Geriatric Nursing Commons^™

Remembering Time, Jonathan Carey

Capstones

My parents were dressed in their Sunday best, heading to a church revival. I was 12 and still the baby of the family, so staying home alone was out of the question. My grandmother Lillian, who preferred to be called Nana, came to babysit me. She relished a little time away from the doldrums and senior citizen gossip that engulfed the high-rise building where she lived,five minutes from my house in Petersburg, Virginia. That evening, as the sounds of “The Young and the Restless” echoed through the house, I tiptoed downstairs to give Nana a playful scare.

A Resident-Centered Dementia Care Staff Education Project To Reduce Challenging Behaviors At A Long-Term Care Facility, Margaret Huryk

Seton Hall University DNP Final Projects

Frequent use of antipsychotic medication (APM) for behavioral and psychological symptoms of dementia (BPSD) persists at high levels in long- term care (LTC) facilities despite extensive evidence of modest clinical benefits, serious adverse effects, public health advisories and a national initiative to improve dementia care. There is a gap between best-practice evidence and actual clinical practice related to pharmacological and nonpharmacological care for persons with dementia (PWD) and BPSD and/or neuropsychiatric symptoms (NPS) of dementia. The literature shows that clinicians often ignore FDA (Food and Drug Administration) warnings, CMS (the Centers for Medicare and Medicaid Services) initiatives and expert opinion …

Self-Care Among Older Adults With Heart Failure, Sumayya Attaallah, Kay Klymko, Faith Pratt Hopp

Social Work Faculty Publications

Background: It is estimated that 5.7 million Americans are living with heart failure (HF) today. Despite the fact that HF is one of the most common reasons people aged 65 years and older are admitted into the hospital, few studies describe the self-care in this older adult population. Purpose: The purpose of the study was to review the current literature on self-care in this population to better understand the influence of selected factors on self-care and health outcomes. Methods: A literature search was completed and resulted in including 28 studies. Results: Multiple factors have been reported as barriers to self-care …

Nonpharmacological Approaches In Dementia Care, Gay Lynn Warren

Master's Projects and Capstones

The 6A acute care unit has been seeing a higher number of patients that are afflicted with dementia. Often times, these patients display challenging dementia-related behaviors. It is commonplace for these patients to be medicated with a psychotropic medication in order to halt the challenging behavior. The global aim of this project is to improve dementia care on the 6A acute care unit. The specific aim, educating staff members about the benefits of nonpharmacological approaches in the management of challenging dementia-related behaviors and to encourage their use, is relative as the education is necessary before improvement can be expected to …

Nurse Shift Handoff Report At The Patient's Bedside: Improving Nurse-To-Nurse Communication, Francis R. Estrella

Master's Projects and Capstones

The purpose of the CNL project is to develop a standardized approach to communication during nurse shift handoffs through utilization of bedside shift reporting (BSR). Shift handoffs are integral to nursing practice; therefore, this process must be accurate, effective, and consistent in order to ensure the delivery of safe and quality care. The project focuses on the CNL curriculum element of Quality Improvement and Safety, under the role of an Outcomes Manager. Prior to BSR implementation, shift handoffs in the sub-acute unit were being conducted at the nurse’s station or by the medication carts. Nurse shift handoffs were often rushed, …

Approach To Safety Improvement: Focusing On Better Care (Fall Prevention In Medical Surgical/Intermediate Care Unit), Jose Fox Caballes Jr

Master's Projects and Capstones

Patient safety is one of the major concern of any healthcare provider during their patient’s hospital stay. This project addressed the steady trend of fall incidences compared to last fiscal years’ data of an average of 4 falls per month. This trend created urgency to envisioned a plan for solutions to prevent this circumstance from happening. This Clinical Nurse Leader led a project in creating a process in identifying all patients that are high risk to fall (HRTF) prior to their admittance or transfer to Medical Surgical/Intermediate Care Unit and throughout their hospital stay until they are discharged. In addition, …

Ihss: Repackaging Consumer Information, Deloras N. Puran

Master's Projects and Capstones

Currently, qualified Californians with disabilities and aging individuals can receive consumer-directed care through the IHSS program. Despite the strong demand for the program, new consumers are still struggling to begin their service after enrollment.

