Geriatric Nursing Commons^™

Implementing An African American Cultural Awareness Program For Skilled Nursing Facility Staff, Adekemi T. Adedipe

Doctor of Nursing Practice (DNP) Projects

Background: Patient care is most effective when patients and providers establish a therapeutic connection in a cultural context. Nurses’ lack of awareness of a cultural context for patient care impairs establishing a therapeutic provider/patient relationship, with care of lesser quality and poorer health outcomes as consequences.

Local Problem: Staff at a Northern Californian skilled nursing facility (SNF) caring for African American patients with mental illness lacked self-awareness of the cultural context of care. Staff did not consider cultural constructs of care in treating patients and developing care plans.

Methods: Educational intervention to increase the cultural competence of a skilled …

Patient Education Improvement Initiative For Self-Management Of Congestive Heart Failure Among Senior Residents Of A Long-Term Care Facility, Abigail A. Abella, Brooke Sheck, Daniela Ramos, Ivy H. Nguyen, Mary Tran, Roshni Nagarajan

Master's Projects and Capstones

The purpose of this quality improvement project was to use evidence-based practices to determine if personalized education on disease self-management would lead to improved treatment adherence in a residential facility. The target population consisted of four elderly female patients who had been diagnosed with congestive heart failure (CHF) and were struggling with the self-management of their disease. Contributing barriers to effective CHF self-management were determined using a root cause analysis, and included a lack of educational templates, declining cognitive ability of the residents, and no electronic health record (EHR). Using the Self-Determination theory, the interventions were implemented. Phase one was …

The Effects Of Non-Pharmacological Interventions For Behavior And Psychological Symptoms Of Dementia: A Benchmark Study, Rachel R. Williams

MSN Capstone Projects

The management of behavioral and psychological symptoms of dementia (BPSD) in patients who reside in nursing homes can be challenging. These neuropsychiatric behaviors can include but are not limited to aggression, agitation, delirium, depression, and psychosis (Cloak & Al Khalili, 2022). Patients with BPSD often have difficulty expressing their needs due to the disease process, resulting in further complexity when managing behaviors. There are no psychotropic medications to treat BPSD specifically, but many are often prescribed to treat the symptoms or behaviors exhibited by patients. The use of psychotropics, especially long-term can cause a myriad of adverse effects and should …

Nursing Homes In The Mountain West, 2023, Annie Vong, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents nursing home data in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah. Data from a September 2023 ProPublica publication titled, “Nursing Home Inspect” are presented including the total number of nursing homes, homes with serious deficiencies, homes with infection related deficiencies, the amount nursing homes paid in penalties and the number of payment suspensions for nursing homes in the Mountain West.

The Meanings Of Daily Activities And Attitudes Of Older Breast Cancer Survivors: A Case Study Research, Wadha Alquraini

Doctoral Dissertations

Objectives: The aim of the study was to explore how older breast cancer survivors made meaning from daily activities and their attitudes to life and behaviors in it. Method: Secondary data was analyzed from nine older women with breast cancer. Data on living women was used to elicit the influence of breast cancer on survivors' attitudes and behaviors. Results: Eight significant themes were identified that were related to breast cancer meanings, attitudes to it, and behaviors that impact participants' survivorship; breast cancer means death or being close to death, survivor-provider relationships, social support, the meaning of dignity or …

Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

Problem: Loneliness related to social isolation among the older adult population has become an increasing health concern with few interventions available for the general population. Loneliness has been directly associated with depression, poorer physical health outcomes, and overall quality of life.

Methods: The purpose of this study is to evaluate loneliness in the older adult population residing in a senior living community in an urban area in Missouri. Weekly one-on-one socialization, ranging from 45-60 minutes, will be implemented over 6 weeks, with pre and post-intervention screening for loneliness with the 28-item Visit-A-Bit (VAB) screening tool. Approval was received by both …

Social Activity Restriction And Psychological Health Among Caregivers Of Older Adults With And Without Dementia, Elliane Irani, Kylie Meyer, Scott Emory Moore, Kedong Ding

Faculty Scholarship

Objectives: We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups. Methods: Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers’ age, gender, race, education, relationship to care recipient, and self-rated health. Results: Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting …

Factors Hindering The Care Of Geriatric Patients Admitted In A Tertiary Care Hospital In Karachi, Pakistan, Muhammad Shoaib

