Nursing Commons^™

Educational And Experiential Factors Affecting Nursing Students’ Bias Towards Gerontology And Dementia Care, Hannah Holt

Honors Theses

According to the World Health Organization, ageism is defined as the stereotyping, prejudice, and discrimination against people based on their age (WHO, 2019). Ageism can be found everywhere and has been normalized in modern day society. Ageism can result in older adults being overlooked for jobs and portrayed in a negative way in the media (WHO, 2019). Many researchers have explored the topic of ageism and the lack of quality in dementia care by nurses (Chaston, 2010), but there is a gap in existing literature related to the root cause. For example, (Chan, 2008) highlights areas of concern regarding dementia …

Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco

Journal of Geriatric Emergency Medicine

No abstract provided.

Loneliness, Social Isolation, And Their Connection To Overall Health Across The Lifespan, Paige Miller

Senior Honors Theses

Due to recent circumstances, the incidence of loneliness and social isolation has skyrocketed. Fortunately, there have already been countless studies examining the longer-term implications of these two factors on health. Loneliness and social isolation have been found to impact cardiovascular health, stress response, immune function, resilience, mental health, attachment, spiritual health, and many other determinants of health. A variety of research was examined outlining the psychological implications of loneliness and social isolation. These factors also influence physiological processes and can exacerbate a variety of diseases. After presentation of this evidence, a collection of possible interventions will be discussed, and their …

Implementing Geriatric Frailty Screening In Acute Care, Christine Longley

Student Scholarly Projects

Practice Problem: Frailty is a syndrome of age-related physiologic decline characterized by an increased burden of symptoms and higher susceptibility to adverse health, including higher functional decline rates, pressure ulcers, falls, and delirium. In the general medicine unit of this project, geriatric patients were not screened for frailty.

PICOT: The PICOT question that guided this project was: In hospitalized patients 65-years-of-age and older (P), how does implementing a geriatric frailty screening tool (I), compared to standard assessments (C), influence frailty identification and personalized plans of care (O) over eight weeks (T)?

Evidence: Literature supports screening for frailty in the hospitalized …

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 …

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, …

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 …

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 …

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 …

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 …

「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。

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。

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

Faculty Articles

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, …

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …

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 …

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

"It's The Way You Sing It": Translating Music Therapy For Isolated Older Adults Affected By Covid-19 To The Television Screen, Eunice Wong

Expressive Therapies Capstone Theses

The current Covid-19 pandemic has increased the likelihood of loneliness and social isolation among older adults due to the restrictions on movement and visitations in care facilities. Loneliness and social isolation have consistently been identified as risk factors for poor mental and physical health in older people. Meanwhile, a growing number of older adults are utilizing technological resources to enhance their interpersonal relationships and overall quality of life. In the winter of 2020/2021, an innovative music therapy-informed television program was designed and produced for isolated older adults in need of mental and emotional support. This project, produced jointly by a …

How Various Exercise Modalities Impact Quality Of Life, Physical Activity, And Program Adherence In Patients With Copd, Hannah Brookshire, Sarah Barnes, Natalie Cagle, Nancy Starnes, Elia Schaefer

Symposium of Student Scholars

How Various Exercise Modalities Impact Quality of Life, Physical Activity, and Program Adherence in Patients with COPD

Background: Chronic obstructive pulmonary disease (COPD) is a group of diseases that causes breathing difficulty due to airway obstruction. Adherence to physical activity recommendations for those with COPD is often problematic and leads to worsening dyspnea and quality of life. Due to the prevalence of COPD, it is important to understand how different exercise modalities impact quality of life and adherence to physical activity.

Objective: The purpose of this systematic review was to determine if patients with COPD have a better quality of …

The Effect Of Alternative And Personalized Therapy In The Treatment Of Depression In Older Adults Living In Long-Term Care Facilities, Amber Davis, Olivia Gilbert, Kayla Kelley, Mitch Elliot, Deanna Hebert

Symposium of Student Scholars

Abstract

Title: The effect of alternative and personalized therapy in the treatment of depression in older adults living in long-term care facilities

Background: In older adults, depression can lead to changes in memory, physical pain, fatigue, sleep disturbances, and even suicidal ideations. Due to the shortage of healthcare workers in long-term care facilities, older adults have a difficult time receiving treatment. Therefore, alternative treatment methods and personalized therapy are becoming more important when treating patients in long-term care facilities.

Objectives: This systematic review set out to determine whether personalized therapy and alternative treatment methods may significantly reduce the symptoms of …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Evidence-Based Recommendations For Assistive Technologies For Safety In Dementia Care, Lee A. Diener

Masters Projects

A Quality Improvement (QI) project in a Midwestern Continuing Care Residential Community (CCRC) was designed to examine the evidence-base of four assistive technology platforms marketed as safety platforms as means to improve outcomes for older adults residing in memory care environments. Using the Evidence-Based Design Model Socio-Technical Systems Theory, survey data and observational data collected from the organization were considered with respect to the evidence-base supporting each technology. Ten organizational priorities derived from collected data were used to develop an Evidence-Based Assistive Technology Fitness score for each of the AT platforms reviewed. This methodology provides a means to evaluate planning …