Geriatric Nursing Commons^™

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 …

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 …

Letters Against Loneliness: The Effect Of A Pen Pal Program Uniting Older Adults And College Students On Perceived Loneliness, Allyson Miriani, Caroline Crawford

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Surveys within years and particularly the COVID-19 pandemic have revealed increasing rates of loneliness. More research is also emerging linking loneliness with a myriad of negative health outcomes as well as reduced quality of life. There is little research about effective interventions addressing loneliness. This paper reviews the available literature on the topic and proposes a pen pal program for college students and older adults developed based on available evidence.

Advance Care Planning Protocols And Hospitalization, Rehospitalization, And Emergency Department Use In Home Health, Sharon Bigger

Electronic Theses and Dissertations

Aim. The aim of this study was to examine the relationship of advance care planning protocols with hospitalization, rehospitalization, and emergency department use rates in U. S. home health agencies (HHA).

Background. Since 2003, CMS has required HHAs to report on quality outcomes such as hospitalization, rehospitalization, and emergency department use rates, made publicly available online. Advance care planning (ACP) is a conversation about beliefs, goals, values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on ACP have taken place outside of HHAs among populations with serious …

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, …

Preventing Insulin Storage And Administration Errors, Makena Reddick

Scholars Week

■The research problem was discovered when nurses were observed storing and administering insulin improperly. The objectives of this project were to find the correct policies for these procedures, obtain research that backed these policies, and present this information to nurses to create a safer habit. In researching, it was found that reducing the physical distance between a person completing work and the materials required to do so increased compliance (Gibbs & McLernon, 2017). In a second study, the delivery of safe, effective and high-quality care for patients with diabetes in the community is dependent upon (district) nurses having appropriate knowledge …

Differences In Smoking Behaviors And Readiness To Change For Patients With Copd And Differing Categories Of Depression, Jessica M. Floyd

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Depression is a common comorbidity of COPD and affects patient outcomes and smoking cessation. The purpose of this study was to explore and describe factors influencing smoking behaviors and readiness to change in patients with comorbid COPD and depression.

Aims: The research question that guided this study was, “What are the relationships among smoking, COPD, and depression?” The following aims stemmed from the research question: to describe the characteristics of a convenience sample of people living with COPD and differing categories of depression who …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Prospectus For Mitigating Loneliness During Quarantine For Older Adults In Long Term Care Facilities, Emily Gines

Master's Projects and Capstones

In 2020 as the COVID-19 pandemic resulted in quarantine safety measures and facility closures, facilities that cared for older adults in particular were hit the hardest. Long term care facilities (LTCFs), specifically those that care for older adults with memory care problems, must find ways to provide high-quality, standard care, despite many regulations and changes. Although infection control is an important aspect of care among this population, we must also consider how we can maintain quality of life and social connection. Loneliness is defined as the subjective feeling of being alone or perceived isolation. It can also relate to the …

Utilization Of Asthma Guidelines In Primary Care, Kate R. Miller

Dissertations

Background: Chronic lower respiratory disease, including asthma, is the fourth leading cause of death in the U.S. Financially, asthma accounts for approximately 54 billion dollars in healthcare spending annually. The National Heart Lung and Blood Institute [NHLBI] established guidelines to reduce impairment and to reduce future asthma attacks.

Purpose: This Quality Improvement (QI) pilot implemented the Asthma Control Test (ACT) and the Asthma Action Plan (AAP) per NHLBI guidelines. This project aimed to increase provider use of the ACT and AAP to 50% in patients with a diagnosis of asthma over one month.

Methods: A convenience sample of six adult …

Brown Bag Review For Identification Of Discrepancies In Patient Medication Use, Chandra James, Shawna Mason, Shellye Vardaman, Amy Yoder Spurlock

Journal of Interprofessional Practice and Collaboration

Patients suffer unintentional harm from their medications. Many organizations have proposed that healthcare providers implement strategies to decrease medication related harm for patients. This study implemented a brown bag review along with medication safety education within a clinic that caters to the poor and uninsured. It was notable that the majority of the participants educational levels were equivalent to a high school graduate or beyond. In the pre-intervention survey, they expressed that they were knowledgeable about the purpose of their medicines, they knew the correct way to use their medications, and they were aware of potential side effects. During their …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

The Use Of Tailored Interventions To Prevent Falls: A Quality Improvement Project In The Telemetry Unit, Roda Galang

Student Scholarly Projects

Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion.