This study assisted San Francisco In Home Supportive Services Public Authority to understand how new consumers can navigate the IHSS program services after enrollment. Focus group and semi-structured in-depth interviews were conducted to gather feedback from consumers regarding what type of information would they need after enrollment, and how would they want to receive the information. Based on the feedback, written and virtual deliverables were designed …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Older Adults Perspectives Of Bed Bathing, Nikki D. Sumner, Katherine C. Hall Phd

Undergraduate Honors Theses

The purpose of this qualitative pilot study is to explore the patient perspectives about what it is like to receive a bed bath. Examining studies of bath basins versus alternative methods has shown a decrease in the spread of nosocominal infections. However, there is not sufficient evidence evaluating the patient perspectives of assistive bed bathing and interactions with nurses and nursing support staff. This information can provide healthcare providers, especially nurses, with a better understanding of patient perspectives and values. It also supports the national healthcare approach towards patient-centered care.

Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Shawn E. Raymond

Medication cost is a major contributor for patient medication nonadherence. Take in the fact that a large population lives in poverty, many cannot afford to pay the retail prices associated with purchasing their medications. By incorporating wholesale medications into a charitable health clinic, the reduced cost of medications for treatment of both acute and chronic illnesses could be passed on to those in need thereby decreasing cost associated medication nonadherence. Nurse Practitioners in the state of Kansas are not afforded the privilege to purchase, repackage and distribute or resell wholesale …

Strategies To Prevent Hospital Transfers In The Snf Environment, Vinai P. Decena

Master's Projects and Capstones

This project focuses on the CNL curriculum element of Care Environment Management. The purpose of this project is to reduce hospital readmissions in geriatric patients who are currently having any changes of medical condition within the SNF microsystem. In this project, the CNL functions as the team manager and care coordinator. The CNL facilitated, and utilized patients’ outcome data to make changes in care processes to reduce acute hospital transfers in the skilled nursing facility. The CNL lead the interdisciplinary team and was resource or point of contact for this project. The CNL educated nurses to utilize (Interventions to Reduce …

Standardized Blood Transfusion Documentation, Kelly A. Hill

Master's Projects and Capstones

The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses (RNs). When surveyed, …

A Systematic Review Of Recruitment For Older Chinese Immigrants Into Clinical Trials, Wen-Wen Li, Yuaner Wu, Angela Chia-Chen Chen

Asian/Pacific Island Nursing Journal

Purpose: To identify barriers and discuss strategies for recruitment of older Chinese immigrants into clinical research studies.

Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). PubMed, WEB of Science, CINAHL Plus, and the Cochrane Central Register of Controlled Trials were searched from 2001 to 2014. Empirical studies with Chinese immigrants aged 60 or older were identified and analyzed. Numerical analysis, such as calculation of response rates as indexes for recruitment outcomes, was conducted. Content analyses for recruitment barriers were abstracted.

Results: Thirteen studies of 4753 subjects were analyzed. Response rates ranged from …

A New Look At Successful Aging : Exploring A Mid-Range Nursing Theory Among Older Adults In A Low-Income Retirement Community., Valerie Lander Mccarthy

Valerie L. McCarthy

The current view of successful aging excludes elders with disease or disability, limits the potential for success among disadvantaged populations, and fails to consider older adults’ own criteria for success, especially in the existential or spiritual domain. This cross-sectional study was a preliminary investigation of a mid-range nursing theory (Flood, 2005) of successful aging. A random, stratified sample (N= 112) was used. Questionnaires were administered to small groups of non-demented older adults. Relationships among study variables were examined using hierarchical multiple regression. Adaptation and transcendence explained 45.4% of the variance in successful aging, independent of age, income, function, and health. …

The Role Of Transcendence In A Holistic View Of Successful Aging : A Concept Analysis And Model Of Transcendence In Maturation And Aging., Valerie Lander Mccarthy, Amanda Bockweg

Valerie L. McCarthy

BACKGROUND: Although successful aging is most often defined by the absence of disease and disability, older adults consistently report aging successfully even in the presence of chronic illness and functional limitations. A more holistic way of looking at old age suggests transcendence may be an important missing criterion for successful aging. AIM: Transcendence, a late life developmental process, appears to have a profound effect within the spiritual domain, but is an abstract, complex and unfamiliar concept. A clear understanding of the meaning of transcendence is necessary to explore the concept’s usefulness as a potential basis for future interventions to increase …

Promoting Self-Transcendence And Well-Being In Community-Dwelling Older Adults : A Pilot Study Of A Psychoeducational Intervention., Valerie Lander Mccarthy, Jiying Ling, Sharon Bowland, Lynne A. Hall, Jennifer Connelly

Valerie L. McCarthy

Self-transcendence changes how older adults perceive themselves, their relationships with others, the material world, and the metaphysical or spiritual dimension. It is associated with multiple indicators of well-being. The purpose of this pilot study (N = 20) was to examine the feasibility and effectiveness of a psychoeducational intervention to increase self-transcendence and well-being of older adults. Data were analyzed using generalized estimating equations. All variables trended in the directions hypothesized. Self-transcendence increased in the intervention group and decreased in the control group but not significantly. The group × time interaction for life satisfaction was significant (z = 2.89, p = …

