Geriatric Nursing Commons^™

Depression Screening And Early Intervention On The Post-Stroke Patient, Marco Oliver Dugan Lopez

Doctor of Nursing Practice (DNP) Projects

Statistics in the United States (US) have shown an increase in the prevalence of Cardiovascular Disease (CVD) or risk for developing CVD. Approximately 78 million American adults, 20 years and older, have hypertension, 31.9 million have elevated serum cholesterol levels, and 68.2 million use tobacco products. Within California, San Francisco (SF) was ranked 8th among counties with adult residents that have CVD. It is estimated that approximately 1.02% of these individuals will have a stroke each year and 16.25% will die from stroke. Of those that survive, it is estimated that at least half will develop neurologic deficits, and at …

N653 Fall Prevention Final Project, Sam Clark

Master's Projects and Capstones

N653 Fall Prevention Final Project

by Samuel K. Clark, RN

This project was done with patient safety in mind through the use of the most current EBP available.

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

A Phenomenological Study Of Anticipated Intimacy And Sexual Expression Needs Of Aging Male And Female Baby Boomers., Charles Shawn Oak

Electronic Theses and Dissertations

The purpose of this study was to understand the phenomenon of how heterosexual Baby Boomers define and understand intimacy, sexual expression, along expectations and desires relating to their respective expressions across the lifespan through their individual experiences and reflections. A set of guiding questions were used in a hermeneutic phenomenological qualitative research design. Data was gathered from thirteen subjects (n=13) using the Rappaport Time Line (RTL) that was used to develop individualized semi-structured interviews and follow-up interviews that were professionally transcribed. These were coded to identify emergent themes. Results of the study provided insight into the phenomenon of how heterosexual …

The Lived Experience Of Aging: Listening To The Oldest-Old, Julia A. Pusztai

Loma Linda University Electronic Theses, Dissertations & Projects

Although embraced as desirable by most, living into very old age is largely unexplored as a distinct season of life, with increased, varied, and cumulative changes during a unique time of vulnerability and frailty. The purpose of this study was to listen to the oldest-old, and to explore their lived experience of growing old. This hermeneutic phenomenology study examines the experience of finding meaning and living with losses and gains in advanced old age. This study design included three separate interviews one month apart with participants over 85 years of age. Purposive sampling resulted in 13 participants, 5 being male …

Telephone Calls To Reduce 30-Day Readmissions For Older Adults With Heart Failure, Juanette G. Clark

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidenced based practice project was to evaluate the effectiveness of discharge follow-up calls for heart failure (HF) patients recently discharged from a private hospital.

Background: HF is the number one discharge diagnosis among patients 65 years and older. It affects 5.8 million people in the United States. HF admissions total (1) million annually, however, 24% of these patients are readmitted within 30 days of discharge. Re-hospitalizations are associated with high mortality rates and expenditures approximated at $13,000 per patient contributing to the overall annual expenditure of $33.7 billion. In 2012, the Centers for Medicare …

Instituting Patient-Self Test Meters In Adults On Warfarin In A Cardiology Practice, Melvyn Grace Manzano Rabanal

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the oral anticoagulant that is most commonly used to control and prevent thromboembolic disorders. It requires meticulous testing and dosing adjustments to attain therapeutic international normalized ratio (INR) levels. Patient self-testing (PST) is associated with a reduced risk of all-cause mortality and lower rates of thromboembolism and bleeding. PST meters offers convenience and promotes self-initiative of care.

Purpose: The purpose of the project is to evaluate the effectiveness of INR PST in adult patients diagnosed with atrial fibrillation, deep vein thrombosis, and mechanical heart valve on warfarin therapy in a Cardiology practice compared to traditional …

Improving Dental Care To The Elderly In A Nursing Home, Cara M. Licavoli

Master's Projects and Capstones

The project is about the collaboration between Peninsula Health Care District (PHCD) and Apple Tree Dental (ATD) in a team approach to address the current issues of improving dental care of frail and elderly patients in nursing home facilities. The specific aim is to improve dental care of clients at the San Mateo County nursing home facility by 100% by May, 2015. The methods use in this project was the adaptation and implementation of existing dental/oral health assessment tools, that is nurse driven for patient assessment upon admission to the nursing facility. The process includes staff education regarding the adapted …

