Medicine and Health Sciences Commons^™

Assessment Of Self-Efficacy And Practice Change Following Pressure Injury Education In A Long-Term Care Facility, Charity L. Booker

Electronic Theses and Dissertations

The purpose of this scholarly project was to evaluate if pressure injury education improved nursing knowledge and self-efficacy in the prevention and management of pressure injuries with the intent to improve practice. A literature review was conducted to evaluate educational interventions for adult learners and nursing roles in the care process. Existing studies indicated that patient outcomes are improved when nurses have adequate knowledge in pressure injury prevention. This quality improvement project was implemented in a long-term care facility with 28 nursing staff. The Agency for Healthcare Research and Quality pressure injury best practices presentation was the basis for the …

Geriatric Interest Plan For Individuals With Dementia: Improved Quality Of Life, Alexis T. Francois

Department of Occupational Therapy Entry-Level Capstone Projects

The purpose of this Capstone experience was to identify the specific needs to improve the quality of life for individuals with Dementia and Alzheimer’s. According to the Alzheimer’s Association (2022a), 1 in 9 people aged 65 and older have dementia. It is imperative for people living with this disease to be actively involved in meaningful activities that can reduce their negative symptoms. People with dementia constitute 40% of patients with significant depression (Alzheimer’s Association, 2022a). The common risk factors that increase the likelihood of depression in these adults include social isolation and loneliness, lack of exercise, and functional limitations that …

Implementing An Evidence-Based Pressure Injury Bundle To Reduce Acquired Pressure Injuries In A Long-Term Care Facility, Latecia Rhoden

Doctor of Nursing Practice Projects

Background: Pressure injuries in the United States affect between 1-3 million people. Of the percentage of patients affected by pressure injuries, a range from 2% to 28% of those patients are in long-term care facilities. In Alabama, the pressure injury rate in long-term care facilities ranges from 2.3% to 18.4%. According to this long-term care facility's November 2022 quality improvement report, the acquired pressure rate rose from 2.2% to 8.3% in a year. A total of nineteen newly acquired pressure injuries were reported. Eleven of the nineteen pressure injuries occurred in the long-term stay unit, accounting for almost 58% of …

International Comparison Of Literature On Home Health: Taiwan And The United States, Jaden Gloden

University Honors Theses

Taiwan is one of the world's fastest-aging societies and in 1994 implemented its universal National Health Insurance program which would later include a comprehensive long-term care system. The United States is also an aging society and a growing number of Americans are in need of long-term care services that the government has yet to provide or finance. Aging in place, the desire of older adults to stay in their homes as they age has consistently remained popular among Americans 50+ resulting in the popularity of home-based medical care. Taiwan society also values aging in place and an emphasis on Confucian …

A Systematic Literature Review On Long-Term Care Quality Improvement Initiatives In The United States, Daisy D. Pang

Capstone Experience

As the number of people 65 and older increases due to the baby boomer population, there will be a greater demand for long-term care (LTC) services. Quality improvement in LTC is essential to ensure positive health outcomes, patient satisfaction, and reduction in healthcare costs. The purpose of this systematic literature review is to identify the current quality initiatives for LTC in the United States and evaluate the outcomes, effects, and values of each quality initiative identified to support the claim that current the quality initiatives have a limited effect on quality improvement in LTC settings. The Preferred Reporting Items for …

Occupational Stress In Long Term Care In Georgia And Virginia During The Covid-19 Pandemic, Lacountess Renee Hooks

Walden Dissertations and Doctoral Studies

Nursing staff working in long-term care settings experience high levels of occupational stress related to many factors that can lead to poor outcomes for the nursing staff and the residents. In 2020, the World Health Organization declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, a pandemic which over the course of 3 years, has added an additional source of work-related stress for long-term care nursing staff. This quantitative cross-sectional study was guided by the job demand-control-support model to explore perceived stress and nursing stress among nursing staff working in the long-term care setting in Georgia and …

Occupational Stress In Long Term Care In Georgia And Virginia During The Covid-19 Pandemic, Lacountess Renee Hooks

