Nursing Commons^™

The Effects Of Post-Discharge Phone Calls On 30-Day Readmission Rates In The Older Adult Population, Amy Salyer

DNP Projects

Abstract

Objective: The purpose of the project is to develop a specialized and evidenced-based transitional care program including post-discharge phone calls for the older adult population within the University of Kentucky Good Samaritan Hospital system.

Background: Problems in the post-discharge period such as failure to communicate/understand discharge instructions appropriately and lack of timely follow-up appointment with primary care physician lead to increased readmission rates. Utilizing post-discharge phone calls will facilitate prompt communication with the patient after discharge ensuring full understanding of the plan of care.

Aim: Assess the readmission rates of those who received post-discharge phone calls compared to those …

Change In Falls And Sitter Cost Post Implementation Of Remote Centralized Video Monitoring In Hospitalized Adult Patients, April Nicole Dougherty

DNP Projects

PURPOSE: Falls are the leading cause of injury in hospitalized patients. Patient sitter programs are proven to be an effective way to reduce falls in hospitalized patients. Innovative technologies have been examined that provide a safe and cost-effective way to reduce sitter costs and prevent falls. An innovative technology option is a remote centralized video monitoring system containing one video monitoring technician watching and verbally redirecting multiple patients at one time using mobile cameras. The purpose of this project is to evaluate the implementation of a remote centralized video monitoring system for adult patients in the acute care hospital setting. …

Fall Risk Assessment In Community- Dwelling Older Adults: An Explanatory Sequential Mixed Methods Study, Maryann Dool

Honors Undergraduate Theses

Abstract

Aims: 1) To determine fall risk assessment using subjective and objective measures; 2) To understand older adults' perception on fall risk assessment.

Methodology: An explanatory sequential mixed methods design was used and consisted of two phases. Phase 1, the quantitative data was collected from nineteen older adults at an independent living facility in Orlando, Florida. Phase 2, the qualitative data was collected from three participants of Phase 1. After obtaining Institutional Review Board approval, the study was conducted at Lutheran Towers an independent living facility located in the downtown area of Orlando, Florida. Three measurement tools were used: demographic …

Fear Of Falling Assessment And Interventions In Community-Dwelling Older Adults: A Mixed Methods Case Study, Amanda S. Cappleman

Honors Undergraduate Theses

Background: Fear of falling has significant adverse physical and psychological effects for the community-dwelling older adult. Objective: The purpose of this study was to assess fear of falling in community-dwelling older adults and explore participant perceptions of fear of falling assessments and interventions. Methods: A mixed methods case study was utilized to gain an in-depth understanding of older adults' perceptions. It consisted of quantitative data collection by objective measures and qualitative data collection by four individual in-depth interviews. A sample of four community-dwelling adults aged 65 years and older and living in Orlando, Florida, completed the study in their home …

A Video Decision Aid To Influence Advance Care Planning, Angela Petry

Graduate Theses, Dissertations, and Problem Reports (ETD)

The best mechanism to achieve successful advance care planning has yet to be identified. A randomized, controlled, experimental study was performed with a sample of 54 men and women who met inclusion criteria and were randomized into the intervention versus the control group in an outpatient clinical setting in rural West Virginia (WV) from December 2018 to March 2019. Participant mean age was 72.4 years. For those who chose to participate (n=42), the intervention group received the usual standard of care, which was a face to face advance care planning (ACP) discussion with the new intervention of a video decision …

Health-Services Utilisation Amongst Older Persons During The Last Year Of Life: A Population-Based Study, Danielle Ní Chróinín, David E. Goldsbury, Alexander Beveridge, Patricia M. Davidson, Afaf Girgis, Nicholas Ingham, Jane L. Phillips, Anne M. Wilkinson, Jane M. Ingham, Dianne L. O'Connell

Research outputs 2014 to 2021

BACKGROUND: Accurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia.

