Geriatric Nursing Commons^™

Examining A Fatigue Management Model That Identifies Risk Factors And Consequences Of Fatigue In Older Individuals, Maral Torossian

Doctoral Dissertations

Fatigue is experienced by 40-74% of older individuals living with a chronic disease. Despite advances in scientific knowledge around risk factors and consequences associated with fatigue, a comprehensive model that can serve as a guide for healthcare providers caring for older individuals with fatigue is lacking. Thus, the purpose of this study was to examine a fatigue model based on the Theory of Unpleasant Symptoms (TUS). The model included psychological, physiological, and situational risk factors of fatigue, as well as fatigue outcomes, such as physical, social, and cognitive performances, perceived health, and quality of life (QOL). This was a secondary …

Retention Of Nursing Assistants In Assisted Living Using Stay Interviews: A Qualitative Case Study, Daphne H. Dominguez

Doctor of Education (Ed.D)

The expectation of the impact of an aging population and the future availability of nursing staff is a significant challenge for senior living communities around the world. Lack of nursing staff retention has driven managers to hire quickly, denying residents living in long-term care communities the care they need. Exploratory, qualitative design, using case study research, was used for this study to learn what motivates resident care attendants (RCAs) to stay employed in assisted living communities of senior living. Richard Finnegan’s five stay interview questions were used to interview nine RCAs from various assisted living communities in Louisiana. The data …

Evaluating Loneliness In An Older Adult Population, Kelli Rowland

Dissertations

Problem: Loneliness and social isolation are severe burdens on global public health and can impair overall health outcomes. Unfortunately, both loneliness and social isolation are prevalent in the older adult population. The purpose of this quality improvement project was to evaluate loneliness in older adults enrolled in a weekly socialization program and its impact on loneliness.

Methods: A descriptive cohort design was utilized to analyze surveys completed three months apart. A convenience sample was used with older adults already enrolled in a weekly socialization program. The Iowa Model of Evidence-Based Practice was applied to evaluate and promote quality …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Communication Strategies To Promote Infection Control Compliance: My Health Is In Your Hands, Ezra Macabio

Master's Projects and Capstones

Abstract

Problem: The facility has less than 70% adherence to handwashing hygiene every week. Moreover, staff does not comply with the required PPE, affecting their infection-control performance and compliance to circumvent COVID-19. Furthermore, the microsystem lacks information flow and communication systems focusing on hand hygiene, and PPE usage significantly affects the healthcare staff's ability to perform such vital practices.

Context: Herman Health Care Center provides multiple services to its residents depending on medical needs after patient hospitalizations, such as short-term rehabilitation and long-term skilled nursing services. The COVID-19 pandemic had a remarkably negative impact on the skilled nursing facility. The …

Social Determinants Of Health Assessment For Skilled Nursing Patients, Heather Welch

Master's Projects and Capstones

Section I: Abstract

Problem: Skilled nursing facility (SNF) patients are vulnerable, aging, and have complex medical histories. Readmissions from an SNF impact healthcare costs and hospital resources and indicate poorly coordinated transitions home. Patients discharging from SNFs are at risk for higher social determinants of health (SDOH) disparities, such as limited caregiver support, transportation, housing insecurity, and food access. These SDOH risks can significantly increase an SNF patient's risk for hospital readmissions. Assessing and addressing SNF patients' social needs to reduce 30-day post-SNF readmissions can improve health outcomes and positively impact healthcare costs and a patient's financial liabilities.

