Geriatric Nursing Commons^™

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Improving The Staff Responsiveness By Bundling Care, Practicing Proactive Authentic Hourly Visits, And Using The Four P’S, Robert Vega

Master's Projects and Capstones

Abstract

Problem

Staff responsiveness is an important Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Rating composite tool that hospitals monitor because it is consumer-driven information. The intent is that the HCAHPS composite promotes patient satisfaction, contributes to the prevention of harm, and can save millions of dollars (Danaf et al., 2017). On admission, the patient is orientated to their room, provided a nurse call light button to use, and told not to get out of bed alone and to wait for their nurse (Mitchell et al., 2014). On Three North, a gap exists in the delay it …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

A Quality Improvement Initiative To Implement The Geriatric Depression Scale In A Geriatric Inpatient Psychiatric Unit, Candice Hall

Doctor of Nursing Practice

The World Health Organization (2017) estimated that over 300 million people worldwide have depression. According to the Centers for Disease Control and Prevention (2013), 7 million Americans over 65 years old experience depression annually. The United States Preventive Health Services Task Force recommends the use of a depression screening tool in the adult population. The purpose of this evidence-based quality improvement project was to improve screening for depression in an inpatient geriatric psychiatric unit. The primary objectives included educating nursing staff on depression screening and using the geriatric depression scale (GDS) to assess patient's level of depression at admission and …

Recognizing Delirium At End Of Life In The Hospice Setting: A Process Improvement Project, Latonya Roberts

Doctor of Nursing Practice

Despite advancements in health care, hospice registered nurses and medical professionals caring for patients at end of life lack the required knowledge effectively to care for this patient population. Educational gaps contribute to deficiencies. This process improvement project aimed to increase nurses’ and medical staff’s knowledge and recognition of delirium at end of life through the use of a delirium assessment tool and evidenced-based treatment guideline when managing symptoms. Project implementation occurred at a small hospice company with a patient census of 180, utilizing 2 teams of registered nurses, medical doctors, and a nurse practitioner. A 2-hour educational session had …

The Relationship Between Fall Rates And Fall Risk Inducing Drugs In Older Adult Patients In The Hospital Setting, Kristen Eldridge, Susan Kane Patton

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The aim of this study was to analyze the risk of falls relative to the use of fall risk inducing drugs (FRIDs) among older adult patients admitted to the hospital setting. Quality improvement of nursing fall risk assessment was of special interest. To analyze this a retroactive review of fall incident reports was conducted in collaboration with the study hospital’s risk manager. Medications were correlated with injuries sustained to identify high risk FRIDs. The selected study population consisted of 166 patients over the age of 65 who fell on the acute care campus of a hospital in the mid-south region …

Using Motivational Interviewing To Increase Walking And Functional Ability In Older Adults: A Quasi-Experimental Study, Erin Lamoureux

Doctoral Dissertations

The purpose of this study was to determine if brief motivational interviewing (MI) sessions would increase daily steps and functional ability in older adults. Regular exercise in the older adult can slow the physical, psychological, and functional decline that is often associated with aging. However, only 25% of adults aged 65 and older meet the suggested physical activity recommendations of the American Heart Association and the National Institute of Health. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might identify interventions that would successfully increase physical activity. This study focused specifically on …

Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger

Master's Projects and Capstones

Abstract

The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Prospectus For Improving Measure Ii Scores Of Hospice Visits When Death Is Imminent In The Hospice Item Set, David Ainsworth

Master's Projects and Capstones

Abstract

Problem: Center for Medicare Services (CMS) created a new quality measure pair to collect data on hospice visit patterns by a registered nurse in the last three days of life (Measure I), and at least two visits by a social worker, home health aide, licensed vocational nurse or spiritual counselor in the last seven days of life (Measure II). A hospital-based hospice organization created a quality improvement project to address this problem and improve both parts of the measure pair, but special emphasis was placed on improving Measure II, as initial data revealed the …

Introduction Of Communication Strategies To Decrease Patient Falls In An Acute Rehabilitation Setting, Alicia Joachim

Master's Projects and Capstones

Background: Due to the lack of appropriate fall prevention measures in an acute rehabilitation unit, there has been a notable increase of patient fall occurrences within a 6 month period. The purpose of this practice improvement project was to reduce patient falls within a 36-bed unit, using visual aids and effective communication among nursing staff. The multi-disciplinary members involved licensed nurses, nursing assistants, nursing supervisors, director of nursing, and executive administrator. Methods: The method used to implement this project included a literature search, informational interviews and staff surveys, and prioritization of interventions by the team. Project implementation was guided by …

Early Detection Of Mild Cognitive Impairment In Older Adults Through The Use Of Annual Screening In The Primary Care Setting, Jordan Fulcher, Donald Tisdale, Charles Knapp, Jessica Mann, Kayla Mcmorise

