Family Caregivers Of Older Adults With Physical Disabilities In Rural Thailand, Denis Tuttle, Jiranan Griffiths, Anuchart Kaunnil

The Qualitative Report

Thailand is one of many countries experiencing changes in the demographics of its population. People are living longer and having fewer children resulting in an increasing percentage of older adults in the general population. This presents a challenge in providing care for older adults, especially in countries where there is a culture of family caregiving. This study aims to investigate the experience of family caregivers, exploring the problems of caring for older people with physical disabilities and the needs of family caregivers. This is done to better understand ways to support caregivers. Using a descriptive qualitative approach, 15 family caregivers …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong

Master's Projects and Capstones

The nursing shortage in the United States has been an ongoing issue due to nursing burnout and retirement. Together with the COVID-19 pandemic, it has further exhausted the healthcare system’s resources and healthcare providers. In order to sustain the healthcare system in society, a large number of internationally educated nurses (IENs) have been transferred to work in the United States. As a result of different nursing practices, cultures, and communication styles, many IENs experience language and cultural barriers at work. Difficulty in communication influences the quality of patient care provided, which can lead to negative health outcomes for patients and …

Impact Of Montessori-Based Dementia Programming On Engagement And Affect Of Older Adults With Dementia, Meredith S. Sheppard

Master's Projects and Capstones

The COVID-19 pandemic has profoundly impacted the Adult Day Services program and Adult Day programs across the country. As the Adult Day Services program transitions to an in-person format, goals within the organization include developing appropriate programming, increasing group size, and keeping clients entertained. The framework guiding this quality improvement project is Montessori-Based Dementia Programming ® (MBDP). This project aims to increase client engagement, decrease client anxiety, and decrease staff workload. This will be measured by a self-developed staff workload survey, the Menorah-Park Engagement, and the Affect rating scale. Implementation of MBDP at the Adult Day Center did not meet …

Nurses Addressing The Knowledge Gap In Advance Care Planning, Stephanie Winkel, Elaine B. Harwood

International Journal of Faith Community Nursing

Background: Advance care planning allows people autonomy about values and preferences related to care at the EOL. Engaging in advance care planning enables one to consider decisions about medical treatment at the EOL and informing significant others, including health care providers, about preferences (National Institute on Aging [NIA], 2018).

Methods: In this QI project, the intervention will be a one-time ZOOM^® meeting between nurse leaders and participating church members. The nurse leader will present the 5 Wishes curriculum and lead a question-and-answer portion at the end of the ZOOM^® meeting. Participants will be asked to complete a short …

Advance Care Planning In Faith Communities: A Quality Improvement Project, Lorie Hacker, Jan Gaddis, Jessica Grimm, Catherine Chung

International Journal of Faith Community Nursing

This quality improvement project examined the impact of providing an advance care planning training tool to faith community nurses in the community setting on advance care planning knowledge, self-efficacy, and implementation of advance care planning outreach and advance directive completion. The pre- and post-intervention frequencies measure and paired-t test survey design resulted in clinically significant improvements in knowledge, and self-efficacy of advance care planning among faith community nurses. A fifty-fold increase was seen in advance care planning outreach activities among the group from pre- to post-intervention. The limitations of the project included small sample size and short implementation timing. However, …

Evidence-Based Selection Of A Fall Risk Assessment Tool: A Program Evaluation Review, Lindsey Adams

Student Scholarly Projects

Fall prevention strategies are a consistent topic of discussion for healthcare regarding patient safety, as patient falls are costly to the patient and the organization. This project uses the CDC Framework for Program Evaluation to assess the fall prevention policy of a local hospital system, with particular emphasis on the fall risk assessment tool, Hester Davis. This project also explores the risks and benefits of adopting an alternative fall risk assessment tool, predictive analytics. Predictive analytics uses electronic health record (EHR) data analysis to provide a highly individualized patient fall risk score based on a large variety of patient and …

Reducing Readmission (And Mortality) For Older Patients & Survivors Of Life-Threatening Conditions: A Study Using The Staarr Protocol, Akhenaten Amun