Lived Experiences Of Individuals With End-Stage Renal Disease On Peritoneal Dialysis, Jessica W. Airheart

Nursing Theses and Capstone Projects

End-stage renal disease (ESRD) is a prevalent condition among the elderly population in the United States. ESRD is the most feared stage of chronic kidney disease (CKD), as it is a terminal diagnosis requiring long-term management. Peritoneal dialysis (PD) is the most common method of home-dialysis treatment for individuals with ESRD. The purpose of this research is to gain insight into patient experiences of integrating PD therapy into daily lifestyle for a selected sample of people diagnosed with ESRD and currently on PD therapy. The research questions addressed include: how decisions about ESRD treatment options are made, choosing between PD …

Hope And Health Related Quality Of Life Of Older Women Who Have Had Heart Attacks, Alice Mary Kelly-Tobin

Dissertations, Theses, and Capstone Projects

Background: Heart disease is the number one cause of death and leading cause of disability in adults in the United States. Coronary heart disease (CHD) is the most common form of heart disease with heart attack as its acute manifestation. Health Related Quality of Life (HRQoL) is a multidimensional concept of self-perception of physical, emotional health, and overall sense of well-being. Hope, an inner process focusing on maintaining physical and mental well-being, is considered necessary for survival of chronic illnesses, such as CHD.

Method: Women age 65 and older who have had heart attacks (N=91) volunteered to participate in this …

A Structured Telephonic Transition Program For Heart Failure Patients, Julia E. Robinson

Doctor of Nursing Practice Final Manuscripts

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors.

The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior …

Reducing The Incidence Of Hospital-Acquired Pressure Ulcers By Enhancing The Role Of Unit-Based Skin Champions, Anne V. Loewenthal

Master's Projects and Capstones

Reducing the Incidence of Hospital-Acquired Pressure Ulcers by Enhancing the Role of Unit-Based Skin Champions

Abstract

Hospital Acquired Pressure Ulcer continues to be an alarming issue in today’s healthcare systems. Often preventable, it is a significant nursing role and a frequently used benchmark for quality care. Studies have shown that hospital-acquired pressure ulcer (HAPU) complications have been associated with “up to 60,000 deaths each year in the United States” (AHRQ, 2014). A major health problem, it presents grave consequences on the patient’s well-being, significant treatment and recovery delays, increase length of inpatient stays, and have become a “never” event from …

Implementing Ways To Reduce Catheter-Associated Urinary Infections (Cautis), Maryam Keyhani

Master's Projects and Capstones

Abstract

Center for Control and Disease Prevention (CDC), estimates that 40% of all Urinary Tract Infections (UTIs) are related to Hospital-acquired Infections (HAIs) (CDC, 2013). The Facility where the project was done consists of oncology, orthopedic, medical-surgical, telemetry, incentive care, and step-down units. This hospital with 242 licensed beds has approximately 51,571 ER visits and a total of 10,606 admissions per year.The prevalence of Cather-associated Urinary Tract Infections (CAUTIs) on the 4th floor, the medical-surgical unit with 42 beds was significantly higher than other units. The hospital goal is to increase patient safety and satisfaction as well as reduce and …

Telephone Follow-Up For Heart Failure Patients Discharged To Skilled Nursing Facilities, Anna Laura Trimbur

Graduate Theses, Dissertations, and Capstones

Abstract

Reducing hospital readmissions has become a national priority for health care institutions. Telephone follow-up, a cost-effective intervention, has been used with varying degrees of success in reducing 30-day readmissions for heart failure (HF) patients. However, little is known about interventions directed toward HF patients discharged to skilled nursing facilities (SNFs). The purpose of this project was to test the effect of telephone follow-up with SNF staff by an advanced practice nurse (APN) on 30-day readmission rates. A one-time call to SNF staff was made by the APN to review key components of HF management. Readmission rates for the intervention …

Impact Of Nurse-Led Telephone Follow-Up On Heart Failure Readmissions, Anna Laura Trimbur

Graduate Theses, Dissertations, and Capstones

Abstract

Heart failure readmissions are a common and costly issue. Poor transitions of care as patients move from one setting to another are thought to be a major contributor to this growing problem. For those patients discharged to skilled nursing facilities (SNFs), poor transitions can be especially problematic. Telephone follow-up by nurses is a cost effective intervention commonly used to improve communication and coordination of care, thought little is known about interventions directed at patients discharged to SNFs. The purpose of this review is to evaluate the evidence regarding nurse led telephone follow-up in the transition of care process and …