MSN Research Projects

The purpose of this study was to determine primary care providers’ adherence to USPSTF (2015), and the Alzheimer’s Association’s (2013) recommendations and guidelines advocating annual cognitive impairment screening on patients ages 65 years and older. The Alzheimer’s Association issued an algorithm for detecting cognitive impairment in older adults; this cognitive assessment algorithm was accepted and mandated by U.S. Centers for Medicare and Medicaid Services during annual wellness visits of patients 65 years and older. In addition to the Alzheimer’s Association, USPSTF acknowledges the increasing prevalence of cognitive impairment and the benefits of early detection. However, USPSTF argues a lack o …

The Effect Of Social Networks On Self-Care Behaviors And Health Outcomes Among Older People Living With Multiple Chronic Conditions, Raeann G. Leblanc

Doctoral Dissertations

Background: Older adults are the fastest growing segment of the population in the United States. By 2030, 72.1 million Americans will be over sixty-five years of age and many live with and manage multiple chronic conditions. Self-care behaviors are a priority to effectively manage chronic conditions, yet a gap exists in our understanding of how social networks influence the outcomes of self-care behavior and health within the context of aging and managing multiple chronic conditions. Objective: The aim of this study was to determine how social network features and functions influence self-care behaviors and health among community dwelling older adults …

Measurements That Matter: Assessment & Management Of The Symptoms Of Chronic Illness Using The Integrated Palliative Outcome Scale (Ipos), Deborah Jeffery

Dissertations

ABSTRACT

Measurements that Matter: Assessment and Management of the Symptoms of Chronic Illness Using the Integrated Palliative Outcome Scale (IPOS)

Background: The mission of the Advanced Illness Management (AIM) program at the Visiting Nurse Association of Greater St. Louis (VNA) is to relieve the burden of serious illness by providing exceptional care to patients and families through symptom management. A validated symptom tool was needed for holistic assessment.

Purpose: This is a quality-improvement project aimed at enhancing symptom management in patients experiencing advanced illness in a community-based palliative care program. Provider use of the Integrated Palliative Outcome Scale (IPOS) as …

Hospital Acquired Pressure Injury Prevention On An Inpatient Unit, Cherilyn Schumacher

Master's Projects and Capstones

Abstract

The aim of the project is to improve the process and delivery of care with established and accepted standards by implementing evidence-based change. The plan is to create a HAPI prevention plan with the main expected outcome to reduce the HAPI occurrences on the unit to zero by July 30, 2018. This will be accomplished by increasing awareness among nursing staff members through education and diligent monitoring of prevention practices and treatments.

The education portion of the plan will include reviewing basic pressure injury education and HAPI prevention and management in the form of visual aids provided by the …

Improving Hand-Off Communication Between The Skilled Nursing Facility And The Emergency Department, Dubravka Labovic

Master's Projects and Capstones

Abstract

The purpose of this project is to improve hand-off procedure between Skilled Nursing Facility (SNF) and Emergency Department (ED). Patient population consists of all retired veterans who currently reside in California Department of Veterans Affairs, Veterans Home of California (CalVet) – the state long-term care facility for elderly. The problem occurs when continuation of care is compromised due to poor exchange of information at the time of transfer to ED. Nurses in SNF need a step-by-step procedure that will improve the process of transfer and the intention of this project is to create a process that will become daily …

Reduing Hospital Readmissions: Ideal Discharge Planning For Heart Failure Management, Chun Mei Chen, Chun Mei Chen

Master's Projects and Capstones

Abstract

The objectives during this project were to achieve by the end of 2018 an overall reduction of 25% in HF readmissions within 30 days. By identifying root causes of readmissions and using needs assessment within the microsystem, literature highlights the elements defining interventions that can be used to improve transitions of care and reduce avoidable HF hospital readmissions. A plan was developed for integrating an evidence-based practice, IDEAL Discharge Planning, along with engaging patients and families at bedside from the first day of admission until discharge to more effectively assist staff in providing patient-centered education and self-care skills. The …

Interlace: Designing An Inclusionary Architecture For Alzheimer's Sufferers, Alexander Fashinasi

Bachelor of Architecture Theses - 5th Year

This thesis intends to address the increasing challenges the Alzheimer’s disease poses for our growing American population. The research begins by looking at the brain as a combination of components which make up the individual. Following this, the research compiles information on the Alzheimer’s disease and its symptoms, followed by an analysis of the built environments effects on the condition.

Through analysis of precedent cases and the combined Alzheimer’s research, I chose to propose an experimental community in which those with Alzheimer’s can live a life with greater autonomy while simultaneously slowing the progression of the disease. I place this …

Identification Of Potentially Inappropriate Medication Utilizing The Beers Criteria Among Elderly Patients, Christine B. Mitchell

Doctor of Nursing Practice

Background: The normal process of aging causes numerous physiological changes that affect pharmacodynamics and pharmacokinetics. Therefore, the geriatric population is more vulnerable to the effects of potentially inappropriate medication. The American Geriatric Society’s Beers Criteria identifies potentially inappropriate medication to be avoided for this population and can be implemented in efforts to avoid risks associated for this population.

