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Impact Of Implementing The Geriatric Resource Nurse Model On Fall And Hospital Acquired Pressure Ulcer Rates, And Length Of Stay In Older Adults In An Acute Care Hospital, Elzbieta Kmiecik, Cathie E. Guzzetta, Mary-Michael Brown, Qiuping Pearl Zhou, Desale Sameer

GW Research Days 2015

Background.Older adults are at high risk for adverse care outcomes, such as injuries from falls, hospital acquired pressure ulcers (HAPUs), and prolonged length of stay (LOS). Available evidence suggests outcomes may improve when older adults are cared for by healthcare providers with competence in geriatrics. To improve outcomes, an acute care not-for-profit teaching hospital in Washington DC area implemented a Geriatric Resource Nurse (GRN) model that prepares registered nurses (RNs) as clinical experts on core geriatric principles on four general care wards (three medical-surgical and one cardiac).

Objectives. Toexamine the effects of GRN model implementation on fall and …

Connecticut's Elderly Population: An In-Depth Analysis Of Current And Future Trends In Elder Care, With A Focus On Dementia And Cognitive Decline, Emily J. Snodgrass

Honors Scholar Theses

The aging population in Connecticut currently represents ~15% of the state’s population but is anticipated to rapidly increase over the next 20 years. My thesis is an examination of the types of interventions and programs currently available for elderly persons with memory impairment and cognitive decline, as well as the challenges associated with caring for a larger elderly population. Data collected from interviews with CT healthcare and research professionals representative of the diverse specialties of aging together with an analysis of current research literature are used to demonstrate the importance of continued research and expansion of appropriate and accessible services …

Barriers To Music Therapy In The Care Of Those With Alzheimer's/Dementia, Karin E. Kvam

Honors College Theses

This pilot study examines the barriers caregivers encounter when implementing music therapy in the care of those with Alzheimer’s/dementia. An 8-question survey was distributed at two long-term care facilities and an Alzheimer’s support group to understand how often and in what ways music therapy is utilized, as well as what barriers caregivers face when using the therapy. Results indicated that, although the majority of caregivers report using music therapy, it is not implemented as frequently as it could or should be. Caregivers report a knowledge deficit as the main reason for not implementing music therapy. The data suggests that an …

The Meaning Of Patient-Nurse Interaction For Older Hospitalized Women: A Phenomenological Study, Deborah Mize

Doctor of Education (EdD)

The purpose of this dissertation is was to explore how older women perceived their interactions with nurses after receiving care in a hospital setting. Older women are a vulnerable population subject to being overlooked or misunderstood by the nurses caring for them, hence the importance of this study. To gather the data on older women’s lived world of nursing care, I used a phenomenological approach based on a hermeneutic framework that considers linguistic, historical, and social factors to interpret older women’s lived world of nursing care while hospitalized. I personally interviewed seven women between the ages of 66 and 81 …

Search Strategies Used By Older Adults In A Virtual Reality Place Learning Task, Rebecca L. Davis, Catherine Weisbeck

Peer Reviewed Articles

Purpose of the study: Older adults often have problems finding their way in novel environments such as senior living residences and hospitals. The purpose of this study was to examine the types of self-reported search strategies and cues that older adults use to find their way in a virtual maze

Design and Methods: Healthy, independently living older adults (n = 129) aged 55–96 were tested in a virtual maze task over a period of 3 days in which they had to repeatedly find their way to a specified goal. They were interviewed about their strategies on days 1 and 3. …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

An Evaluation Of Fall Prevention Interventions Among Older Adults In A Long Term Care Facility, Courtney Anita Bennett

Doctoral Projects

Falls are serious unwanted events that are a common occurrence among older adults in long term care facilities (LTC). Fall prevention in LTC facilities requires the efforts of an interprofessional team that promotes safety within an organization. The purpose of this capstone project is to implement and evaluate evidence-based fall prevention interventions at a LTC facility. Specific objectives of the project include: (a) providing education to healthcare professionals on evidence-based practices to recognize, assess, and prevent falls among older adults in a long term care facility and (b) replacing the existing fall prevention policy and program with a falls and …

Relationships Among Uncertainty, Coping, And Psychological Distress In Older Adults With Mild Cognitive Impairment, Jennifer Sjostedt Avery

Dissertations (1934 -)

Mild cognitive impairment (MCI) has an average prevalence of 18.9% and most often affects people 60 years of age or older. It is a cognitive stage between normal functioning and dementia (Petersen, 2003; Petersen, 2011; Petersen et al., 2014). MCI can be broken into two subtypes classified by the presence of memory impairment (amnestic MCI) or the lack thereof (nonamnestic MCI). Medical diagnostic criteria are commonly used to guide research with older adults with MCI. A theoretical framework that addresses the antecedents and consequences of MCI, specifically one examining the relationships among MCI, uncertainty, coping and psychological distress, is essential …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Primary Care At Home: Nurse Practitioners' Perceptions And Practices, Tonya Bragg-Underwood