Context: Frailty, …

Testing A New Workflow To Integrate The Voice-Of-The-Customer In Readmission Analysis For Skilled Nursing Facility Readmissions From Home, Stephanie Edurese Bilbao

Master's Projects and Capstones

Abstract

There are multiple layers of oversight across the healthcare delivery system. Measuring acute hospital readmissions has been identified as an important outcome measure of quality care. Our patients are one of the major stakeholders in the healthcare system. One role of a clinical nurse leader is to integrate evidence-based leadership practices that identify and assess outcomes, mitigate risk, enhance health promotion, deliver highly effective patient care, and ensure transparent relationships with stakeholders. Rationales for examining and re-designing the readmission analysis workflow based on the customer’s experience are discussed in this paper. The global aim of the project is to …

Osteoporosis Implications For The Aging Adult, Grace Alford

Nursing Student Class Projects (Formerly MSN)

This poster describes the pathophysiology, symptoms, implications for care, and treatment of osteoporosis for advanced practice RNs. The research was conducted within health-related databases. The literature review narrowed the search to only include the pathophysiology, interventions, and care for osteoporosis. Literature was restricted to within the past five years. The research showed that osteoporosis reduces mineral density in bones and can be adequately treated within a short amount of time. It is important for nurses and advanced practice providers to be aware of current guidelines, screenings, and treatments for osteoporosis.

Chronic Obstructive Pulmonary Disease, Aaron Mcneilan

Nursing Student Class Projects (Formerly MSN)

The following poster presentation provides a brief overview of the disease process of Chronic Obstructive Pulmonary Disease (COPD). COPD is one of the leading causes of disability and death worldwide, and its incidence does not appear to be declining. The most common factor causing COPD is cigarette smoking, which is modifiable. Other contributors are environmental air pollutants which some people may encounter depending on where they live or their occupation. This presentation is a culmination of information from different scholarly sources which discuss the symptoms, pathophysiology, causes, management, and prevention of COPD.

The Right Premtm: Rasch Analysis Of A New Patient Reported Experience Measure For Use By Older People In Hospital, Louise Heuzenroeder, Jyoti Khadka, Alison Kitson

Patient Experience Journal

Healthcare rights exist to protect older people from harm and to empower older people to participate in their care with independence, choice and control. Multiple investigations revealing abuse provide evidence that older people’s rights are being breached. Older people must have the opportunity to report on their experience of care against their rights. The Right PREM^TM is a new instrument designed to measure older people’s experience of care against their healthcare rights. The objective of this cross-sectional validation study was to assess the psychometric properties of a new instrument to measure the experience of care consistent with the healthcare …

Reduction Of Inpatient Fall Rate In An Adult Acute Care Setting, Manjusha Maprel

Student Scholarly Projects

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries.

PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 …

The Individualized Multidisciplinary Immediate Fall Response Program, Adenike Y. Awotundun

Doctor of Nursing Practice (DNP) Projects

Abstract

Falls are frequent in older residents in the United States. 800,000 falls occur yearly, one in three residents will fall again within a year (Agency for Healthcare Research and Quality [AHRQ], 2017). In Frey Village, about 25 falls occur monthly with annual fall-injuries of 1.9%. This project focused on the Individualized Multidisciplinary Immediate Fall Response Program (IMIFRP).

PICOT Question: In the older adults in a long-term facility (P), does an implementation of the individualized multidisciplinary immediate fall response program (I), improve fall care processes, and reduce fall rate (O) within 2-months post-intervention (T), compared to 2-months pre-intervention (C)?

Conceptual …

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Mental Health Effects Of The Covid-19 Pandemic On Older Adults, Elizabeth Kerr

Dissertations

Problem: Significant psychological effects such as anxiety, depression, stress, and loneliness are shown to affect the older adult population, aged 65 years and older. The social isolation and disconnectedness related to the COVID-19 pandemic potentially worsens anxious and depressive feelings, increasing the risk for adverse outcomes in the high-risk older adult population. This project aimed to identify older adults at risk for acute, situational mental health issues associated with the pandemic.

