2번이나 한 번 정도 한다.
과일, 채소 또는 유제품을 거의 먹지 않는다.
치아가 약하여 음식을 씹는 것이 힘들다.
돈이 부족하여 필요한 음식을 사지 못하는 경우가 있다.
거의 매번 혼자서 식사를 하는 경우가 많다.
지난 6개월 사이 의도적으로 체중을 조절하지 않았음에도 불구하고 몸무게가 5% 이상 늘거나 줄었다.
2~2 체중관리 현재 어르신의 체형이 어떻다고 생각하십니까? ① 매우 마른편이다. ② 약간 마른편이다. ③ 보통이다. ④ 약간 비만이다. ⑤ 매우 비만이다.
3. 위생관리 3~1 목욕 1주에 목욕을 몇 번 하시나요? 번/주
외출 후/식사 전에 비누로 손을 씻습니까? 예 아니오
3~2 구강관리 하루에 2번 이상 이를 닦습니까? 예 아니오
최근 1년간, 구강검진을 받은 적이 있습니까? 예 아니오
4. 신체활동 4~1 일상생활 수행능력 지난 1주일간 일상생활에 필요한 동작을 수행하는데 다른 사람의 도움이 어느 정도 필요한지 확인하기 위한 도구: ADL
4~2 도구적 일상생활 수행능력 지난 1주일간 일상생활에 필요한 동작을 수행하는데 다른 사람의 도움이 어느 정도 필요한지 확인하기 위한 도구: IADL
4~3 허약유무 허약 유무를 확인하기 위한 도구: 한국형 노쇠측정도구
4~5 운동 운동을 하십니까? 예 아니오
일주일에 며칠을 운동하십니까? 일/주
어떤 운동을 하십니까?
한번 운동하실 때 몇 분 정도 하십니까? 분/회
어떤 강도로 운동을 하십니까? ① 중강도 이하 ② 중강도 ③ 고강도
4~6 수면 1일 평균 수면 시간은 몇 시간입니까? 시간/일
자고 일어나면 개운합니까? 예 아니오
5. 사회활동 5~1 가족관계 내용 예 아니오
우리 가족은 나의 이야기를 잘 들어주고 나의 감정을 존중해줍니까?
가족 내에 걱정되는 문제가 있습니까?
고민이 있거나 괴로울 때 의논할 수 있는 가족이나 친구가 있습니까?
5~2 친구관계 친구들과의 관계는 만족하십니까?
5~3 사회관계 현재 사회생활에 만족하십니까?
사람들이 나를 좋아하는 이유를 2가지 이상 말할 수 있습니까?
의견이 달라도 그것을 인정하고 단체 활동에 계속 참여 할 수 있습니까?
6. 안전의식 6~1 안전인식 내용 예 아니오
길을 건널 때 교통신호를 잘 지킵니까?
자동차를 탈 때 항상 안전벨트를 맵니까?
6~2 사고예방 욕실/화장실 사용 시 미끄러지지 않도록 물기를 제거합니까?
야간 낙상을 방지하기 위해 잠자리 가까이에 전등 스위치가 있습니까?
7. 노인학대 7~1 노출 여부 및 정도 내용 예 아니오
타인으로부터 신체적인 고통을 당하였다. (밀치거나 때리는 행위 등)
타인으로부터 금전적으로 피해를 입었다. (수입을 동의 없이 사용, 강제로 명의 변경 등)
타인의 말과 행동이 내 감정을 상하게 만들었다 (대화 기피, 의견무시, 못들은 척, 짜증, 불평 등)
가족/보호자가 건강하지 않은 상태의 나를 돌봐주지 않았다.
가족이나 보호자가 거의 찾아오지 않거나 생활비 등을 전혀 주지 않았다.
8. 건강행위 8~1 흡연 현재 담배를 피우십니까? 예 아니오
하루에 몇 개피 정도 피우십니까? (담배 1갑=20개피) 개피
최근 1년 동안 담배를 끊고자 하루 이상 금연을 한 적이 있습니까? 예 아니오
앞으로 1개월 안에 담배를 끊을 계획이 있습니까? 예 아니오
8~2 음주 지난 1년간 술을 얼마나 자주 마셨습니까? 일/월
술을 한번 마실 때 평균 몇 잔정도 마십니까? (소주, 양주 구분 없음, 캔맥주 1개 (355cc)=맥주 1.6잔) 평균 잔
최근 1년 동안, 일단 술을 마시기 시작하면 자제가 안 된 적이 있습니까? 예 아니오
최근 1년 동안, 음주 때문에 일상생활에 지장을 받은 적이 있습니까? 예 아니오
8~3 약물사용 약물을 잘못 복용하거나 과량 (진통제, 수면제 등) 복용으로 치료를 받은 적이 있습니까? 예 아니오
9. 성의식 9~1 성문제 내용 예 아니오
현재의 성생활에 만족하십니까?
성문제로 고민한 적이 있습니까?
에이즈나 성병에 걸리지 않는 방법을 알고 있습니까?
9~2 성인식 육체적, 정신적, 성적으로 학대를 당한 적이 있습니까?
성매매의 제안을 받은 적이 있습니까?
10. 정신 건강 10~1 정신건강 내용 예 아니오
(자살, 우울) 자살을 생각해보신 적 있습니까?자살을 시도해 보신 적이 있습니까?
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