Practice problem: The objectives of the fall initiative …

Dnr No Polst Project, Reanda Scherson

Master's Projects and Capstones

Problem: The DNR No POLST project aims to increase the number of physician orders for life-sustaining treatment (POLST) forms completed on hospitalized patients who are designated DNR status. Currently, there is no process for ensuring completion of advanced care planning (ACP) materials, including the POLST form, on designated DNR patients throughout the hospital. Ensuring patients receive a complete and accurate POLST prior to discharge decreases the chance of unwanted overtreatment.

Context: This quality improvement project utilizes regionally trained life care plan (LCP) facilitators to initiate and assist patients and families in the completion of the POLST form. Approximately 70% of …

Insulin Injection Re-Education For Improved Glycemic Control, Daniela Shon

Doctor of Nursing Practice Final Manuscripts

Title: Insulin Injection Re-education for Improved Glycemic Control

Background: Patients on insulin therapy often continue to show suboptimal glycemic control. Data from adult patients with T2DM have demonstrated that 56.1% had poor control, despite adherence to treatment, oral and injectable. Poor glycemic control stems from many sources, including poor self-efficacy regarding insulin dosage adjustment, inaccurate insulin dosing, expired insulin, lipohypertrophy of the injection site and technique, and equipment issues.

Purpose: This project aimed to implement and assess the efficacy of re-education in the insulin injection technique for improved glycemic control.

Methods: This project was conducted based on …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Implementation Of Post Falls Huddles In Skilled Nursing Facility, Princess Lomax

Evidence-Based Practice Project Reports

The purpose of this paper is to discuss the quality improvement project, implementation of the post fall huddle in a long-term care facility. Falls are the most common problem in adults 65 years and older. Falls in this population can have devastating effects, often leading to significant changes in morbidity or death. Adults in long term care settings have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion (CDC, 2015). At the skilled facility, there has been a significant increase in hospitalizations due to injuries sustained from falls. To address this …

Continuous Glucose Monitors To Decrease Hypoglycemia, Sara B. Woodcock

MSN Capstone Projects

Diabetes is a disease that affects millions of people from children to older adults. There is no cure, although it can be managed to prevent complications. Education of student nurses is where they are born and raised to become nurses who save and change lives. Teaching student nurses in depth about diabetes as a disease and the treatments that best fit their specific needs is where educating patients begins. Learning about a secondary option for blood glucose checks can make all the difference for several patients. Multiple finger sticks daily has been the leading way to check blood sugar for …

Supporting Older Adults Through Aging In Place And Capable Programs, Laura Compton

OTD Capstone Projects

This experiential component or doctoral capstone project involved a partnership with Habitat for Humanity of Greater Memphis. Through this agency, projects were completed based on identified needs of the Aging in Place and CAPABLE programs. The Aging in Place (AIP) program provides critical home repairs to low-income adults aged 60 years and older. The CAPABLE program provides the same critical home repairs along with a select number of visits from a registered nurse and an occupational therapist to help the older adults age in place safely.

Self-Monitoring Of Blood Pressure In Community – Dwelling Senior Adults, Laura N. Love

Doctoral Projects

Unregulated hypertension is a public health concern. Hypertension is a chronic disease affecting adults across the lifespan. Although hypertension is easy to diagnose and treat, rates of blood pressure control continue to be low (AHA, 2017). Because of this, it is imperative to employ novel strategies for blood pressure control; especially in high risk populations. The purpose of this evidence-based, project was to determine whether self-monitoring of blood pressure (SMBP) improves knowledge about hypertension, while also increasing the frequency of SMBP. Another outcome of interest was a reduction in mean systolic blood pressure for the cohort. The project enrolled participants …

Caregiver Burden From Caring For Dependent Elderly In Yangon, The Republic Of The Union Of Myanmar, May Zun Naing, Sein Yaw May, Min Htike Aung

Makara Journal of Health Research

Background: Elderly population and well-being of those are emerging as major challenges for families and communities. This study aimed to identify caregiving burden among caregivers who care for dependent elderly.

