Geriatric Nursing Commons^™

Addressing Stroke Care Disparities Through Patient Education, Christina Annerino

Honors Capstones

It has been found across current studies and evaluations of stroke care and patient outcomes that there is a disparity in disability and mortality between male and female patients who have experienced stroke. The aforementioned studies did not identify the cause of this disparity, although a number of hypotheses for this phenomenon were provided. This study then conducted a preliminary survey of 130 participants, both men and women, aged 18-80 years old, to evaluate potential barriers to accessing stroke care and receiving treatment effectively. Preliminary survey data demonstrated consistent gaps in knowledge related to stroke risks, stroke symptoms, and when …

Maggot Debridement Therapy Vs. Negative Pressure Wound Therapy And Their Effectiveness On Tissue Healing On Older Adults, Angelica L. Funes

Soaring: A Journal of Undergraduate Research

Chronic ulcers, particularly prevalent in older adults, significantly impact patients' quality of life, leading to prolonged hospital stays and increased healthcare costs. This study explores the efficacy of two common therapies, Negative Pressure Wound Therapy (NPWT) and Maggot Debridement Therapy (MDT), in promoting tissue healing for chronic ulcers in adults aged 60 and older. A methodical search was conducted using databases such as CINAHL, PubMed, EBSCO, and ProQuest, employing specific search strategies and inclusion/exclusion criteria. Four high-quality Level 1 randomized controlled trials were selected for analysis, comparing NPWT and MDT in various settings. The results indicate that MDT exhibits superior …

Individualizing Patient Education To Reduce Heart Failure Readmissions, Melissa M. Andersen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) is a chronic condition with high readmission rates, often due to inadequate patient knowledge about home care and symptom management. Individualized patient education combined with standardized approaches could improve patient outcomes.

Objective: This project’s goal was to determine if using individual patient knowledge to create a personalized education along with standard HF education would improve patient HF knowledge, improve home management and decrease HF readmission rates.

Methods: This pilot quality improvement (QI) project was conducted in an acute care hospital using a convenience sample of 29 patients admitted due to a HF exacerbation using pre-posttest design. …

Improvement Of Hypertension Self-Care Management In African American Older Adults With Uncontrolled Hypertension Through Shared Decision-Making, Sigga Jobe

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hypertension affects nearly half of the population in the U.S., with the prevalence disproportionately higher in African Americans (Centers for Disease Control and Prevention [CDC], 2023). Complications of uncontrolled hypertension, such as cardiovascular disorders and stroke, increase with age, prompting the importance of controlling high blood pressure in older adults. African American older adults are at higher risk of developing uncontrolled hypertension and related complications due to the lack of healthcare access, financial constraints leading to the inability to access healthier food choices, exercise capabilities, weight control, adherence to recommended medications, and knowledge deficit.

Methods: This project focused on …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

The Effect Of An Educational Intervention On Early Mobility Compliance In Oncology Nurses, Jonathan A. Hacker

DNP Projects

Background: Geriatric adult patients admitted into acute care hospital settings are at risk of functional decline in their capacity for activities of daily living and independent ambulation. Many of these patients fail to achieve pre-hospitalization levels of function and continue to decline, requiring additional support and care after discharge. Current literature supports early mobilization and ambulation during hospitalization. However, ambulation and patient mobilization has been shown to be the most missed item of nursing care. There is a gap in literature and patient outcome data regarding the impact of early mobilization on medical-surgical patient populations.

Purpose: The purpose of this …

Implementing A Nurse-Driven Clostridium Difficile Screening Protocol, Sandrela Magnuson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: Clostridium difficile infection (CDI) is a prevalent infection often contracted in hospitals. CDI is also increasingly originating from community settings. In addition to the health risks associated with CDI, diagnosis of a hospital-acquired CDI can have a significant financial impact on hospital systems. When hospital acquired, hospital systems are no longer reimbursed by payers. Secondary to the increasing prevalence of community-acquired CDI, mechanisms for early detection and isolation are warranted.

Local Problem: J.W. Ruby Memorial Hospital has an integrated Clostridium difficile (C. difficile) electronic health record (EHR) screening questionnaire that requires updating to align with current guidelines.

Purpose: …

Developing, Implementing, And Evaluating A Clinical Dashboard To Improve The Efficiency And Ease Of Tracking Institute For Healthcare Improvement Ihi Age-Friendly 4ms Framework Data., Margaret Parniawski Nsn, Ne-Bc, Kenneth Forte, Denis Mohess Md, Ray Wauthier Bsn, Erica Zerl Ssa, Edward Ostrowski Msn

Posters

The purpose of this study was to describe a user-centered development, implementation and preliminary evaluation of clinical dashboards to track Age-Friendly 4M Framework Data.