Symposium of Student Scholars

Readmission rates for patients admitted for heart failure, pneumonia, chronic obstructive pulmonary disorder, a myocardial infarction, a hip or knee arthroplasty, or coronary artery bypass surgery tend to have high readmission and mortality rates within 30 days of their discharge from a hospital. Starting in October 2012, the Healthcare Reimbursement Reduction Program enforced penalties on Medicare reimbursements for hospitals with readmission rates, for patients with the conditions above, were higher than averages based on facilities with similar characteristics and patient populations. Teach-back and verify (Klingbeil & Gibson, 2018), interdisciplinary teams that engage in patient care and support (Reiter-Palmon et al., …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …

Unmasking The Leading Injuries In Hospitals And A Promising Change, Taylor Karisny

Symposium of Student Scholars

Abstract

The problem that will be studied is the increased development of pressure ulcers among hospitalized intensive care unit patients. The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately and effectively is increasingly important for all professionals in wound care. The review of the literature shows, hospital-acquired pressure ulcers are expensive to treat with the U.S. median cost at $39,000 per patient stay and costing U.S. health care system $3.6 billion per year. Several interventions and preventive measures are current used …

For Bedside Nurses In Acute Care, Can Additional Education Contribute To Adequate Performance Of Prevention And Treatment For Hospital-Acquired Pressure Injuries?, Hannah Ly

Symposium of Student Scholars

Background: Hospital-acquired pressure injuries (HAPIs) are common preventable medical issues among patients receiving acute or critical care, such as cancer, spinal cord injuries, or heart disease. Despite the rapid development of healthcare, HAPIs remains one of the biggest challenges that affect patient outcomes, breach patient safety, and become an economic burden for many healthcare facilities worldwide. The healthcare members, especially nurses, often underestimate the harms because the issues are not a life-threaten concern in the inpatient setting. However, HAPIs can lead to emergency conditions such as sepsis. This study aims to access and provide additional education that acknowledges and improves …

Risk Assessments In The Reduction Of Medication Errors In Older Adults With Polypharmacy, Jacquelyn Blackwell

Symposium of Student Scholars

Abstract

Background: An increasing number of people are on multiple medications which is referred to as polypharmacy. Research has shown that polypharmacy increases the risk of adverse events related to medication errors, especially among elderly patients who are more sensitive to the effects of medication due to physiologic changes that occur due to aging. Information also exists on interventions that may decrease the likelihood of medication errors. However, there is a lack of research on the success of said interventions in preventing medication errors. This project aims to identify, develop, implement, and evaluate the effectiveness of the proposed interventions, …

Evidence-Based Best Practice For Transitions Of Care: A Policy Review On Medication Reconciliation Standards, Lovelyn Chizoba Ogbennah

Student Scholarly Projects

Practice Problem: Medication reconciliation (MR) is crucial in care transitions among healthcare facilities. Developing evidence-based discharge planning strategies, improving communication, optimizing electronic health record intelligence interoperability, and stakeholder engagement will promote a better transition process for patients and healthcare providers.

PICOT: The PICOT question that guided this project was: In an urban-based adult skilled nursing facility, how does an evidence-based structured review, and revision of current MR policy and procedures, compared to the existing MR policy, affect the clarity of the process for communication between clinicians during transitions of care over a 10-week review cycle?

Evidence: Fifteen …

Promoting Sleep To Decrease Delirium, Stephanie Mayne

MSN Capstone Projects

Delirium is potent risk factor for complications, an increase length of stay, and mortality. Hospital acquired delirium is a prevalent and serious health condition that can occur in patients, especially the older adult population, when admitted to the hospital. It has the ability to be prevented if properly addressed and interventions are set in place to help reduce the occurrence of hospital acquired delirium. Many factors can contribute to the development of delirium, including a disruption of one’s circadian rhythm. Sleep is not always a high priority in the hospital, therefore there are little interventions and goals aimed at improving …

Factors Impacting Organ Transplant Outcomes, Katelyn Grubich

Nursing | Senior Theses

Organ transplants are crucial to the survival of those on the receiving end. With medicine advancing, so has transplantation. Health care providers are becoming more aware of the strategies necessary to prolong the transplanted organ and how to obtain better outcomes. Heart, lungs, kidney, liver, pancreas, and some where more than one organ are involved, are the types of organ transplants performed.

Providing patients information will allow them to be a part of their treatment and can help to ease their anxiety knowing what is being performed and what can be expected. Health care providers must ensure that patients and …

Addressing Obstacles In Following Prescribed Medication Regimens In Patients With Type 2 Diabetes Mellitus, Cristina Sarro

Doctor of Nursing Practice

Background. Type 2 diabetes is the ninth leading cause of death in the United States. Micro/macro vascular complications are common in diabetes. Purpose. To implement an evidence-based protocol addressing obstacles for patients with type 2 diabetes in following their prescribed medication regimens to reduce glycosylated hemoglobin levels. Evidence. Failure to follow treatment plans increases diabetes complications. Perceptions and complexities of treatment plans, side effects of therapies, and cost contribute to patients not taking their medications as prescribed. Goals. To increase the number of patients with type 2 diabetes who follow their prescribed medication regimen and reach their targeted glycosylated hemoglobin. …

The Lived Experience Of Losing Employment After Diagnosis With Dementia: A Phenomenological Analysis, Susan K. Blaine

Doctoral Dissertations

The purpose of this study was describing the experiences of people with dementia (PWD) who lose their employment after diagnosis with dementia, but sooner than originally planned. A phenomenological approach based on tenets of Maurice Merleau-Ponty was used. Six telephone interviews were conducted, with participants sharing their experiences. Transcripts were transcribed verbatim, and subsequently analyzed via a hermeneutical analysis approach. Themes were identified within and between transcripts, considering the contextual grounds of Merleau-Ponty’s phenomenology: body, others, time, and world, and the contextual ground of participants’ experience: the stigma of dementia. An overarching, central theme of “still working” was identified across …

Repositioning Patients To Prevent Pressure Ulcers, Janeth Covarrubias

Symposium of Student Scholars

The purpose of this project is to demonstrate whether alternating between the nurse and certified nurse aid (CNA) to reposition immobilized patient’s every two hours, as opposed to being repositioned solely by one person, will reduce pressure ulcer development.

Background: Nurses and CNAs work together to turn patient’s every 2 hours, but some patients have stated that they have not been turned all day; consequently, they’ve developed new pressure ulcers or are not healing from previous ones. Without interventions, patients are at risk for developing severe infections, lengthening their hospitalization, and increased pain levels.

Literature review: Like the registered …

Uncovering The Benefits Of Naturalistic Blue-Depleted Lighting In Hospitals: A Qualitative Study, Sam P. Cotton

Symposium of Student Scholars

With exponential technological advances, hospitals are tasked with prioritizing which expensive innovations truly impact as many patients as possible to give them the greatest chance of recovering and discharge them earlier. It is no surprise that most of the attention is focussed on pharmaceutical drugs and a variety of different equipment and machinery, but hospital facilities should look into simpler additions that can aid every patient admitted. The use of naturalistic blue-wavelength lighting is something that can benefit each patient’s recovery immensely. Multiple studies have proven positive effects that blue-depleted lighting compared to standard indoor fluorescent lighting has lowered stress …

Use Of Text Messaging For Type Two Diabetes Management In Patients Over Sixty-Five, Charles Head

Master of Science in Nursing Family Nurse Practitioner

Why is there a need for tight glucose control for diabetics sixty-five years old or older? Tight control of glucose which can be trended as a 90-day snapshot of blood sugar control is measured using HgA1C levels(Centers for Disease Control and Prevention, 2019). HgA1c levels under six percent in diabetics have been shown to reduce diabetic complications that be detrimental to health(Krapek et al., 2004). Adults aged sixty-five years old or older are also at greater risk for the development of acute and chronic diseases that are a result of poor blood sugar management(Leung et al., 2018). Adherence to prescribed …

Physical Activity, Daily Step Counts And Functional Ability In Older Adults: Using Nhanes Database, Chunfang(Maggie) Chen

Doctoral Dissertations

Maintaining functional ability and independence are essential in the healthcare of older adults. Physical activity(PA) has been acknowledged as effective and economical health promotion strategies in older population. However, the amount of PA needed to maintain functional ability in older adults remains unclear. This investigation used PRISM Dose-response Curves Stimulation Variable slope model to explore the relationships between the amount of PA and functional ability in community-dwelling young-old, middle-old and old-old age group adults. ANOVA analysis was used to examine the relationship between functional ability and self-perceived active level changes compared to 10 years ago. NHANES 2005-2006 older participants datasets …

Toolkit For Screening Older Adults Desiring To Age In Place In Independent Living, Sister Raymond Marie Labonte

Seton Hall University Dissertations and Theses (ETDs)

The world is experiencing an increase in the aged population. This increase stimulated the popular theme of aging in place. Much time, effort and research have been channeled into exploring this model as an alternative to assisted living or skilled nursing settings for senior citizens worldwide. Elders desire to age in place. Current, recent, and decades old literature identifies this preferential option of the elderly and supports the need to develop plans and tools to assist elders to be able to successfully age in place. This quality assurance project is the venture to create both a congregate living community and …

Improving Hypertension Self Management In African American Men, Elizabeth C. Felix

Electronic Theses and Dissertations

Hypertension is a cardiopulmonary condition linked to genetic, environmental, and social factors. Left untreated, it can lead to fatal conditions such as heart disease. In the United States, African Americans experience disproportionately high rates of hypertension, earlier onset of symptoms, greater severity, and higher related mortality rates. African Americans also statistically have more difficulty self-managing their hypertension than other demographics. The aim of this project was (a) to identify, define, and measure perceived barriers to self-management of hypertension among African American men and (b) to target these barriers and increase patient engagement through personalized intervention plans. The researcher recruited 24 …

Efficacy, Acceptance, And Feasibility Of Virtual Reality For Chronic Pain Relief In Older Adult Veterans Residing In Long Term Care, Valicia Philibert

Dissertations, Theses, and Capstone Projects

Older adults residing in Long-Term Care (LTC) have a high prevalence of chronic pain. Pain management strategies have primarily focused on pharmacological approaches, but with physiological changes associated with aging, this population is at an increased risk for adverse effects from prescribed medications. More research is needed on innovative non-pharmacological interventions in the LTC setting. This study examined the feasibility, acceptance, and preliminary efficacy of Virtual Reality (VR) for chronic pain among older adult veterans in LTC. In this quasi-experimental, 12 older adult participants living with chronic pain in a long-term care facility received two sessions of VR. Pain intensity …

Trends In Health Outcomes Before And After Long Term Care Federal Regulations Limited Antipsychotic Medication Use: A Secondary Data Analysis, Karen Robson

Electronic Theses and Dissertations

Trends in resident falls did not significantly change, although trends in serious injury from falls declined ten years after regulations restricted antipsychotic medications in long-term care facilities. Trends in functional and continence status worsened after the regulations were implemented.

Improving Moisture Associated Skin Damage In A Veteran Unit, Beverly Chen

Master's Projects and Capstones

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Caring For The Caregiver During Covid-19 Suspended Visitation, Melissa D. Rouse, Lorie K. Shoemaker, Priscilla Kyle, Chris Tenold, Whitney Anthony, Jordan White

Patient Experience Journal

During the 4th surge of COVID-19, August to November 2021, visitation was suspended in a hospital system in North Georgia. The Compassionate Connections Call Center (CCCC) was created to alleviate staff stress and to manage calls and communication. The goal of the initiative was to reduce interruptions to patient care caused by the increased number of calls to the clinical units by patients, families, loved ones and personal caregivers. The CCCC managed all incoming calls and communicated with the patient’s primary nurse through a coordinated process which limited interruptions. By caring for the caregiver, the aim was to improve the …

Educational Plan For Certified Nursing Assistants In Long-Term Care Facilities On Assessing Pain Of Residents With Dementia, Rachel Lynn Spoon

DNP Scholarly Projects

Certified nursing assistants employed in long-term care agencies may have little education on the assessment of pain experienced by residents with dementia. The purpose of the Doctor of Nursing Practice Project was to develop an evidenced-based teaching plan for certified nursing assistants caring for residents with dementia in long-term care settings. The plan includes content on dementia, dementia symptoms, pain indicators, and pain assessment in residents with dementia, non-medicinal management strategies, and communication strategies for referring assessment findings to licensed practical and registered nurses. Supplemental PowerPoint™ slides were developed that match the teaching plan. The draft teaching plan was judged …