Methods: A cross sectional descriptive study was conducted in Tharkayta Township, Yangon, Myanmar. Total 200 caregivers were selected applying multi-stage sampling method and structured questionnaires were used to collect data. Dependent score of elderly was assessed by using Barthel Index of activities of daily living (ADL) and assessment of caregiver burden through Zarit Burden Interview.

Results: The results showed that over one fifth of caregivers 21.5% had …

A Nurse Practitioner-Led Group Advance Care Planning Program In An Independent And Assisted Living Community, Alexander Bustos

DNP Qualifying Manuscripts

It has been well documented that the majority of people want to spend their last days in the comfort of their own homes, free of pain, and off any dependent machine. , However, the majority of people have not documented these wishes or talked with their family or provider about end of life care (Hamel, Wu, & Brodie, 2017). The Patient Self Determination Act (PSDA), which took effect on December 1, 1991, was enacted to raise awareness and promote discussions between patients and providers about end of life (EOL) healthcare decisions. The primary care nurse practitioner is in a prime …

Chronic Constipation Among Community-Dwelling Older People In The East Coast Region Of Peninsular Malaysia, Patimah Abdul Wahab, Azidah Abdul Kadir, Yeong Yeh Lee, Siti Hawa Ali, Dariah Mohd Yusoff

Makara Journal of Health Research

Background: This study aimed to investigate the prevalence, symptoms, and factors associated with chronic constipation among community-dwelling older people in the East Coast region of Peninsular Malaysia. Methods: A cross-sectional study was conducted in four selected health clinics using stratified cluster sampling. A face-to-face interview was carried out among the elderly outpatients, in order to complete a structured questionnaire. Results: A total of 400 participants were included in the study. The mean age was 68.7 ± 6.4 years, and 55% of the cohort were women. The prevalence of chronic constipation was 32.3% among the sample population. The …

Interventions In Hospice Caregivers’ Coping Mechanisms, Ollie Urbanski

Grace Peterson Nursing Research Colloquium

Abstract

Background: There is an increasing awareness, and need for, hospice services in the United States. While some may choose to receive their care in an inpatient setting, many prefer the comforts of home. When they receive their care at home, their loved ones end up shouldering many of the burdens of that care. There is a noticeable lack in support for this specific population of caregivers.

Objectives: The purpose of this integrative literature review is to investigate current best practices in regards to coping mechanisms for informal hospice caregivers and to analyze potential areas for development of research in …

Reducing The Number Of Falls In On Lok Participants By Enhancing Homecare Services, En Zhu

Nursing and Health Professions Faculty Research and Publications

Falls in elderly are one of the major health concerns in the US. They comprise up to 80% of the key risk factors for injuries in the elderly in the US (Spears, Roth, Miake-Lye, Saliba, Shekelle, & Ganz, 2013). The project aims at reduction of falls among the elderly participants in On Lok program. Based on the findings of the literature review and observations conducted, the proposed intervention to address the practice gap will involve emphasizing the need for carrying the mobility devices, such as canes or walkers, along with clearing the participants’ home environment from hazards. The anticipated measure …

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

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 …

Healthy Aging In The Community Initiative, Didem Kadriye Unver

Master's Projects and Capstones

In 2016 the Sequoia Health Care partnering with Peninsula Family Services developed a non-profit and free program called 70 Strong. It is a personal resource guide for the 60 and above client base for activities and services from Redwood City to Foster City to encourage independence amongst the older population. It includes a wide array of categories, such as fitness and social activities, volunteer opportunities, transportation, enrichment, and support groups. This is not an acute healthcare provider; however, it is a primary prevention effort by Sequoia Healthcare District to increase wellness among the older population in the county. The purpose …