Improving Patient Safety: Reducing Medication Errors In The Microsystem, Erica M. Dent

Master's Projects and Capstones

In a 72-bed for-profit long-term acute care hospital located in an urban setting, there has been a fifteen percent increase of medication errors that the pharmacy department has detected across nursing, and pharmacy departments, as well as with physicians from both day and night shifts. Over the last month there has been a total of twenty-eight medication errors including the transcription, administration, evaluation, and documentation processes. The microsystem consists of a telemetry/medical-surgical unit as well as a small intensive care unit consisting of ten beds.

The prospectus details a project implemented to reduce medication errors within the microsystem. The steps …

Factors Contributing To Registered Nurse Job Satisfaction In The Nursing Home, Michael Shipley

Seton Hall University Dissertations and Theses (ETDs)

Over the next several years the aging population will increase the number of patients suffering from chronic illness. A sicker aging population, coupled with changes in healthcare reimbursement will require nursing homes to admit sicker patients for shorter lengths of stays. To meet the needs of the increased number of chronic patients and those patients with higher acuities, nursing homes will require more skilled, registered nurses. Registered nurses (RNs) are the linchpin to providing high-quality care in the healthcare environment and especially in nursing homes.

Understanding the factors of RN job satisfaction in the nursing home is important in increasing …

Gap In Patient Expectations Of Deep Brain Stimulation For The Treatment Of Parkinson's Disease, Colleen D. Knoop Dnp-C

Graduate Theses, Dissertations, and Capstones

Abstract

Purpose: This project studied a specific group of patients with Parkinson’s disease to: determine if they were asked to verbalize expectations of DBS pre-operatively; determine if patient expectations were met post-operatively; gain information that could aid in improved pre-operative patient education for deep brain stimulation (DBS), address unrealistic expectations before surgery, and meet patient expectations post-operatively.

Methodology: This study was a retrospective, single academic center, two-part design that included a questionnaire and chart review of 29 patients. Those included were patients with Parkinson’s disease who had DBS programming at the academic center, between the years 2007 and 2014.

Results: …

Using Education And A Prevention Protocol Tool To Decrease The Incidence Of Pressure Ulcers In A Nursing Home, Kristina L. Scalzitti

Evidence-Based Practice Project Reports

Over 1.3 million persons are residents in nursing homes (NHs); one in ten have pressure ulcers. The purpose of this evidence based practice project was to determine if implementation of a pressure ulcer prevention tool, along with staff education, decreases the incidence of pressure ulcers within the NH. Florence Nightingale’s Environmental Model and the Stetler Model were used to guide this project. The setting was a NH in northwest Indiana. Eleven nurses attended a 15 minute educational session on pressure ulcer prevention and implementation of the Pressure Ulcer Prevention Protocol Intervention (PUPPI) tool. PowerPoint slides were distributed and flyers about …

Advanced Practice Nurses Knowledge And Use Of Fall Prevention Guidelines, Katherine Hays

Doctor of Nursing Practice Scholarly Projects

Falls are a significant public health issue resulting in a significant economic and social burden on society. Specific strategies are available that can reduce the risk of falling for older adults age 65 and older; however, providers have failed to integrate these guidelines into clinical practice (Rubenstein, Solomon & Roth, 2004; Chou, Tinetti, King, Irwin, & Fortinsky, 2006; Jones, Ghosh, Horn, Smith, & Vogt, 2011). The CDC has published the STEADI toolkit, a healthcare resource for integrating fall prevention guidelines into clinical practice; but little information is available on the knowledge and use of the STEADI toolkit by Advance Practice …

Oral Wellness: Using Occupational Therapy To Enhance Oral Hygiene Delivery In Long-Term Care, Lauryn J. Banovitz, Liberty Bellah, Rosemarie Lion

Dissertations, Masters Theses, Capstones, and Culminating Projects

Based on current literature, oral health in long-term care (LTC) facilities is frequently of low priority and does not follow evidence-based best practices. Poor oral health reduces the quality of life of older adult residents and patients and can lead to systemic diseases, such as cardiovascular disease, stroke, and pneumonia, the leading cause of death in LTC. Occupational therapists can play an instrumental role as oral care consultants, and educators, and can act as resource guides to raise the standards of oral care in LTC facilities.

This capstone project explored ways in which occupational therapy, a profession traditionally designated for …

Use Of Dietary And Herbal Supplements In Older Adults With Osteoarthritis, Sharon Denise Mcdonald

Dissertations

Over the past several decades, older adults with Osteoarthritis (OA) have increasingly used more natural products in an effort to manage chronic pain. The theoretical framework for this study was the Lazarus and Folkman transactional theory of stress and coping. This framework was chosen based on the belief that older adults with OA are taking natural products as an active problem solving coping strategy to manage the pain, disability, and alterations they experience in their health related quality life including functional status, physical symptoms, emotional health, and social functioning. Older adults also take prescription medications for Osteoarthritis and a variety …

Clinical Effectiveness Of Inr Patient Self-Testing: Adults On Warfarin Therapy In Private Practice, Anisa Munshi

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the most commonly prescribed oral anticoagulant for the prevention and treatment of venous thromboembolism. Due to its narrow therapeutic index, warfarin requires close monitoring of the international normalized ratio (INR) to ensure proper anticoagulation control and safety. INRs outside of this range are strongly associated with an increased risk of major bleeding, thromboembolic events, and death. Patient self-testing (PST) using a point-of-care device allows patients to monitor INR results at home. Evidence shows that PST improves the clinical outcomes of warfarin therapy compared to usual care, which includes laboratory INR monitoring. Purpose: To compare the clinical effectiveness …

Barriers To Music Therapy In The Care Of Those With Alzheimer's/Dementia, Karin E. Kvam

Honors College Theses

This pilot study examines the barriers caregivers encounter when implementing music therapy in the care of those with Alzheimer’s/dementia. An 8-question survey was distributed at two long-term care facilities and an Alzheimer’s support group to understand how often and in what ways music therapy is utilized, as well as what barriers caregivers face when using the therapy. Results indicated that, although the majority of caregivers report using music therapy, it is not implemented as frequently as it could or should be. Caregivers report a knowledge deficit as the main reason for not implementing music therapy. The data suggests that an …

The Effects Of 12 Weeks Of Instructor-Led Yoga Classes On Balance In Older Adults, Patricia C. Hart

Evidence-Based Practice Project Reports

Participation in a regular exercise program is an effective way to reduce and/or prevent a number of functional declines associated with aging (Chodzko-Zajo et al., 2009). Older adults are advised to participate in regular aerobic activity and practice muscle strengthening activities and exercise that maintains or improves balance (U.S. Department of Health and Human Service, [USDHHS], 2012). Less than one third of older adults engage in 30 minutes of low to moderate intense physical activity at least five days a week as recommended in current guidelines (USDHHS, 2012), and these guidelines fail to address losses in strength and flexibility seen …

The Meaning Of Patient-Nurse Interaction For Older Hospitalized Women: A Phenomenological Study, Deborah Mize

Doctor of Education (EdD)

The purpose of this dissertation is was to explore how older women perceived their interactions with nurses after receiving care in a hospital setting. Older women are a vulnerable population subject to being overlooked or misunderstood by the nurses caring for them, hence the importance of this study. To gather the data on older women’s lived world of nursing care, I used a phenomenological approach based on a hermeneutic framework that considers linguistic, historical, and social factors to interpret older women’s lived world of nursing care while hospitalized. I personally interviewed seven women between the ages of 66 and 81 …

The Relationship Between Hearing Status And Cognitive Performance And The Influence Of Depressive Symptoms In The Older Adult, Julie A. Daugherty

USF Tampa Graduate Theses and Dissertations

Hearing loss and cognitive impairment are significant health problems, threatening the independent function of older adults. While there appears to be a strong relationship between the two conditions, the mechanisms underlying this association are complex and are not fully elucidated.