Walden Dissertations and Doctoral Studies

Nursing staff working in long-term care settings experience high levels of occupational stress related to many factors that can lead to poor outcomes for the nursing staff and the residents. In 2020, the World Health Organization declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, a pandemic which over the course of 3 years, has added an additional source of work-related stress for long-term care nursing staff. This quantitative cross-sectional study was guided by the job demand-control-support model to explore perceived stress and nursing stress among nursing staff working in the long-term care setting in Georgia and …

The Impact Of Race/Ethnicity On Occupational Stress In East Texas Certified Nursing Assistants, Jackie Schniederjan Mcdonald

Nursing Theses and Dissertations

Significance: Certified nursing assistants (CNAs) provide direct care to those who live in long-term care facilities. As the population ages, the need for CNAs has grown. Nurse researchers have studied turnover and occupational stress, but no studies have examined racial/ethnic differences in CNA stress in East Texas.

Design / Purpose Statement: A convergent parallel mixed methods study was planned to address occupational stress experienced by CNAs in East Texas long-term care facilities. The Work Stress Scale and demographic questions were used to compare levels of reported occupational stress between racially diverse CNAs. However, lack of response to interview invitations necessitated …

Supporting The Role Of Professional Caregivers In Long-Term Care: Education, Training, And Caregiver Mental Health Interventions That Promote Dementia Care Excellence, Katelyn A. Nelson

Occupational Therapy Capstone Presentations

The purpose of this capstone experience was to create a dementia caregiver education program to support caregivers in their role of caring for individuals with dementia. The first four weeks of the capstone experience were spent at Emerald Crest in Burnsville, MN, learning from an occupational therapist with more than 13 years of experience. Advanced knowledge was gained through engaging in OT evaluation and intervention sessions, completing two dementia certifications, interviewing staff members to highlight the value of interdisciplinary collaboration, and applying theory to practice. Knowledge was then synthesized, applied, and built upon to create a training manual for the …

Examining Nurse Engagement In Antimicrobial Stewardship At Long-Term Care Facilities, Mosam S. Patel, Kathryn L. Dambrino, Olivia Bahemuka, David Phillippi

DNP Scholarly Projects

Background: The World Health Organization stated that antimicrobial resistance is one of the top 10 threats to global health. To combat antimicrobial resistance, antimicrobial stewardship (AMS) programs were developed. Efforts to engage nurses in stewardship efforts have been limited. Bedside nurses are in an optimal position to help decrease antimicrobial use, which is especially relevant in long-term care facilities where up to 75% of antibiotic use is deemed unnecessary or inappropriate. The purpose of this Doctor of Nursing Practice scholarly project was to examine factors that influence nurse engagement in AMS at long-term care facilities in Tennessee. Methods: A …

The Lived Experience Of Older Adults With Visual Impairments And Their Integration Into Social And Recreational Activities In The Long-Term Care Setting: A Phenomenological Study, Julie Ann Conboy Russo

Theses & Dissertations

The prevalence of vision loss in the elderly is high. Visual impairment in long-term care (LTC) settings may be a barrier to fully interacting in therapeutic recreational and social activities. Living with visual barriers may hamper safety (i.e., fear of falling and navigating in unfamiliar settings); cognitive ability; and participation in activities leading to isolation, depression, and loss of self-esteem. Decreased stimulation may affect one’s overall happiness and quality of life. A qualitative phenomenological design was followed to capture the lived experience of older adults with visual impairments living in LTC settings and their integration into social and recreational activities …

Hand Hygiene Compliance In Nursing Staff Of Long-Term Care Facilities, Lindsay Clontz

Master of Science in Nursing Theses and Projects

Elderly residents of long-term care facilities are most at risk to acquire serious infections. Because of the relationship with nursing staff members, they are most likely to get an infection from a member of the nursing team. It is imperative that nursing staff members receive proper training related to hand hygiene in order to adhere to infection prevention and control guidelines. The goal of this project is to improve hand hygiene in nursing staff to reduce the number of resident infections recorded on the monthly infection surveillance report. This project utilizes a multi-faceted approach including a pre-test, presentation, post-test, return …

