Geriatric Nursing Commons^™

Limiting Potentially Inappropriate Medications In Long-Term Care, Clare M. Ironside

Doctor of Nursing Practice Scholarly Projects

Aim: This project aimed to assess the effectiveness of the STOPP/START tool in identifying and reducing potentially inappropriate medications among multi-morbid, older, long-term care residents in a metropolitan area of a Southwestern state.

Design: In this quality improvement project, seven prescribers working within four long-term care facilities were trained to assess for potentially inappropriate medications using the STOPP/START tool. The medication lists for long-term care residents (n =45) over age 65 were collected at baseline and again at three months post-intervention and assessed for overall medication use, psychotropics, and proton pump inhibitors. The project also assessed prescribers’ comfort and …

Sleep Deprivation And Delirium Development In The Icu, Cynthia Howell Msn Fnp-Bc, Stacy Murillo Msn Fnp-Bc, Amy Wilson Msn Fnp-Bc, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Delirium is an acute syndrome characterized by disturbances in cognition occurring in critically ill patients, particularly those over 65 in the intensive care unit (ICU). Numerous risk factors are associated with delirium development, with sleep being a modifiable factor. This review explores existing literature regarding the relationship between sleep deprivation and delirium development while evaluating the effectiveness of a sleep promotion protocol to decrease the incident of delirium in those ICU patients 65 years or older.

Method A literature review of peer-reviewed studies from PubMed and additional search engines was completed. Articles reviewed were published within the last five …

Evidence-Based Best Practice Toolkit For Competency-Based Orientation In Integrating An Adult Pneumococcal Protocol To Improve Vaccine Rate: A Program Evaluation Review, Magda Angel Cifuentes

Student Scholarly Projects

Practice Problem: Low pneumococcal vaccine uptake among high-risk adults is partly due to underutilized or lack of nurse-driven vaccine protocols, limited understanding of vaccine intervals and indications by nurses, and lack of proper training. Currently, physician-driven orders are the only avenue for high-risk adults to obtain this vaccine in ambulatory sites.

PICOT: In adults 65 years or older within an ambulatory setting, does the use of an adult pneumococcal vaccine protocol, compared to a physician order (no vaccine protocol) impact the rate of vaccination over 2 months?

Evidence: Utilization of two or more interventions provided higher immunization rates. …

Action Planning With Self-Monitoring Blood Pressure Improves Blood Pressure Control In Geriatric Patients, Thuy Ai Oh

Student Scholarly Projects

Practice Problem: Uncontrolled hypertension is a global healthcare problem. Hypertension is controlled in fewer than 1 in 5 people and has been attributed to premature deaths (WHO, 2021).

PICOT: The PICOT question that guided this project was “In patients 65 years of age and older with uncontrolled blood pressure, how does a nurse-led blood pressure control program compared to standard of care improve blood pressure control at an outpatient clinic over 8 weeks?”

Evidence: Five studies provided evidence that a nurse-led blood pressure decreased blood pressure results. The evidence supported the practice change of implementing a nurse-led …

How To Control Healthcare Associated Infection, Yeojin Son, Jungyoon Hur

Scholars Week

Healthcare-Associated Infections (HAI) are infections patients acquire while receiving care in hospital. The main reasons of occurring the infections are insufficient knowledge about infection control and decreased compliance with rules by hospital protocol. The purpose of this evidence-based presentation is to exemplify how to control HAI via motivating healthcare workers to comply with infection control policy.

Effective Communication In Dementia Patients, Morgan Loveless, Callie Hardesty

Scholars Week

Effective Communication with Dementia Patients - Abstract

Throughout every nurse’s career, one will have the experience of working with those with dementia. Patients who suffer with dementia require different approaches to communication and may have difficult interactions with healthcare workers. A barrier many nurses continue to endure is poor communication and relationships with dementia patients. Many nurses work at a very quick and stressful pace, putting a strain on many nurses’ relationships with dementia patients. Ineffective communication may lower the quality of care dementia patients receive as nurses may lack the extra time needed to effectively communicate. This can lead …