The purpose of this secondary analysis was to explore the relationship between hearing ability and cognitive performance in older adults. In addition, this study attempted to examine the role of depressive symptoms in the relationship between hearing loss and cognitive performance. Comprehensive measures of peripheral hearing, central auditory processing and cognitive performance were utilized to examine these relationships in a …

The Effect Of Art Therapy On Hospice And Palliative Caregivers, Carol E. Gress

Nursing Theses and Capstone Projects

A quazi-experimental, one-group, pretest/posttest study was conducted with a group of 25 hospice workers employed by a medium sized county hospice organization in the southeastern United States that was experiencing rapid personnel turn-over. Participants in the study included a doctor, a physician’s assistant, a nurse practitioner, a massage therapist, a grief counselor, a licensed practical nurse, a certified nursing assistant, two clergy, three administrative staff, three social workers, seven volunteers, eight registered nurses and one other. The purpose was to investigate whether attending four 1-hour art therapy sessions could help reduce stress and thereby Burnout. Stamm’s (2010) Professional Quality of …

Early Intervention Of Non-Invasive Positive Pressure Ventilation In Elderly Patients With Rib Fractures, Jaclyn Gosnell

Nursing Theses and Capstone Projects

Rib fractures in the elderly population, 65 years and older, is more prevalent than any other population. Mortality increases with each year over the age of 65 and with each number of ribs fractured. Rib fractures are painful and can lead to a decreased respiratory effort. This results in complications such as pneumonia, respiratory depression, respiratory failure, Acute Respiratory Distress Syndrome (ARDS), and respiratory infections. Non-Invasive Positive Pressure Ventilation (NIPPV) assists with reducing the patient efforts to breathe while also ensuring spontaneous lung expansion. NIPPV can assist with promoting positive outcomes in patients with respiratory complications. The purpose of this …

Rural Healthcare Providers' Behavioral Intentions With Hospice Referrals: Attitudes, Knowledge, Beliefs, Benefits And Barriers, Meki Jacobs Graham

Nursing Theses and Capstone Projects

As hospice programs gain recognition, hospice referrals are gaining momentum. Yet for multiple reasons hospice referrals are challenging amongst rural healthcare providers (HCPs). For rural healthcare providers, lack of knowledge about hospice services and care contributes to a decrease in hospice referrals. The purpose of this capstone project was to develop an intervention to improve rural health care providers' behavioral intention to make hospice referral. The study sought to determine if an educational intervention would improve behavioral intentions to make a hospice referral resulting in increased hospice referral rates. Outcome data was based on utilizing a pretest/posttest survey design. An …

Polypharmacy Practice Inquiry Project, Mary T. Skinner

DNP Projects

“The impending crisis, which has been foreseen for decades, is now upon us.The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.” Institute of Medicine.

Given the rising tide of people over the age of 65, taking multiple medications or polypharmacy is a becoming more prevalent in older adults. Unfortunately, there are many negative consequences associated with polypharmacy. Specifically, this burden has been associated with greater health care costs and an increased risk of adverse drug events, drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes including cognitive impairment. …

Delirium Screening Instrument Knowledge And Perception Among Cardiovascular Intensive Care Nurses, Brittany Lynn Dahl

DNP Projects

Background: Delirium is a serious condition that affects critically ill adult patients in the intensive care unit. Bedside nursing delirium measurements are considered a dependable source of information that can be used for clinical decision-making. Nurse education and assessment of perceptions is important when building a framework for successful delirium assessment. However, few data exist about nursing perceptions and practices associated with delirium screening instruments. The overall purpose of this project is to examine nurse perceptions and knowledge about delirium and delirium screening instruments at the University of Kentucky (UK) Hospital’s Cardiovascular Intensive Care Unit (CVICU).

Objectives: The aims of …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Perception And Use Of Communication Care Plans By Certified Nursing Assistants In Nursing Homes: The Role Of Professional Support, Christen G. Page

Theses and Dissertations--Rehabilitation Sciences

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs.

The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care …