Increase Knowledge And Attitude In End-Of-Life For Long-Term Care Nurses, Lisa Mitchell

Walden Dissertations and Doctoral Studies

Nurses are key health professionals in long-term care facilities who have an essential role in providing compassionate care at the end-of-life. The customary education that nurses receive in end-of-life care is inadequate to meet the complex care of dying patients. The purpose of this scholarly project was to implement an evidence-based end-of-life educational program to improve the nursing staff knowledge, attitudes towards care of the dying, and standards in long-term care. The theoretical framework to guide this project is Bandura’s self-efficacy to support the confidence and attitude of nurses caring for the dying. The End-of-Life Nursing Education Consortium (ELNEC) Geriatric …

Maintaining Occupations For Long-Term Care Residents, Lara Albano

Occupational Therapy Doctorate Capstone Projects

This Capstone project focused on client-chosen occupations and the use of client-centered evaluations and interventions for long-term care residents. Client-chosen occupations keep our clients actively engaged in therapy, gives them a sense of control, and maintains their identity. The purpose was to prepare occupational therapists to address long-term care residents’ unique occupational needs and promote participation in their chosen and meaningful occupations. It aimed to examine how occupational therapists interpret and include client-chosen occupations and occupation-based assessments in evaluations and interventions for long-term care residents in skilled nursing facilities.

An Analysis Of The Special Focus Facility Program And Nursing Home Quality, Annie S. Rhodes

Theses and Dissertations

The Special Focus Facility Program is an intensive program meant to rapidly support 88 of the lowest quality nursing homes in the United States, as determined by the Five-Star Quality Ranking system. There are also 435 facility candidates which are similarly low performing but not enrolled in the program. Academic literature has largely ignored this program, and the existing grey literature is more than a decade old and does not include COVID-19 data. Applying a political economy of aging framework and using a case matching methodology, Special Focus Facilities (SFF), Special Focus Facility Candidate (SFFc) nursing homes, and 5-star nursing …

Understanding The Current State Of Health Information Exchange In Long-Term Care Homes, Kendra R. Cotton

Electronic Thesis and Dissertation Repository

Research Questions: The research questions within this thesis aimed to examine the current state of health information exchange (HIE) processes within the Canadian long-term care (LTC) setting and identify opportunities to improve these processes through the proliferation of health information technology (HIT).

Methods: The first study undertook a scoping review following Levac et al’s. approach to the methodology. Next, an interpretive study using semi-structured interviews and Hsieh and Shannon's conventional content analysis methodology was undertaken.

Findings: The scoping review highlighted that effective HIE processes are susceptible to variations in HIT resources, workload, and social and organizational cultures. The findings of …

Education Of Nurses On The Use Of The Interact Tool, Daniyele L. Feaster

Electronic Theses and Dissertations

Abstract

Research reveals long-term care facilities face challenges with unnecessary transfers to acute care facilities. Use of the INTERACT quality improvement program has been effective in decreasing rehospitalizations in long-term care facilities. The researcher used a 15-question survey regarding the components of the INTERACT tool to assess the knowledge base of licensed nurses in long-term care facilities and develop a one-hour education session to bridge the knowledge gap. After the education session was held, a posttest was administered to test the licensed nurses’ knowledge of the INTERACT program. Using a paired-samples t test, the researcher found an overall increase in …

Intent To Stay, Moral Distress, And Nurse Practice Environment Among Long-Term Care Nurses, Amil Tan

Dissertations, Theses, and Capstone Projects

Background: Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed at least in part to moral distress and a negative nurse practice environment. Licensed nurses working in long-term care facilities experience ethical challenges such as lack of resources, use of restraints, end-of-life issues, and caring for residents with dementia that, if not resolved, can lead to moral distress- especially if left unresolved. Long-term care administrators and nurse managers increasingly strive to improve leadership support for long-term care staff that will positively affect the nurse practice environment.