Methods: A descriptive study design was used. Telephone interviews were conducted to explore effects of the COVID-19 pandemic on mental health responses in older adults. A convenience sample …

Nurse-Delivered Shoe-Lacing Intervention: Effect On Comfort And Toe Pressures For Active Community-Dwelling Adults (Age 65+), Mary C. Clayton-Jones

Doctoral Dissertations

Significance: Problems with shoe fit are endemic, affect gait and balance and lead to falls. Falls are physically, emotionally, and economically costly. Low-cost, easily implemented interventions, that reduce pain and improve balance meet the “triple aim” of the Institute for Healthcare Improvement.

Purpose: Evaluate the impact on community-dwelling adults (65+) of two nursing interventions involving foot repositioning and shoe relacing.

Outcome measures: Toe pressures, experiences of pain and comfort.

Method: Repeated-measures, mixed-methods lab-based study. Walk #1 Control. Intervention #1, participant’s heel secured to back of shoe, the participant’s chosen lacing pattern snugged. Intervention #2, heel secured to back of …

Admissions Of Covid-Positive Patients To Us Nursing Homes With Personal Protective Equipment Or Staffing Shortages, Diane M. Gibson, Jessica Greene

Publications and Research

Background: US nursing homes are required to follow Centers for Disease Control guidance for COVID-19 transmission-based precautions (TBP) when admitting COVID-positive patients.

Objective: To assess how frequently nursing homes had shortages of personal protective equipment (PPE) or staffing in weeks when they admitted COVID-positive patients, which likely made it more difficult to follow TBP, and to compare facility characteristics by admissions practices.

Design and Setting: Facility-level data from the Nursing Home COVID-19 Public File for the period between June 7, 2020 and March 7, 2021 was combined with additional data. The percentages of nursing homes that admitted COVID-positive patients and …

江門市老年照顧者的照顧壓力及社會支持研究報告 = A Research Report On The Caregiving Pressures And Social Support Of Older Carers In Jiangmen City, 香港嶺南大學亞太老年學研究中心, 江門市恒愛社會工作綜合服務中心

APIAS Research Report 研究報告

根據中國第七次人口普查的結果顯示，2021年65歲及以上人口為19064萬人，占總人口的13.50% (國家統計局, 2021年5月11日)。中國老年人口於2025年將突破3億，2033年會突破至4億，2053年將達到峰值4.87億，占屆時全球老年人口的4分之1 (鄒波，2017)。隨著老年人口的不斷增加和壽命的增長，老齡化將是中國和很多發達國家面臨的重要問題。

此研究的地區為江門市，它是廣東省最“老”的城市，2019年該市戶籍老人為88.3萬人(比2018年增加5.7萬人)，占戶籍總人口比例為22.1%(2018年為20.7%)。2019年江門市戶籍老人增速達6.9%，遠高於戶籍人口增速0.3%，亦高於全國和廣東省平均水準。老年人數量更以每年2.5萬到3萬人的速度增加，預計於2036年將達到戶籍人口的25%以上。受計劃生育政策的影響及2016年開放二胎政策，很多家庭都為獨生子女家庭，未來將呈現出“四二二”的家庭結構。這意味著青壯年的照顧壓力會進一步加劇,更多老年人將成為照顧者。

老年照顧者在照顧患病家人的過程要面對很多的困難。陳茜等(2008)通過分析國內外相關文獻後，認為老年照顧者主要需要承受體力上的壓力、精神上的壓力、經濟上的壓力和社會壓力。羅小茜等(2015)通過分析文獻發現，老老照護者會產生多種不良結果，如軀體症狀、心理症狀和照護品質下降。康峻鳴等(2020)對148例腦卒中後遺症患者及其家庭照顧者進行健康測量簡表(SF—36)以及社會支持量表(SSRS)調查，發現腦卒中後遺症患者家庭照顧者的生活品質與社會支持呈正相關。目前對於老年人照顧壓力的研究大多以理論、文獻的分析為主，或者僅僅從某一類型疾病的照顧壓力進行研究，如張睿等(2008)對10名認知障礙患者的照顧者進行非結構訪談，瞭解其照顧感受。可是針對老年照顧者的壓力的實證研究比較少，且對老年照顧者的需求及社會支持的研究更加缺乏。因此，本研究期望通過對江門市老年照顧者的深度訪談，去瞭解他們的照顧壓力來源及其社會支援網路。此研究報告分為三部分，第一部分指出研究的問題及此研究的方法。第二部分是主要發現。最後一個部分提供相關的建議。