METHODS: Data from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included. Several measures of hospital-based service utilisation during the last year of life were assessed from retrospectively linked data comprising data for all registered deaths, cause of death, hospital care during the last year of life …

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be …

Improving The Staff Responsiveness By Bundling Care, Practicing Proactive Authentic Hourly Visits, And Using The Four P’S, Robert Vega

Master's Projects and Capstones

Abstract

Problem

Staff responsiveness is an important Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Rating composite tool that hospitals monitor because it is consumer-driven information. The intent is that the HCAHPS composite promotes patient satisfaction, contributes to the prevention of harm, and can save millions of dollars (Danaf et al., 2017). On admission, the patient is orientated to their room, provided a nurse call light button to use, and told not to get out of bed alone and to wait for their nurse (Mitchell et al., 2014). On Three North, a gap exists in the delay it …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

A Quality Improvement Initiative To Implement The Geriatric Depression Scale In A Geriatric Inpatient Psychiatric Unit, Candice Hall

Doctor of Nursing Practice

The World Health Organization (2017) estimated that over 300 million people worldwide have depression. According to the Centers for Disease Control and Prevention (2013), 7 million Americans over 65 years old experience depression annually. The United States Preventive Health Services Task Force recommends the use of a depression screening tool in the adult population. The purpose of this evidence-based quality improvement project was to improve screening for depression in an inpatient geriatric psychiatric unit. The primary objectives included educating nursing staff on depression screening and using the geriatric depression scale (GDS) to assess patient's level of depression at admission and …

Recognizing Delirium At End Of Life In The Hospice Setting: A Process Improvement Project, Latonya Roberts

Doctor of Nursing Practice

Despite advancements in health care, hospice registered nurses and medical professionals caring for patients at end of life lack the required knowledge effectively to care for this patient population. Educational gaps contribute to deficiencies. This process improvement project aimed to increase nurses’ and medical staff’s knowledge and recognition of delirium at end of life through the use of a delirium assessment tool and evidenced-based treatment guideline when managing symptoms. Project implementation occurred at a small hospice company with a patient census of 180, utilizing 2 teams of registered nurses, medical doctors, and a nurse practitioner. A 2-hour educational session had …

The Relationship Between Fall Rates And Fall Risk Inducing Drugs In Older Adult Patients In The Hospital Setting, Kristen Eldridge, Susan Kane Patton

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The aim of this study was to analyze the risk of falls relative to the use of fall risk inducing drugs (FRIDs) among older adult patients admitted to the hospital setting. Quality improvement of nursing fall risk assessment was of special interest. To analyze this a retroactive review of fall incident reports was conducted in collaboration with the study hospital’s risk manager. Medications were correlated with injuries sustained to identify high risk FRIDs. The selected study population consisted of 166 patients over the age of 65 who fell on the acute care campus of a hospital in the mid-south region …

Nurse Practitioner Students: Providing Wellness Screenings To Underserved Older Adults, Rexanna Tatlock

Purdue Journal of Service-Learning and International Engagement

Rexanna Tatlock (BSN, RN, CCRN) received a BSN from Saint Francis College in 2003. As a registered nurse, she specialized in critical care nursing and eventually enrolled in the Adult Gerontology Nurse Practitioner master’s program in Purdue University’s School of Nursing in 2016. Upon graduation in May 2018, Rexanna has planned to focus on primary health care. The service-learning project provided primary care clinical experience, while meeting the needs of an underserved older adult population. This article will discuss the community partnership, a needs assessment, and a wellness screening offered to Fairington Apartments (FA) residents.

Improving Communication To Reduce Patient Falls In A 48-Bed Medical-Surgical Unit, Christian Gella

Nursing and Health Professions Faculty Research and Publications

Abstract

Problem: Patient falls has been associated with increased morbidity, mortality and decreased quality of life. The increase in total patient falls for 2018 relative to 2017, and a spike of 10 patient falls for the month of June 2018 from a baseline of 5.3 falls per month has gained greater attention to reduce patient harm from falls while hospitalized. Prevention of falls minimizes patient exposure to the possibility of being injured. Despite efforts to curtail patient falls, improvement in communication is essential to address the safety issues surrounding improving quality of care practices, and consequentially reduce un-reimbursable hospital costs …

Impact Of Tai Chi On Peripheral Neuropathy Revisited: A Mixed-Methods Study, Melinda Hermanns, Barbara K. Haas, Linda Rath, Brittany Murley, Arturo A. Arce-Esquivel, Joyce Ballard, Yong T. Wang