Aim and Methods: The purpose of this project was to implement the Beers Criteria to identify potentially inappropriate medications among patients 65 years and older. The objectives were to increase the percentage of charts reviewed for inappropriate medications and to increase the …

Evaluating The Effectiveness Of A Formal Dementia Care Training Program: Abilities Care Experts™, Carmen Joaquin, Michelle D'Amato, April Perez, Louiza Alexandria Villarina, Sophie E. Miller

Dissertations, Masters Theses, Capstones, and Culminating Projects

Overview: Abilities Care Experts™ (ACE™) is an educational training program for nursing staff who care for individuals with dementia in skilled nursing facilities (SNF). The objective of the program is to provide the nursing staff with knowledge, and methods to engage residents’ remaining abilities in order to maximize occupational participation using a stage-specific dementia care approach. ACE™ training has yet to be evaluated for effectiveness in a controlled study design.

Objectives: This study sought to evaluate the effectiveness of the ACE™ training.

Design: The study employed a quantitative, cross-sectional, quasi-experimental design.

Participants: A total of 29 CNAs, 13 ACE™ trained …

The Relationship Between Community Dwelling Older Adult’S Fall Risk And Beliefs Of Risk For Falling In Northwest Arkansas And Bolgatanga, Ghana., Natalie Gohman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Title: The Relationship Between Community Dwelling Older Adult’s Fall Risk and Beliefs of Risk for Falling in Northwest Arkansas and Bolgatanga, Ghana.

Gohman, N., Patton, S., Smith-Blair, N., Agana, C.: University of Arkansas, Fayetteville, AR

Background: Older adults worldwide live with comorbidities, physical and psychological changes associated with aging. Statistically, however, older adults are more likely to die as a result of falling. As the worldwide population of individuals over 65 rises, so will the possibility for injuries from falls. Much research has been published concerning fall risk prevention, but minimal research surrounding protocols and practices for protecting against falls …

Advanced Disease Management In Home Healthcare: Palliative Integration, Missy Stober

Graduate Theses, Dissertations, and Capstones

Advanced Disease Management in Home Healthcare: Palliative Care Integration

Abstract

With home health caring for patients with serious illnesses and advancing disease states, palliative care in a community setting like the home, can provide many benefits. This population currently has a gap in the healthcare continuum at the point of advancing disease state to end of life care. Recently, new payment models based around clinical outcomes, including hospitalization scores and quality indicators, has caused home health to explore different ways to deliver quality and effective care, especially for those with the highest risk of hospitalization. A literature review was conducted …

Enhancing Elderly Advance Care Planning Experience At A Primary Care Clinic, Oi Shan Wong

Doctoral Projects

The purpose of the project was to examine if the identification of readiness for an advance care planning (ACP) discussion of elderly participants would enhance the outcomes of participants' satisfaction, improve the likelihood of having an ACP discussion and increase the completion rates of an advance directive (AD) document after an office visit.

Forty-four elderly participants, who met the selection criteria, were recruited from a primary clinic in Northern California from October 1, 2017 to December 31, 2017 (Female, n =28). All participants were randomly assigned to either an intervention group (n= 22) or a control group ( …

Direct Care Nursing Aide Turnover In Long-Term Care Facility, Qilian Luo

Muskie School Capstones and Dissertations

This capstone project, Direct Care Nursing Aide Retention in a Long-Term Care Facility, will uses both qualitative and quantitative analyses to identify the possible contributors to high nursing aide turnover rates in Maine. The quantitative analyses of this project are based on the staffing payroll data of one Maine assisted living facility. The final product of this capstone project will be shared with the study facility, in the hope that they may find uses for its content.

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores, …

Improving Palliative Care Management In The Nursing Home Setting: An Interprofessional Approach, Nicholas Adam Fredette

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Current projections indicate that the number of individuals age 65 and older throughout the U.S. will reach nearly 88 million by 2050, nearly double current estimates. With the increase in older adults, an increase in persons with chronic illness requiring nursing home care is also sure to rise. Currently, roughly 1.4 million adults reside in certified nursing facilities throughout the U.S. while nearly 25% of older adults die within this setting. Palliative care, an approach aimed at improving the quality of life of patients facing life-threatening illness is one strategy utilized to help manage this population. As the quality …

Outcomes Of Family Presence During Resuscitation (Fpdr) In The Acute Care Setting: A Review Of The Literature, Audra M. Corn

Honors Undergraduate Theses

Family Presence During Resuscitation (FPDR) remains controversial and is not consistently implemented during resuscitation events or invasive procedures. Evidence has demonstrated positive outcomes produced by implementation of FPDR; such as, decreased rates of post-traumatic stress symptoms, decreased symptoms of anxiety, and depressive symptoms were not significantly different. Unfortunately, use of FPDR in the acute care setting is not widely accepted or readily implemented. The primary purpose of this integrative literature review is to evaluate the use of FPDR in the acute care setting. The secondary purpose is to evaluate the health care professional's level of perceived value associated with the …

An Inpatient Rehabilitation Interprofessional Care Pathway For Traumatic Hip Fracture: A Pilot Quality Improvement Project, Sarah Plante

DNP Scholarly Projects

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around $30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period.

Purpose: The primary aim of …

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …