Geriatric Nursing Commons^™

Assessing Preinjury Frailty In The Elderly Hip Fracture Patient To Promote Palliative Care Referral In Those At Risk For High Morbidity And Mortality, Alicia N. Walker, Jewyl Gibson, Sara Dunham

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

The objective of this project is to assess preinjury frailty in hip fracture patients aged 65 and older as a predictor for postsurgical morbidity and mortality, prompting early referral to palliative care services in patients deemed high-risk for postoperative complications. Including palliative care in the multidisciplinary care of the high-risk patient has been shown to improve quality of life, increase patient and caregiver satisfaction, and reduce healthcare costs. The design is a quality improvement initiative. The setting is an academic medical center, serving as the region’s Level 1 Trauma Center. There is no current process for measuring frailty as a …

Implementing A Pressure Ulcer Bundle, Amy D. Johnson, Pamela Hardesty, Janice Zimmer, Patricia Moore

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

Background: A quality improvement DNP project in a rural southern hospital was implemented to improve hospital-acquired pressure ulcers by implementing an evidence-based pressure ulcer prevention policy and education. Framework: The Evidence-Based Practice framework utilized in the project's development, implementation, and evaluation was the John Hopkins Evidence-based Practice Model. Local Problem: The hospital had no pressure ulcer bundle in place. Design: Quality improvement project utilizing the plan-do-study-act cycle. Methods: An educational presentation on pressure ulcers and the steps to implement a bundle. A pre-and post-test using Pieper's Pressure Ulcer Knowledge Test, modified from Agency for Healthcare Research and Quality (AHRQ) website. …

Pressure Injury Prevention: A Quality Improvement Project Utilizing Incontinence Care Education, Laura Renner

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

Objective: Evaluate whether the initiation of incontinence care education can improve pressure injury knowledge by an average of 5% in post-test scores over 1 month. Design: Theoretical Framework: Lewin’s Three-Step Model for Planned Change and Evidence-Based Practice Improvement Model. Setting/Local Problem: A 20-bed acute care geriatric unit in a large metropolitan hospital in middle Tennessee with inappropriate use of incontinence management products. Participants: Nurses and nursing assistants employed at the project site. Intervention/Measurements: An educational tool was developed to improve knowledge on pressure injury prevention through incontinence management. A pre-test and post-test were conducted immediately before and after educational tool …

Increasing Advance Directive Rates In Primary Care: Implementation Of A Redesigned Form, Abbie Cheatham, Samereh Abdoli

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

Background: Less than half of individuals 65 and older have completed an advance directive despite evidence to their benefit. Lack of advance directives can have emotional and financial consequences for the family and individual. A major barrier to advance directive completion is the high literacy level most state sponsored forms are written at, with the average form written at a high school level. Methods: This quality improvement project was a three-month trial to increase the number of advance directive rates at a primary care clinic in the Knoxville area. Five Wishes, written at an 8th grade reading level was …

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

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

Abstract

Background

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

Elearning Module For Nursing Students To Improve Delirium Identification, Prevention, And Management, Shannon Baker

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Delirium is a serious, acute alteration in cognition and consciousness, which is common amongst older hospitalized patients and has an overwhelmingly negative impact on patient outcomes. Under-recognition by healthcare providers poses a barrier and contributes to poor patient outcomes, including increased morbidity and mortality.

Purpose: To reduce the incidence of delirium amongst acutely ill patients via internet-based education for student nurses on delirium prevention, assessment, and management.

Methods: An eLearning intervention consisting of a virtual lecture with an unfolding case study for undergraduate nursing students. This project utilized the Nurses’ Delirium Knowledge Assessment (NDKA) …

Increasing Health Literacy Through Noteaid Translational Tool In Nursing, Liz Catherine S. Cory

Doctor of Nursing Practice (DNP) Projects

Background: Many adults in the United States lack health literacy necessary to understand patient education materials given to them, such as discharge summary. Re-hospitalization rates are higher due to poor transition of care planning. Older adults may only be provided with written instruction for their complex chronic conditions with multiple changes in medical or treatment plan, or uncommon surgical procedures. Nurses are instrumental in bridging the gap, as they often educate, advocate, and use health technology.

Purpose: To educate nurses on the availability of NoteAid as a natural language translation system that can help increase their comprehension of electronic health …

A Provider-Driven Approach To Preventative Oral Care In Nursing Home Facilities, Molly Anderson, Brandon Mccrossin, Kary Franchetti, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern.

The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

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 …

Nurses’ Experience Of Leadership In Assisted Living: A Situational Analysis, Carole H. Bergeron

Antioch University Full-Text Dissertations & Theses

This study concentrates on the voice of registered nurses as they describe their experiences of leadership within the nontraditional, non-institutional, non-hospital environment of assisted living. It further expounds upon regulatory and corporate information as context for the nurses’ leadership experiences. The desire to hear nurses describe their personal experiences of leadership influenced the decision to use grounded theory as a methodological process. The belief that voice requires context to be most effectively understood influenced, in turn, the addition of a situational analysis approach to the grounded theory methodology. As a result, interviews and scrutiny of contextual elements form the core …

The Criminal Justice Response To Elder Abuse In Nursing Homes: A Routine Activities Perspective, Brian K. Payne, Randy R. Gainey

Sociology & Criminal Justice Faculty Publications

Politicians and researchers have begun to pay more attention to elder abuse in recent times. Most of the research on elder abuse has focused on cases of abuse perpetrated by family members, treating the phenomenon as a social problem, but it is increasingly being conceptualized as a crime problem. The current study examines elder abuse in nursing homes from a criminological perspective. Using routine activities theory as a guide, particular attention is given to the criminal justice system's response to abusive activities committed by nursing home employees. In all, 801 cases of abuse investigated by Medicaid Fraud Control Units are …