Nursing Faculty Publications and Presentations

Exercise may be beneficial to older persons living with peripheral neuropathy (PN), but maintaining an exercise program is challenging. After participating in a 12-week tai chi (TC) study, 12 participants requested classes continue. A mixed-methods design was used to explore long-term engagement of older persons with bilateral PN enrolled in a TC class for 18 months beyond the original 3-month study. Pre- and posttest measures of functional status and quality of life (QOL) were conducted. Focus groups were held after 18 months of twice-weekly classes. Psychosocial support was critical to participants’ long-term commitment to exercise. Participants reported, and objective assessments …

Knowledge And Attitude Of Nurses In A New Rn Graduate Residency Program Regarding Pain Management, Kathryn Lee Wampole

Doctoral Dissertations and Projects

Most people have encountered pain at some point in their lives. It is a very common complaint nurses hear from patients. When assessing patients, nurses are taught to take what the patient says as his or her pain level as fact. Pain is not a vital sign that can be measured with medical equipment like temperature or blood pressure. Therefore, many nurses find assessing pain challenging. Adding to the complexity of pain management is the current opioid crisis. To help combat some of these issues, the project leader worked with healthcare administrators at a regional teaching hospital in the southeastern …

Conflicts, Concerns And Family Circumstances In Custodial Grandmothers Over 8 Years, Cristina Noriega, Carol Musil, Jaclene Zauszniewski, Camille Warner

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

Although many grandmothers raising grandchildren experience transitions in their roles as family strains and circumstances change, little longitudinal data has been examined. This qualitative study assessed the relationships between custodial grandmothers’ appraisals of their family conflicts and concerns and family circumstances across eight years. Participants were thirty-five Ohio grandmothers who were raising their grandchildren in 2006-2007 and provided additional self-report survey data in 2008-2009 and 2014-2015. Data were gathered from open-ended questions that were analyzed through conventional content analysis. The reported concerns were financial and emotional difficulties, grandchildren outcomes, mental and physical health of the grandchild and other family members, …

Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger

Master's Projects and Capstones

Abstract

The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Prospectus For Improving Measure Ii Scores Of Hospice Visits When Death Is Imminent In The Hospice Item Set, David Ainsworth

Master's Projects and Capstones

Abstract

Problem: Center for Medicare Services (CMS) created a new quality measure pair to collect data on hospice visit patterns by a registered nurse in the last three days of life (Measure I), and at least two visits by a social worker, home health aide, licensed vocational nurse or spiritual counselor in the last seven days of life (Measure II). A hospital-based hospice organization created a quality improvement project to address this problem and improve both parts of the measure pair, but special emphasis was placed on improving Measure II, as initial data revealed the …

Introduction Of Communication Strategies To Decrease Patient Falls In An Acute Rehabilitation Setting, Alicia Joachim

Master's Projects and Capstones

Background: Due to the lack of appropriate fall prevention measures in an acute rehabilitation unit, there has been a notable increase of patient fall occurrences within a 6 month period. The purpose of this practice improvement project was to reduce patient falls within a 36-bed unit, using visual aids and effective communication among nursing staff. The multi-disciplinary members involved licensed nurses, nursing assistants, nursing supervisors, director of nursing, and executive administrator. Methods: The method used to implement this project included a literature search, informational interviews and staff surveys, and prioritization of interventions by the team. Project implementation was guided by …

Early Detection Of Mild Cognitive Impairment In Older Adults Through The Use Of Annual Screening In The Primary Care Setting, Jordan Fulcher, Donald Tisdale, Charles Knapp, Jessica Mann, Kayla Mcmorise

MSN Research Projects

The purpose of this study was to determine primary care providers’ adherence to USPSTF (2015), and the Alzheimer’s Association’s (2013) recommendations and guidelines advocating annual cognitive impairment screening on patients ages 65 years and older. The Alzheimer’s Association issued an algorithm for detecting cognitive impairment in older adults; this cognitive assessment algorithm was accepted and mandated by U.S. Centers for Medicare and Medicaid Services during annual wellness visits of patients 65 years and older. In addition to the Alzheimer’s Association, USPSTF acknowledges the increasing prevalence of cognitive impairment and the benefits of early detection. However, USPSTF argues a lack o …

Measurements That Matter: Assessment & Management Of The Symptoms Of Chronic Illness Using The Integrated Palliative Outcome Scale (Ipos), Deborah Jeffery

Dissertations

ABSTRACT

Measurements that Matter: Assessment and Management of the Symptoms of Chronic Illness Using the Integrated Palliative Outcome Scale (IPOS)

Background: The mission of the Advanced Illness Management (AIM) program at the Visiting Nurse Association of Greater St. Louis (VNA) is to relieve the burden of serious illness by providing exceptional care to patients and families through symptom management. A validated symptom tool was needed for holistic assessment.