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

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 …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

Estimulación Cognitiva Y De La Actividad Fisica En La Persona Mayor - Una Experiencia Desde La Práctica, Maria Victoria Rojas Martinez, Adriana Hernandez Bustos, Blanca Gregoria Melo Melo

Ciencias de la Salud

El trabajar con la persona mayor que presenta limitación física o mental, lleva a la aparición de grandes retos para el estudiante y futuro profesional de enfermería, más aún cuando el campo de acción es el hogar, porque el cuidado será compartido entre la persona, el cuidador o grupo familiar, dentro de su propio espacio, por lo tanto, se convierte en una intervención individual con el uso de recursos propios y generalmente con la participación directa del cuidador o acompañante. Para el cuidado en el hogar el autocuidado es base fundamental para el cumplimiento de metas en la salud de …

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 …

Early Integration Of Palliative Care With Curative Oncology Treatment For Patients With Advanced Cancer: Implications For Clinical Nursing Practice, Rhea Rughani

Honors Projects

Palliative care, though clinically established to improve health-related quality of life measures for patients with advanced illness, remains underutilized and largely limited to end of life care. This project aims to inform oncology nursing practice through the analysis of literature supporting the early integration of palliative care with standard curative oncology treatment for patients with clinically advanced cancer. Informed by relevant research, clinical practice guidelines, and improved specialty palliative care training, oncology nurses and nurse practitioners are ideally situated to advocate for and initiate early palliative care integration, to holistically improve the standard approach to complex cancer care.

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.

A Physical Therapy Mobility Checkup For Older Adults: Feasibility And Participant Preferences From A Discrete Choice Experiment, Dalerie Lieberz, Hannah Borgeson, Steven Dobson, Lindsey Ewings, Karen Johnson, Kori Klaysmat, Abby Schultz, Rachel Tasson, Alexandra L. Borstad

Journal of Patient-Centered Research and Reviews

Purpose: Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. A preventive model of care called Mobility Checkup is being designed to reduce mobility disability in older adults. This study had two purposes: 1) determine feasibility and outcomes of the Mobility Checkup, and 2) identify preferences of older adults regarding this model of care using a discrete choice experiment.

Methods: Adults over 55 years of age were recruited from the community. In the study’s first phase, participants completed a Mobility Checkup, with feasibility evaluated using 6 criteria. In the …

Increasing Rates Of Urine Albumin Creatinine Ratio Ordering By Providers In Diabetics In Adult Primary Care: A Quality Improvement Initiative, James Ehrlich

DNP Scholarly Projects

Background: The rising incidence of diabetes within the United States and worldwide has led to increased diabetes related morbidity and mortality. As the leading cause of end stage renal disease (ESRD), more attention needs to be placed on increasing rates of diabetic nephropathy screening. The vast majority of diabetics are treated in primary care, positioning primary care as a center focus for diabetes related screening and treatment.

Local problem: Low rates of diabetic nephropathy screening were noted at an academic medical center affiliated primary care clinic. A quality improvement initiative was elicited to increase the number of urine microalbumin creatine …

Partnering With Hospital Providers To Facilitate Handoff For Persons With Dementia In The Acute Care Setting, Vanessa Jeune

Student Scholarly Projects

Practice Problem: Individuals with Alzheimer's disease and related dementias cannot verbalize their care needs during transitions of care (TOC) and rely on their home caregivers (HCs) for advocacy. The lack of communication between clinicians in one setting and HCs can lead to detrimental health outcomes for the length of stay.

PICOT: The PICOT question that guided this project was: With the assistance of family nurse consultants (P), how does the implementation of standardized care needs communication tool for support persons of persons with dementia (I) vs. no standardized process (C) enhance the ability for the support person to …

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

Journal of Geriatric Emergency Medicine

No abstract provided.

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 …

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 …

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 …

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, …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

A Descriptive Study Of Health-Related Risks And Outcome Differences By Loneliness Status In A Sample Of Older Veterans, Rachael Beard

Dissertations

There is a need to understand the influences and outcomes related to loneliness in veterans living with complex illness. Patients require self-care to manage complications and exacerbations associated with complex illness. Deficits in self-care result in negative health outcomes and drive resource utilization upward. The identification of potential factors related to self-care is important. Loneliness may be one factor that influences patients’ ability and desire to care for themselves. Descriptive correlational design was used to evaluate loneliness both as a predictor and outcome in veterans admitted to the hospital for three complex respiratory illnesses (heart failure, chronic obstructive pulmonary disease, …

Incorporating Reminiscence Therapy Into Traditional Ot Practice For Adults With Adrd Residing In A Snf/Ltc, Natasha Menard, Becki Cohill, Susan Macdermott, Karen Park

Spring 2021 Virtual OTD Capstone Symposium

As the population diagnosed with Alzheimer’s disease and related dementias (ADRD) raises from 5.3 to 12.7 million over the next three decades, this calls for a demand for treatments to address this population (Alzheimer’s Association, 2021; Atchinson & Dirette, 2017). While traditional practice often focuses on symptom management, the inclusion of functional activities alone does not fully address the negative side effects of ADRD (Kok et al., 2013; Lepore et al., 2017; Mayo Clinic, 2019). Both occupational therapy (OT) and reminiscence therapy have been shown to be effective methods to treat the ADRD population separately, but there is limited evidence …

Improving Caregivers’ Perceived Involvement In Care Through Facilitating Communication With Hospital Providers, Heather Manolas

Student Scholarly Projects

Practice Problem: Involvement of family in care-planning for prevention of delirium in acute care settings is crucial, yet remains underutilized in those who are cognitively impaired. Despite the incidence of delirium in acute care worsening during COVID-19, many factors have led to it being placed on the back burner.

PICOT: In caregivers of cognitively impaired individuals, can implementation of an evidence-based, best practice tool that advocates for evidence-based delirium prevention strategies tailored to their loved-one and facilitates family involvement in care planning for these strategies during a healthcare experience as compared to no other intervention improve confidence in, and …