「認知障礙症照顧者的需要及社會支援」研究 = Study On The Needs And Social Support Of Caregivers For People With Dementia, Mun Yu, Vera Tang, Chak Kwan, Dickon Chan, Mei Ling Lee, Chak Lung Lam

APIAS Research Report 研究報告

香港認知障礙症(dementia)患者個案持續上升，他們大都在接受家庭成員的照顧。本研究旨在了解照顧者面對的困難及在福利服務制度以外獲得甚麼非正規支援(informal support)以協助他們應付有增無減的照顧工作。研究團隊以半結構性訪談(semi-structured interview)的方法，與18位非正規照顧者(informal caregivers)及20位服務提供者(service providers)進行深入訪談。研究發現照顧者面對的困難包括欠缺私人空間、因健康狀況差而難以獨自應付照顧工作、照顧開支帶來沉重的經濟負擔，以及照顧工作造成的心理及人際關係問題。研究結果顯示因應照顧者身處的人際網絡，他們獲得分別來自兄弟姊妹、子女、朋友、鄰里、教友、教會同工或大廈保安員提供不同的非正規支援。他們除了為照顧者提供情感支持外，也分擔了部份的照顧工作，讓照顧者得以「喘息」。部份人士更協助照顧者處理家居問題及應對突發事件，是獨力或年長的照顧者之重要支援者。研究亦發現，除了部份家人能夠分擔患者的起居生活照顧外，其他非正規支援的提供者只能提供周邊工作的支援、情感支持、以及危機應對。主要的起居生活照顧工作，仍由主要的照顧者承擔。研究團隊建議擴大照顧者津貼計劃的對象及提高津貼金額，並加強支援照顧者的服務，包括推行「長者社區保姆」及「家庭托顧」服務、加強宣傳及改善照顧者身心健康的支援服務及、為患者家人提供家庭輔導。此外，研究團隊建議提供培訓給支援人士及團體以增加對認知障礙症患者及其照顧者需要的知識及技巧，透過這些正規服務的承托，寶貴的社會資本可繼續累積及發揮社區互助精神。

Life Course In Hearts: Enhancing Telehealth Resilience And Mindfulness Intervention In Older Adults Experiencing Abuse And Trauma-A Conceptualization, Mary Dioise Ramos

Faculty Publications

Advances in research and evidence-based practice improve the prevention and treatment of diseases, but the marginalized seems to be left behind. The purpose of this paper is to conceptualize a telehealth intervention aimed to improve the health and health span of older adults. More particularly, we articulate the conceptual framework underlying our intervention, Telehealth Resilience Mindfulness (TRM) Intervention, which will be delivered via text messaging (for those who have phones or smartphones), video conferencing such as Zoom (for those with internet connectivity), or in-person (when it is practical) to older adults to enhance HEARTS (health, experiences of abuse and trauma, …

Standardized Education On Physician Orders For Life Sustaining Treatment (Polst) Conversations, Venessa Oteniya

Doctor of Nursing Practice Final Manuscripts

According to research literature, 15% of Medicare beneficiaries spend more than 7 days in the intensive care unit before they die. These Medicare beneficiaries receive aggressive, life-prolonging medical treatments that might not be in agreement with their wishes. Approximately 13% of SNF residents have improperly completed POLST forms that can result in intensive treatments that patients did not want. One barrier to the lack of POLST completion in SNFs is staff difficulty with understanding and explaining the form, a result of inadequate education.

In August 2020, the San Diego Coalition for Compassionate Care formed an education program to provide virtual …