Aim/Purpose: The purpose …

An Interprofessional Approach To Holistic End-Of-Life., Andrew Aschbacher

Doctor of Nursing Practice Papers

Purpose: The goal of this Doctor of Nursing Practice (DNP) project was to develop and evaluate an evidence-based clinical practice guideline (EBP) for an interprofessional approach across four end-of-life care domains (1) ethnocentric spiritual wellbeing, (2) mental wellbeing, (3) symptom management, and (4) value-based goals of care. Design and Methods: The Iowa Model for the Development of Evidence-Based Practice guided the development of the practice guideline. A multi-phase literature review was conducted to establish and grade the best evidence. A two-phase evaluation plan was developed. The University of Louisville Institutional Review Board approved the project. Results: In evaluation phase one, …

Exploring Communication Processes During Transitions From Acute Care To Skilled Nursing Facilities And Perceived Barriers To Communication, Marrizzia Oxford

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: The need for skilled care and long-term care services often becomes necessary as the older adult transitions into the golden years. In the United States, more than 1.5 million adults live in long-term care facilities, with this number expected to double by 2050 (Johnson, Pope joy & Radina, 2010). Effective communication between the healthcare professionals who refer individuals from an acute care setting to a skilled nursing facility can be challenging and ultimately impact their transfer status and Plan of Care (POC) or plan of action implementation for meeting healthcare goals of the patient …

Improving The Utilization Of Cnas In Pressure Ulcer Prevention, Jaclyn N. Bitterman

Doctor of Nursing Practice Projects

An estimated 2.5 million Americans are affected by pressure ulcers annually with the largest majority impacted the geriatric population. In order to achieve prevention of facility acquired pressure ulcers, the nursing team must properly identify patients at risk to prevent the injury associated with pressure. CNAs play a key role in this effort. The purpose of this project was used to develop, implement, and evaluate a training program for CNA students to improve knowledge and promote engaged attitudes in the prevention of pressure ulcers. Results of the project showed improvement after the training, but overall was not statistically significant. Overall …

Market Structure And Quality Of Service: Investigating Oligopolies And The Quality Of Nursing Home Care In California During The Covid-19 Pandemic, Tessa Ireton

Senior Independent Study Theses

Quality-of-service outcomes in nursing homes are of great social and human importance. However, especially during the COVID-19 pandemic, consistently maintaining markets with high quality care has been a pervading issue in the American nursing home industry. Furthermore, the industry is strongly characterized by oligopolies, a market structure that literature indicates may be less compatible with quality service than competitive markets. With this paper, I aim to investigate the possible intersection of oligopolist market structures and the quality of nursing home care during the COVID-19 pandemic. I start by describing quality of care in nursing homes, particularly during the COVID-19 pandemic, …

Is Anybody Listening?: Factors Affecting Pain Management In Veterans Within An Acute Care Rehab Setting, Laura Oseghae

Doctor of Nursing Practice

Background: In the United States, pain is a widely discussed issue due to the opioid epidemic stemming from a history of pain mismanagement. Clinical guidelines for successful pain management techniques are readily available for providers to incorporate into the individualized patient care plan.

Purpose: The purpose of this project is to improve pain management through implementation of the VA pain management guidelines and improved interdisciplinary team communication.

Objectives: This project aims to decrease the number of patients reporting moderate to severe pain, enhance staff/provider communication, and improve the provider’s overall process for managing pain with an individualized treatment plan.

Interventions: …

Preventing Falls In Long-Term Care Using Patient-Centered Fall Interventions, Angela Blakley

Student Scholarly Projects

Practice Problem: The practice problem identified within the Community Living Center included continuous falls, despite using current fall prevention strategies and provider-driven interventions. Baseline data reflected a fall rate of 4.2 in the long-term care areas despite improving the fall prevention program.

PICOT: The PICOT question that guided this project was: In older adult residents (P), what is the effect of a standing operating procedure (SOP) using patient-centered interventions (I) compared to physician-driven fall interventions (C) on decreasing falls and falls with injuries (O) within one month (T)?