Theses & Dissertations

Background: Older adult’s patient care presents multiple challenges to nurses due to their growing numbers worldwide. According to WHO in 2020 the number of older adults aged 60 and above is one billion and by 2050 this population will be doubled. The current geriatric population of Pakistan is above eight million and is estimated to reach twenty-seven million by 2050. This increasing trend of the geriatric population poses a greater challenge to the compromised healthcare systems in Pakistan, healthcare workers especially nurses struggle hard due to limited resources, lack of knowledge regarding geriatric, and the frailty of older patients, to …

The Effect Of Obesity On Comorbidities: A Benchmark Study, Kaley Nolen

MSN Capstone Projects

Obesity is distinguished by a body mass index (BMI) greater than 30. Tremmel et al. (2017) reports obese individuals are at a greater risk for developing cardiovascular disease, diabetes, and cancer. In 2014, approximately 641 million adults were classified as obese (Zhang et al., 2018). This epidemic has drastically worsened over the last two decades resulting in obesity ranking as the fifth most common cause of death globally (Safaei et al., 2021). Okunogbe et al. (2021) states, slowing the incidence rate of obesity by 5% will save approximately $3.3 billion annually between 2020-2060. The pathophysiology and cause of obesity is …

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 …

The Addition Of Nature To The Patient's Healing Regimen, Katelyn Lewis, Audrey Henry

Scholars Week

Through our scholarly research, we have found many benefits to the use of nature to help facilitate healing within patients. Our project aims to spread awareness of the positive aspects of nature during the healing process. Specifically, our research focuses on healing gardens and outside therapy for patients. Our presentation is based upon Nightingales' theory of the environment. Our hope is that facilities will implement the addition of nature to the patient's plan of care.

Enhancing A Pressure Injury Prevention Bundle In A Skilled Nursing Facility, Lorillie Soleta

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The purpose of the project was to address the increase in pressure injuries in a skilled nursing facility, which had risen from 6% to 10% despite the implementation of a prevention bundle. The project aimed to evaluate and enhance the effectiveness of existing interventions.

Aim of the Project: The aim was to add evidence-based interventions to the existing pressure injury prevention bundle. The desired outcome was to decrease the number of acquired pressure injuries.

Review of the Evidence: Research indicated that pressure injury prevention bundles were more successful when incorporating offloading interventions. These offloading measures, including frequent turning and …

Early Identification Of Barriers To Medication Adherence In The Elderly Population Through The Use Of A Modified Screening Tool, Miranda Joyner, Blake Meranto

Doctoral Projects

Medication nonadherence (MNA) is a major contributor to hospitalizations and accounts for billions of dollars spent every year on health care. Despite medications being prescribed in nearly 75% of healthcare interactions, it is estimated that 33 to 50% of Americans do not take their medications as prescribed, if at all (Bartlett Ellis et al., 2020; Kleinsinger, 2018). The COM-B (Capability, Opportunity, Motivation, Behavior) Model used in this DNP project suggests that an individual must have the capability, opportunity, and motivation to enact a certain behavior, and should any of these areas be lacking, the behavior is unlikely to occur. This …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

Fall Risk Identification And Reduction Among The Gerontological Population At A Long-Term Care Facility, Esther A. Lowe, Breanna Cates, Lisa James, Ashley Samson, Jowel Ochoa, Matthew Ng

Master's Projects and Capstones

Abstract

Problem: Data obtained from the facility from February 2022 to July 2023 showed that there were a total of 110 falls at the facility with 51% resulting in injury. The facility also lacked a standardized fall assessment tool with minimal follow up after fall incidents.

Context: A microsystem assessment of the geriatric population at the long-term care facility indicated the need for a standardized fall risk screening tool to accurately assess patients.

Interventions: A staff presentation was created highlighting the high rate of falls at the facility as well as to educate on the implementation of the Morse Fall …

Expanding The Volunteer Role To Include Advance Care Planning Knowledge, Andrea C. Leomo

Master's Projects and Capstones

Problem: Transition patients at the end-of-life are those patients who are not mentally ready or physically eligible for hospice thus not enrolled in a Palliative or Hospice Program. Only one-third of the Transition patient census had completed and filed advance care plans. Healthcare providers are obligated to perform life-saving measures unless documented otherwise. A lack of advance care planning can create complicated scenarios and cause discordant care incidents.