Doctor of Nursing Practice Technical Reports

Background: Primary care at home is not a new idea, but rather a reinvention of an old and almost forgotten practice. Today, only 1% of primary care visits are provided in a home setting; despite the increasing aging homebound population in the United States. Current primary care at home research relates improved patient outcomes with primary care at home visits. Primary care at home is reemerging in the United States, but currently is not generating many positive reviews. There is a gap in the current primary care at home literature regarding nurse practitioner home visit practices and perceptions. Methods: A …

Results And Lessons Learned From A Nurse Practitioner-Guided Dementia Care Intervention For Primary Care Patients And Their Family Caregivers, Richard H. Fortinsky, Colleen Delaney, Ofer Harel, Karen Pasquale, Elena Schjavland, John Lynch, Alison Kleppinger, Suzanne Crumb

Articles - Patient Care

Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients …

Betsy: A Case Study Of A Client With Down's Syndrome And Dementia, Cheryl D. Schlamb, Christine D. Moriconi

Nursing Faculty Publications

No abstract provided.

Changing Places: Adult Children And The Transition Of Aging Parents, Sarah Martin Gilbert

MUSC Theses and Dissertations

Purpose: This dissertation analyzed measurement of relocation transition in older adults, assessed research for the manner in which older adults make the decision to move, and the adult child's role in the transition of their aging parents. Design: Using Hawker, Payne, Kerr, Hardey, & Powell's (2002) mixed research review method, two integrative reviews were conducted. The first examined how relocation transition is measured in the literature while the second applied the Theory of Planned Behavior (Ajzen, 1985) to determine the behavioral beliefs, subjective norms, and perceived behavioral control of older adults as they contemplate a relocation from independent living to …

Active Ageing In Pakistan: Challenges And Opportunities, Samina Vertejee, Noureen Nasruddin Karamali

Department of Surgery Docs

Abstract

The increasing number of ageing population is a signpost for re-directing the resources to ensure quality of life for elderly thus promoting active ageing. However, the challenges to achieve the goal outweigh the opportunities due to scarcity of resources. Several factors including, brain drain, poverty, lack of knowledge of elderly to protect their rights in association with poor state laws determines the poor quality of life for elderly in Pakistan. Although, the apparent scenario is quite unpleasant yet there are several opportunities such as improved crude birth and death rates, increased awareness about gerontology as a specialty care area …

The Relationship Of Education On Geriatric Nurse Practitioners Frequency Of Providing Spiritual Care In Practice, Barbara Vincensi

Faculty Presentations

No abstract provided.

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

Faculty and Staff Scholarship

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 …

The Relationships Between Nursing Staff Knowledge Of Personhood And Resident Cognitive Status, Leeanne Compere Yopp

Inquiry: The University of Arkansas Undergraduate Research Journal

The purpose of this pilot study was to explore the relationships between nursing staff knowledge of extended care resident personhood and resident cognitive status. Eighty nursing staff from two similar extended care facilities in Arkansas completed a self-administered questionnaire to assess their knowledge of 21 residents, including information related to residents’ past jobs/careers; likes/dislikes/ interests; family members; other non-specific knowledge; and total knowledge. The Brief Interview for Mental Status (BIMS) was used to evaluate resident cognitive impairment. Results of a Pearson correlation demonstrate a positive correlation between (1) staff knowledge of residents’ families, and (2) total knowledge of residents with …

Advancing The Future Of Nursing: A Report By The Building Academic Geriatric Nursing, Jennifer L. Bellot, Dana Carthron, Melissa O'Connor, Karen Rose, Casey Shillam, Janet Van Cleave, Amy Vogelsmeier

College of Nursing Faculty Papers & Presentations

In the United States, the number of older adults will double during the next 25 years (United States Census Bureau, 2008). This dramatic demographic shift is changing the landscape of health care practice as more people live longer with multiple chronic conditions. To better prepare nurses to care for this future population, the John A. Hartford Foundation partnered with the American Academy of Nursing in 2000 to launch the Building Academic Geriatric Nursing Capacity (BAGNC) program. Since that time, 251 scholarships and fellowships have been awarded to nurses to advance geriatric nursing education, research, and practice. In 2009, …

A New Approach To An Old Problem: Defining Nursing’S Role In Successful Transitions To Long-Term Residential Care, Kyleen Aldrich

Honors College Theses

A growing body of nursing research addresses the transitional period for older adults entering long-term residential care. However, gaps exist in our understanding of nursing’s role in the transition process. Our aim is to examine the available evidence and develop a model of nursing strategies and interventions to ease the transition to long-term care. This model describes interventions that nurses can incorporate into everyday practice.

A literature review was conducted to examine the transitional care needs and interventions for older adults with a goal of developing a model addressing transitions to long-term care.