Qualitative Data Analysis For Health Research: A Step-By-Step Example Of Phenomenological Interpretation, Sue Monaro, Janice Gullick, Sandra West

The Qualitative Report

Phenomenological studies have been critiqued when analytic activities and intersection with the underpinning philosophy lack clarity. This methodological discussion paper describes data analysis in hermeneutic interpretive phenomenology. Data management strategies (transcript preparation, coding, philosophy application, tabling/concept maps, and Microsoft Word) and data analysis processes (reduction, display, and conclusion drawing/verification) are illustrated. Deconstruction, reconstruction, and reorganisation of themes/subthemes using hierarchical heading styles to populate the navigation pane and philosophical tenets acted as analytic hooks. This paper has outlined data analysis in hermeneutic interpretive phenomenology, including the use of MS Word and its functionality, which was supported by other data display strategies …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Pre-Implementation Of Cocare Help, Thomas D. Finn, Autumn Baldwin, Elizabeth Hill

Doctoral Dissertations

Background: Delirium is a change in consciousness characterized by rapid onset and fluctuating attention, causing impairment in the ability to process and recall information, occurring in 30% of hospitalized older adults. Delirium can increase falls, length-of-stay, mortality, and cost. The CoCare Hospital Elder Life Program® (HELP) is an evidence-based bundle of interventions targeting cognitive impairment, sleep deprivation, immobility, visual/hearing impairment, and dehydration, embedding geriatric principles in care to prevent delirium.

Objectives: To further analyze the pre-implementation of the HELP in order to optimize success of program administration.

Methods: Mixed methods were used to collect retrospective/prospective data (interviews (N=25], surveys [N=25], …

Developing A Standardized Process For An Effective, Evidence-Based Fall Management Program To Reduce Falls In A Nursing Home Setting, Katrina K. Little

Doctor of Nursing Practice Projects

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs.

Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls …

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.

Prevention Of Central Line-Associated Blood Stream Infection (Clabsi) In Adult Icu Patients, Salima Allahbachayo

Student Scholarly Projects

Practice Problem: Central line-associated bloodstream infections (CLABSI) account for most hospital-associated preventable infections in the United States and globally. Implementation of a multifaceted approach including evidence-based CLABSI bundle care has shown to prevent this infection in patients with a central line.

PICOT: The PICOT question that guided this project was that in adult intensive care unit (ICU) patients, how does the use of central line bundle care compared to central line care without bundle decrease central line-associated bloodstream infections within eight weeks?

Evidence: The evidence from a rigorous literature review showed that using a central line bundle …

Delirium Screening To Prevent Falls In The Long-Term Care Setting, Jonathan David White, Bsn, Rn, Samereh Abdoli, Phd, Rn

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

Abstract

Background

Nearly 30 million people fall in the United States (U.S.) every year with 20% resulting in serious injury. These incidents disproportionately occur in the elderly population. Of the 1.6 million people living in long-term care (LTC) settings in the U.S., between 50-75% experience a fall annually with many experiencing multiple falls. This population is 2 times as likely to experience such an event – and due to increased age, they are least likely to recover. Delirium, a main contributing factor to fall, has been found to go undetected in as many as 66% of individuals in the clinical …

Elder Care In The Midst Of The Pandemic: Moving Beyond The Rhetoric, An Interview With Dr. Carole Estabrooks | Entrevue Avec Dre Carole Estabrooks : Les Soins Aux Personnes Âgées Dans Le Cadre De La Pandémie : Aller Au-Delà Du Discours, Florence Myrick, Jacinthe I. Pepin

Quality Advancement in Nursing Education - Avancées en formation infirmière

No abstract provided.