Context: End-of-life care is a delicate subject to navigate conversations with patients. With holistic care being a large component of hospice and palliative care, it is important to have updated and accurate …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

Rounding With A Purpose: Reducing Falls In Geriatrics Residing In A Community Living Center, Ashley Wesson

Student Scholarly Projects

Practice Problem: Falls among geriatrics continue to be a significant concern for healthcare organizations and one of the costliest healthcare problems attributed to increased morbidity and mortality rates. Falls rates in residential dwellings such as nursing homes and community living centers (CLCs) continue to rise despite fall prevention efforts.

PICOT: The PICOT question that guided this project was In geriatrics, age 65 or older, who reside in the Community Living Center (P), how does one-hour purposeful rounding (I), compared to rounding without structured set time intervals (C), affect fall reduction rates (O), within eight weeks (T)?

Evidence: In fifteen high-quality …

A Multi-Stakeholder Perspective On Quality Of Care Among Residents, Family Members And Nursing Staff In Nursing Homes: A Balanced Centricity Approach, Sil Aarts, Erica De Vries, Hilde Verbeek, Gaby Odekerken, Katya Y. J. Sion

Patient Experience Journal

The objective of this study was to use a Balanced Centricity (BC) approach to describe how personal values related to experienced quality of care are defined for residents, family and nursing staff in nursing homes. Capturing the values from a multi-stakeholder perspective, a qualitative approach was conducted in which the stakeholders’ (e.g., residents, family members of residents and nursing staff; a triad) experiences, opinions and values were explored. Participants were recruited from ten nursing homes within the Living Lab in Ageing & Long-Term Care Limburg, the Netherlands. The audio recording of every interview was transcribed verbatim. The analysis made use …

Intervention For Treating Sarcopenia Among Older Residents In A Skilled Nursing Facility, David A. Hernandez, Susan E. Hueck, Donna-Marie Phyllis Lanton

Journal of Social, Behavioral, and Health Sciences

The incidence of sarcopenia, a geriatric syndrome characterized by the progressive and generalized loss of muscle quantity or quality, increases with age and is associated with adverse health and quality of life outcomes. A 12-week strength training intervention program (STIP) was designed to improve measures of muscle mass, muscle strength, physical performance, and quality of life in elderly patients with sarcopenia. Data were collected on these measures at 4-week intervals over 12 weeks. Results showed that the STIP was an effective intervention for reducing the characteristics associated with sarcopenia. Significant gains were made in muscle mass, grip strength, balance, gait …

Chronic Diseases And Inpatient Care Among The Middle-Aged And Elderly People In Indonesia, Ema Madyaningrum

Journal of Health Research

Background: The prevalence of chronic diseases contributes to an increase in healthcare utilization that results in increased vulnerability in middle and old age. This study aims to determine the factors that influence in-patient care among the middle-aged and elderly.

Methods: We conducted a repeated cross-sectional study using the Indonesia Family Life Survey 4 (IFLS 4) in 2007 (10,754 participants) and IFLS 5 in 2014 (12,058 participants). Chronic diseases include hypertension, diabetes mellitus, tuberculosis, asthma, coronary heart diseases, liver diseases, cancer, arthritis, gout, high cholesterol, prostate illness, kidney diseases, and digestive diseases. We used the frequency distribution, and logistic regression to …

Implementation Of An Evidenced Based Peripheral Artery Disease Screening Protocol In An Outpatient Internal Medicine Clinic, Sarah Lee Bolanos

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidenced based project was to implement an evidenced based peripheral artery disease screening protocol in an outpatient internal medicine clinic serving adult patients with multiple co-morbidities. This clinic inconsistently screened patients for PAD using the ankle-brachial index (ABI).

Methods: During a three-month period, 50 patients were screened using current American Heart Association and American College of Cardiology (AHA/ACC) screening guidelines for PAD using the Ankle-Brachial Index (ABI) and the Edinburgh Claudication Questionnaire (ECQ).