Evidence: In twelve high-quality articles that fit the eligibility criteria and …

Exploring The Effects Of The Cycling Without Age Program On Older Adults Living In Long-Term Care, Victoria Cotnam

Electronic Thesis and Dissertation Repository

The Cycling Without Age program, offered in long-term care homes around the world, allows residents to experience the feeling of a bike ride in the trishaw as a volunteer pedals the electrical bike. The purpose of this pragmatic observational study was to measure the effects of an existing program in a Canadian long-term care home on residents’ happiness, quality of life, pain and functional status (using Resident-Assessment Instrument Minimum Data Set 2.0). A convenience sample of 39 residents participated in two groups, a biking group (n=23) and a strolls group (n=16) over the period of 12 weeks. Findings show that …

Evaluation Of Mcgeer Criteria For Uti Determination In A Nursing Home, Julie Rehagen

Dissertations

Problem: Urinary tract infection (UTI) is one of the most complex and challenging medical diagnoses to make in the long-term care (LTC) population. The unnecessary treatment of a UTI can increase cost of care and the likelihood of multi-drug resistant organisms.

Methods: The McGeer criteria which focuses on UTI in the LTC population was utilized to complete a quality improvement initiative. A descriptive cohort project utilizing retrospective and prospective data was completed to determine if an implemented McGeer criteria protocol improved the avoidable treatment of asymptomatic bacteriuria (ASB).

Results: Before implementation of the protocol, 62.5% of residents were unnecessarily treated …

Acute Kidney Injury, Mary Boadu

Nursing Student Class Projects (Formerly MSN)

This poster presents up to date information regarding acute kidney injury (AKI) which often presents in patients in the intensive care unit (ICU). Most patients may not have identifiable symptoms therefore, advanced practice clinicians are charged with a great responsibility to diagnose, treat and follow-up with such patients. It is pertinent that clinicians recognize AKI early in an effort to prevent adverse consequences as seen in the progression of AKI to chronic kidney disease (CKD).

Education Module For Serotonin Syndrome With 24-Hour Dose Monitoring Intervention., Jonathon Blake Hicks

Doctor of Nursing Practice Papers

Background: Serotonin Syndrome (SS) is recognized by a combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity (Volpi-Abadie, Kaye, & Kaye, 2013). Despite the severity and commonality of SS, it is an under reported and an under treated condition (Boyer, 2018). The purpose of this project was to 1) implement an education module on SS using a pretest and posttest design to increase LTC staff knowledge, and 2) evaluate the effectiveness (e.g., confidence level, satisfaction) of the intervention among nursing staff. Method: An education module was implemented focusing on recognizing and treating SS in aging adults. A pretest-posttest design …

Improving Palliative And Hospice Knowledge Among Nurses In A Long-Term Care Facility., Kelly Rae Smith

Doctor of Nursing Practice Papers

Background: Early referral and implementation of palliative best-practices in patients with chronic diseases and at the end-of-life (EOL) significantly decreases patient symptom burden, increases quality-of-life, contributes to patient and family satisfaction with care, and reduces healthcare costs. Nurses in long-term care (LTC) are poised to help identify patients appropriate for referral, to provide quality palliative and EOL care, but lack adequate knowledge. Objectives: To determine if a short one-on-one or two-on-one palliative and hospice educational offering can improve (a) knowledge of best-practice palliative and hospice care symptom management techniques (b) the ability of nurses to identify patients appropriate for hospice …

The Moderating Effect Of Social Support On The Impact Of Perceived Loneliness On The Mental Health Of Long-Term Care Nursing Home Residents, Lindsay Nicole Stivers

Electronic Theses and Dissertations

The purpose of the present study is to examine the moderating effect of social support on the impact of loneliness on anxiety and depression in long-term care residents in nursing homes. Recent research suggests that a relationship exists between loneliness and rates of depression and anxiety in long-term care nursing home residents. The present study seeks to examine the buffering effect of social support and utilize the findings to provide suggestions for policy, practice, and research. A binary logistic regression and a series of multiple linear regressions were conducted to examine the relationships between the variables. The present study’s sample …