Person-Centered Care Practices In Nursing Homes: Staff Perceptions And The Organizational Environment, Sarah Dys, Ozcan Tunalilar, Serena B. Hasworth, Jaclyn Winfree, Diana L. White

Institute on Aging Publications

Person-centered care (PCC) is considered the standard to assure quality of care and quality of life in longterm care, benefiting both residents and staff. This study examines the associations between nursing home staff perceptions of person-centered care practices, the organizational system, and work-related attitudes in a sample of 340 nurses and direct care workers across 32 nursing homes in Oregon. Random-intercepts regression models were used to estimate within- and between-nursing home variation in staff perceptions of PCC practices as measured by the Staff Assessment of Person-Directed Care (SA-PDC), and identify characteristics associated with these perceptions. Staff in nursing homes that …

A Physical Therapy Mobility Checkup For Older Adults: Feasibility And Participant Preferences From A Discrete Choice Experiment, Dalerie Lieberz, Hannah Borgeson, Steven Dobson, Lindsey Ewings, Karen Johnson, Kori Klaysmat, Abby Schultz, Rachel Tasson, Alexandra L. Borstad

Journal of Patient-Centered Research and Reviews

Purpose: Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. A preventive model of care called Mobility Checkup is being designed to reduce mobility disability in older adults. This study had two purposes: 1) determine feasibility and outcomes of the Mobility Checkup, and 2) identify preferences of older adults regarding this model of care using a discrete choice experiment.

Methods: Adults over 55 years of age were recruited from the community. In the study’s first phase, participants completed a Mobility Checkup, with feasibility evaluated using 6 criteria. In the …

Clinical Nurse Specialist Job Description Assignment, Diane R. Maydick Youngberg

Open Educational Resources

The Clinical Nurse Specialist (CNS) is an advanced practice registered nurse with expertise in assessment, diagnosis, and treatment of specialty patient populations. In addition to direct care, the CNS role expands to other areas including research, education, quality improvement, and inter professional teamwork. Creating a detailed CNS Job description helps to clarify the role.

Improving The Process Of Pain Management By Implementing Best Practices In A Nursing Home, Sukhjit Dhillon

Doctoral Projects

Pain is often untreated or undertreated among older adults living in nursing homes. The lack of standardized pain management protocols makes it difficult to address pain in this population. Deficiencies in pain management and documentation were identified in a nursing home and a performance improvement project was implemented with the aim to improve pain management, pain documentation, and staff knowledge of pain management. A pre-and post-intervention study design was used, and data analysis included descriptive statistics and a paired samples t-test. Participants (n=12) included seven registered nurses and five licensed vocational nurses who provide direct care to the residents in …

Improving Telehealth Knowledge And Comfort In An Older Adult Population, Carolyn J. Jones

Doctor of Nursing Practice (DNP) Projects

Background: Telehealth usage is increasing a means of providing healthcare in a more efficient and cost-effective way. Older adults have been left behind from the telehealth movement and this can negatively impact their access to the healthcare system.

Purpose: An educational workshop was offered in a local older adult community with the goal of increasing their knowledge, literacy, motivation, and usage of telehealth.

Methods: The participants completed a pre-assessment survey to determine their baseline knowledge, experience, and perceptions about telehealth. They then participated in an educational workshop, which consisted of a 45-minute presentation given via Zoom with a 15-minute …

Substance Use Disorder: Primary Care Screening, Shari P. Shaltout

Doctor of Nursing Practice (DNP) Projects

Substance use disorder is a significant problem in the United States causing considerable distress and cost to the healthcare system as well as familial, community, and societal resources. Based on evidence-based research, a statement by the United States Preventive Services Task Force in 2015, recommends substance use disorder screening for adults in the primary care setting. A review of the literature concerning screening tools for substance use disorder resulted in twelve studies being included. The purpose of this project is to determine if the more comprehensive substance use disorder screening tool, ASSIST, identifies more at risk patients than the current …

Implementation Of Telehealth Clinical Nurse Leader Interventions To Reduce Rehospitalizations In Rural Home Health Patients, Briana White

DNP Scholarly Projects

Reimbursement for home-based care is moving towards a value-based purchasing (VBP) model. This change brings a renewed sense of urgency to focus efforts in care delivery to sustain positive outcomes such as reducing rehospitalizations. The Clinical Nurse Leader role has been instrumental in hospital settings in improving patient outcomes, and evidence points toward the potential success of implementation of this role in the rural microsystem setting. This quality improvement project implemented a remote telehealth intervention led by Clinical Nurse Leaders, to decrease rehospitalizations of Medicare patients assessed as at-risk for 30-day rehospitalization. The DMAIC QI model was used to ensure …