Factors And Outcomes Associated With Potentially Inappropriate Medication Use In Rural Community-Dwelling Older Adults, Marcia Y. Shade

Theses & Dissertations

Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), …

The Effect Of Heart Failure Education On Knowledge And Readmission, Sara A. Golden

Evidence-Based Practice Project Reports

Heart Failure (HF) is a chronic progressive disease affecting over 5 million individuals with an expected increase in incidence as the population ages (Yehle & Plake, 2010). The costs associated with managing HF continue to increase and the Centers for Medicare and Medicaid Services (CMS) have attempted to identify ways to improve patient management of HF to reduce the revolving door of hospital readmissions and decrease expenditures. According to 2006 data, as many as one fourth of the Medicare beneficiaries discharged from acute care to skilled nursing facilities (SNF) were readmitted to the hospital within 30 days and the majority …

Development Of A Social Marketing Plan To Decrease Long Term Care Nurses Use Of Unnecessary Pharmacological Interventions To Address Residents' Behavioral Disturbances, Kela Spikes Bickham

Doctoral Projects

Seventy-six percent of long term care (LTC) residents display behavioral disturbances associated with psychiatric disorders, including dementia, which “often occur in clusters and include depression, psychosis, aggression, agitation, anxiety, and wandering” (Agency for Healthcare Research and Quality [AHRQ], 2014 para. 2; Perkins, 2012). Forty percent of LTC residents with behavioral disturbances receive pharmacological treatments to manage their behavioral disturbances, but these medications have limited efficacy and significant adverse effects (Gustafsson, Karlsson, & Lövheim, 2013). This remains important because the population, ages 65 and older (approximately 88% of all LTC residents), represent the most vulnerable to the effects of pharmacological interventions …

Policy Brief: Lifespan Respite Care Reauthorization Act, The 2015-2016 Cohort Of New Hampshire Leadership Education In Neurodevelopmental And Related Disabilities (Nh Lend) Program Trainees.

Policy Analysis

The Lifespan Respite Care Act (PL 109-442) provides critical support for families caring for loved ones at home. Family caregivers in the United States provide an estimated $470 billion worth of uncompensated care—a figure that exceeds the total Medicaid budget for 2013 (NAC Task Force, 2016). According to the National Respite Coalition, access to respite care helps protect caregiver health, strengthens families, keeps marriages intact, and prevents the need for expensive institutional long-term care. Reauthorization of the Lifespan Respite Care Act is essential to the well-being of individuals in need of long-term care and their families affected by long-term health …

The Effect Of Music Intervention On Cam Scores Of Hospitalized Older Adults Experiencing Delirium, Mae Lavente Dizon

Doctoral Projects

Older adults are vulnerable to developing while hospitalized is delirium. Research has shown that non-pharmacological interventions are effective in managing delirium and should be the first-line of treatment; however despite this, nurses fmd it difficult to address delirium. The purpose of this research study is to examine the effectiveness of classical music intervention in hospitalized older adults experiencing delirium by evaluating their Confusion Assessment Method (CAM) scores. A pre-and-post study design to compare the CAM scores of patients before and after music intervention was implemented. Study participants were patients 65 years and older identified to be experiencing delirium by a …

A Comparison Of Educational Approaches To The End-Of-Life-Nursing Education Consortium (Elnec) Course, Jennifer L. Bodine

Doctoral Projects

Purpose: The purpose of this project was to compare the effectiveness of two different educational approaches to teaching the End of Life Nursing Education Consortium course.

Background: Terminally ill patients frequently visit the emergency department for palliative care. However, various references show that staff does not have the knowledge base necessary to provide quality end-of-life care in the emergency setting.

Method: Participants from the emergency department at a Level I Trauma Center were recruited. A quantitative, cross-sectional pilot study was conducted to investigate whether lecture or lecture with simulation was more effective in increasing the knowledge base of participants regarding …

The Impact Of Intensive Case Management On Hospice Utilization, Debra Lowry Hummel

Doctoral Projects

Objective: The purpose of this study is to examine if patients enrolled in multi-disciplinary intensive case management program (ImPACT) alter the patient’s end-of-life path or setting of death.

Methods: The quality improvement project is a quantitative retrospective study that compared patients receiving standard primary care vs intensive case management (ImPACT) during 2/2013-1/2014. It is a secondary analysis of a larger study of a quality improvement evaluation that took place at the Veterans Administration facility in Palo Alto, Ca.

Results: Among the 82 patients who died, 19 were enrolled in ImPACT for approximately 249 days compared to 63 who received standard …