Most nursing studies provided descriptive information about …

Effectiveness Of A Pilot Gerontological Nursing Certification Preparation Support Program For Registered Nurses Working In Long Term Care, Gail B. Sprigler

Graduate Theses, Dissertations, and Capstones

Between 2000 and 2025 there will be a 30% increase in the prevalence of Alzheimer’s disease (AD) in Indiana (Alzheimer’s Association, 2010). Many individuals with AD and related dementia are cared for in long term care communities. Adequate knowledge and expertise of nurses caring for older adults, particularly those with dementia, is important for the delivery of quality care and the promotion of quality of life for residents living in long term care. This pilot project examined the benefit of a resource support program to encourage Gerontological Nursing certification for registered nurses in the long term care setting.

Surgical Delay For Hip Fracture Clients And The Use Of Clopidogrel: An Integrative Review, Phoebe Genevieve Waller

Senior Honors Theses

Abstract

Hip fractures in elderly patients have very high postoperative mortality rates and the number of hip fractures in the United States is expected to increase exponentially before 2030. Early surgery is essential to improve outcomes, but patients on clopidogrel (Plavix) have a high risk for increased bleeding if surgery is performed within the usual 72 hour window. This paper presents literature and research addressing the dangers of delaying surgery versus undergoing surgery before the effects of the clopidogrel are gone. Based on articles published after 2006, most researchers advocated earlier surgical intervention than previously recommended and emphasized an individualized …

Nursing Satisfaction In Caring For Elders, Sarah L. Vlachos

Honors Theses and Capstones

Despite the increasing number of Americans who are over 65 years of age, little research exists about the satisfaction of nurses who care for this population. This qualitative descriptive study investigated the factors that influence the satisfaction of such nurses, and yielded five main themes. Registered Nurses (RNs) reported providing high-quality care, developing relationships, and making a difference to be rewarding components of geriatric nursing. The nurses also discussed challenges, which included caring for elders with dementia and being unable to deliver the high-quality care they felt patients deserve. Several of these finding were consistent with existing studies that addressed …

Two Cultures Of Caring: A Comparative Study, Lisa Armstrong, Chistina Polito

Honors Theses and Capstones

There is much that the UK and the US could and should learn from each other to understand the quality of end-of-life care, through comparison of practice, analysis of care patterns and via original research (Higginson, 2005, p.170). Although comparisons between end-of-life care in the United Kingdom and United States have demonstrated similarities and disparities in many contexts, there is little evidence of research that directly compares nursing perspectives between the two Atlantic partners. This research explores nurse’s perceptions and experiences of caring for people within a hospice context and identifies themes of commonalities and disparities in theory and practice, …

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. States design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. The incorporation of multiple, sometimes conflicting incentives into state reimbursement systems has resulted in enormously complex and demanding methodologies that inhibit consumer participation in state rating setting decisions. In turn, the lack of consumer involvement has the potential to result in the adoption of reimbursement systems that favor industry and government interests at the expense of issues important …

Value Of A Graduate Gerontology Certificate Versus A Masters Degree, Janet S. Hahn

Academic Leadership Academy

The WMU Center for Gerontology was established in 2010 and builds on a strong tradition of gerontology education offered at WMU from the late 1970s to 2004. The undergraduate minor has been revised and is again offered. The previous graduate certificate in gerontology has not yet been reestablished.

This project sought to determine the relative value of a graduate certificate in gerontology vs. a masters degree in gerontology.

Developing Positive Attitudes Toward Geriatric Nursing Among Millennials And Generations Xers, Barbara A. Heise, Vickie Johnsen, Deborah O. Himes, Debra Wing

Faculty Publications

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults. With the understanding that younger adults see a …

Multisite Recruitment And Data Collection Among Older Adults : Exploring Methods To Conserve Human And Financial Resources., Valerie Lander Mccarthy, Karen Cassidy

Faculty and Staff Scholarship

The purpose of this article is to describe strategies that were effective in recruitment and data collection among older adults in 3 quantitative studies while decreasing costs in terms of time and money. Factors effective in reducing use of investigators' time and expenses included limiting exclusion of data because of abnormal Mini-Cog scores by careful initial screening and avoiding repeated reminders or follow-up, collecting data in small groups, collapsing consent, dementia screening, and data collection into single sessions, as well as accommodating for sensory and literacy deficits. The cross-sectional, descriptive studies were conducted among community-dwelling older adults attending senior citizen …

A Primer For Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. To ensure that providers behave appropriately, the federal and state governments have established an extensive set of regulations that nursing homes must comply with if they are to be reimbursed for patients insured by Medicaid. Consumers exert considerable influence here by focusing on regulations and enforcement of non-compliance.

States also seek to align providers’ interests with those of other interested parties through controls and incentives built into state reimbursement systems, including with respect to facility cost and quality, access to care, payment equity, service capacity, and budgetary …

Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota For State Policymakers, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. State governments design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control.

Often, participation in the process of developing Medicaid payment policy is limited to state agency officials and providers of care and, occasionally, union representatives and state legislative staff. Invited less frequently to reimbursement policy discussions are consumer representatives. Lack of consumer involvement in the development of state rate setting systems has the potential to result in the …