Purpose: This is a quality-improvement project aimed at enhancing symptom management in patients experiencing advanced illness in a community-based palliative care program. Provider use of the Integrated Palliative Outcome Scale (IPOS) as …

Hospital Acquired Pressure Injury Prevention On An Inpatient Unit, Cherilyn Schumacher

Master's Projects and Capstones

Abstract

The aim of the project is to improve the process and delivery of care with established and accepted standards by implementing evidence-based change. The plan is to create a HAPI prevention plan with the main expected outcome to reduce the HAPI occurrences on the unit to zero by July 30, 2018. This will be accomplished by increasing awareness among nursing staff members through education and diligent monitoring of prevention practices and treatments.

The education portion of the plan will include reviewing basic pressure injury education and HAPI prevention and management in the form of visual aids provided by the …

Improving Hand-Off Communication Between The Skilled Nursing Facility And The Emergency Department, Dubravka Labovic

Master's Projects and Capstones

Abstract

The purpose of this project is to improve hand-off procedure between Skilled Nursing Facility (SNF) and Emergency Department (ED). Patient population consists of all retired veterans who currently reside in California Department of Veterans Affairs, Veterans Home of California (CalVet) – the state long-term care facility for elderly. The problem occurs when continuation of care is compromised due to poor exchange of information at the time of transfer to ED. Nurses in SNF need a step-by-step procedure that will improve the process of transfer and the intention of this project is to create a process that will become daily …

Reduing Hospital Readmissions: Ideal Discharge Planning For Heart Failure Management, Chun Mei Chen, Chun Mei Chen

Master's Projects and Capstones

Abstract

The objectives during this project were to achieve by the end of 2018 an overall reduction of 25% in HF readmissions within 30 days. By identifying root causes of readmissions and using needs assessment within the microsystem, literature highlights the elements defining interventions that can be used to improve transitions of care and reduce avoidable HF hospital readmissions. A plan was developed for integrating an evidence-based practice, IDEAL Discharge Planning, along with engaging patients and families at bedside from the first day of admission until discharge to more effectively assist staff in providing patient-centered education and self-care skills. The …

Interlace: Designing An Inclusionary Architecture For Alzheimer's Sufferers, Alexander Fashinasi

Bachelor of Architecture Theses - 5th Year

This thesis intends to address the increasing challenges the Alzheimer’s disease poses for our growing American population. The research begins by looking at the brain as a combination of components which make up the individual. Following this, the research compiles information on the Alzheimer’s disease and its symptoms, followed by an analysis of the built environments effects on the condition.

Through analysis of precedent cases and the combined Alzheimer’s research, I chose to propose an experimental community in which those with Alzheimer’s can live a life with greater autonomy while simultaneously slowing the progression of the disease. I place this …

Establishing A Hybrid Wound And Ostomy Continuing Education Program, Vivian K. Wong

Faculty Publications

Wound and ostomy nurses receive specialty training and certification to provide care in abdominal stomas, ostomies, wounds, fistulas, and pressure injuries. The eight existing nationwide programs in 2011 were inadequate to meet increasing patient population demands. We developed an innovative nondegree, postbaccalaureate continuing wound and ostomy education program using a hybrid design. The program integrated interactive online classes with intensive onsite classes and skills training. The program has been granted seven-year accreditation; student evaluations have been positive.

The Relationship Between Community Dwelling Older Adult’S Fall Risk And Beliefs Of Risk For Falling In Northwest Arkansas And Bolgatanga, Ghana., Natalie Gohman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Title: The Relationship Between Community Dwelling Older Adult’s Fall Risk and Beliefs of Risk for Falling in Northwest Arkansas and Bolgatanga, Ghana.

Gohman, N., Patton, S., Smith-Blair, N., Agana, C.: University of Arkansas, Fayetteville, AR

Background: Older adults worldwide live with comorbidities, physical and psychological changes associated with aging. Statistically, however, older adults are more likely to die as a result of falling. As the worldwide population of individuals over 65 rises, so will the possibility for injuries from falls. Much research has been published concerning fall risk prevention, but minimal research surrounding protocols and practices for protecting against falls …