Results: Out of the 50 patients screened for PAD, only one patient (2%) had a normal ABI score (1.0-1.4) and was categorized …

The Future Of Cognitive Dysfunction In Elderly Patients: A Clinical Perspective With Recommendations, Laura Taylor

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

Implementing Outpatient Screening Of Adult Patients At High Risk For Peripheral Artery Disease, Coral Roseberry

Doctor of Nursing Practice Final Manuscripts

Background: Peripheral artery disease (PAD) is a prevalent chronic vascular disease that remains often underdiagnosed and inadequately treated. The development of PAD increases both with age and with the presence of modifiable and non-modifiable risk factors. Risk factors for PAD include smoking, diabetes, hypertension, hyperlipidemia, and chronic kidney disease. Furthermore, PAD can be an indicator of systemic atherosclerosis which is associated with coronary artery disease, carotid stenosis, and cerebrovascular disease. Undiagnosed obstructive PAD contributes to damaging atherosclerotic sequelae such as claudication, ulcers, infections, peripheral neuropathy, and amputations. It is common for PAD to exist in the absence of symptoms; therefore, …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Infrared Thermography (It) And Subepidermal Moisture Scanning (Sem) To Identify Early Tissue Injury And Reduce Hospital Acquired Pressure Injuries In Patients Undergoing Procedures Greater Than Four Hours In Duration, Irish Mills Parker, Makaela Waddell, Alexa Johnson

Doctor of Nursing Practice Projects: College of Nursing

Objective: The purpose of this pilot feasibility study was to more effectively prevent hospital-acquired pressure injuries in high-risk patients by using infrared thermography and subepidermal moisture scanning to identify early signs of tissue injury from pressure. Methods: Data was collected in the Cardio-Vascular Intensive Care Unit (CVICU) and cardiac medical-surgical care floors at Nebraska Medicine. Inclusion criteria are adults, scheduled for a surgery or procedure(s) predicted to last four or more hours, and planned admission to the ICU afterward. Participants were scanned with FDA-approved infrared thermography (IT) and subepidermal moisture (SEM) scanners before their procedure, two hours post-procedure, and then …

Faith Influences On Health Of Rural Appalachian Older Adults In East Tennessee: An Ethnonursing Study, Karina Elizabeth Strange

Doctoral Dissertations

As the U.S. older adult population increases and diversifies, healthcare providers need innovative, cost-effective, and culturally congruent approaches to gerontological nursing care. Decades of multidisciplinary evidence demonstrate that spirituality enhances older adult holistic health. However, although research about spirituality and nursing has become more culturally diverse, little is known about spirituality-health linkages of rural Appalachian older adults (RAOAs). This knowledge gap is significant because Appalachia leads the country in mortality related to chronic comorbidities such as heart disease, cancer, and depression. Given age, poverty, limited transportation, and health provider shortage areas, RAOAs experience severe health disparities. Moreover, spirituality is an …

Evaluation Of A Care Management Program On Family Caregivers Of Persons With Dementia, Victoria L. Jackson

Doctoral Projects

Dementia due to Alzheimer’s and other disease is a growing concern for healthcare providers as the number of individuals in the U.S. population ages. Persons with dementia (PWDs) rely on caregivers, primarily family caregivers (FCGs), for basic and instrumental activities of daily living as the disease progresses. There may be negative outcomes, such as depression, strain, and distress for FCGs of PWDs. Routine assessment and intervention by healthcare providers can address needs of FCGs of PWDs. There are multiple interventions that have demonstrated effectiveness in caring for PWDs and FCGs; one such intervention is care management. The University of California, …

Assessing Preinjury Frailty In The Elderly Hip Fracture Patient To Promote Palliative Care Referral In Those At Risk For High Morbidity And Mortality, Alicia N. Walker, Jewyl Gibson, Sara Dunham

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

The objective of this project is to assess preinjury frailty in hip fracture patients aged 65 and older as a predictor for postsurgical morbidity and mortality, prompting early referral to palliative care services in patients deemed high-risk for postoperative complications. Including palliative care in the multidisciplinary care of the high-risk patient has been shown to improve quality of life, increase patient and caregiver satisfaction, and reduce healthcare costs. The design is a quality improvement initiative. The setting is an academic medical center, serving as the region’s Level 1 Trauma Center. There is no current process for measuring frailty as a …

Do-Not-Hospitalize Orders In Assisted Living Facilities: Perspectives From Direct Care Workers, Alanna Kates Dancis Dr.

Doctor of Nursing Practice Scholarly Projects

Context: Do-not-hospitalize (DNH) orders in assisted living facilities (ALFs) are often misunderstood, ignored, or countermanded by direct care workers (DCWs), potentially leading to residents being sent to the hospital against their wishes.

Objectives: The primary purpose of this study was to gather sufficient qualitative data to create an intervention that would help prevent DCWs from sending residents with DNH orders to the hospital against their wishes. To accomplish this goal, the study centered on three research objectives: 1) to understand more fully how DCWs interpret DNH orders; 2) to determine if carrying out DNH orders causes moral distress for DCWs; …