Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Quantifying Differences In Pill Swallow Patterns In Adults, Catherine A. Sullivan, Luis F. Riquelme

Annual SHSP Student Research and Scholarship Day

Difficulty swallowing pills has become an increasing complaint among patients visiting swallow evaluation centers across the globe. Deficits are reported in healthy individuals as well as in clinical populations. In the USA, 40% of 679 persons responding to a survey reported difficulty swallowing pills (Business Wire, 2009). In an effort to facilitate pill intake, several modifications have been reported: use of liquid formulations, crushing tablet, opening capsule, whole pill mixed with food or via feeding tube (Cornish, 2005). A survey of 40 nurses revealed the most common modification was to use apple sauce (Riquelme et al., 2009). Current literature on …

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 …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Optimizing Dry Skin Management Utilizing Np Led Phone Follow-Up, Christine Vazquez Bsn, Rn, Dnp - Fnp/Agnp Student

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led standardized dry skin protocol for outpatient geriatric patients to promote overall well-being and improve quality of life.

Background: Current literature supports using the dry skin protocol to help primary care teams identify patients that require xerosis cutis skin care, particularly of the lower extremities. The primary focus of this project will be timely detection of patients with the dry skin condition that will be identified with the standardized Overall Dry Skin (ODS) scale. When the patient meets the ODS criteria, a timely discussion will be …

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 …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Increasing Access To Medicare Annual Wellness Visits In Primary Care; Utilizing Registered Nurses As Part Of An Interdisciplinary Team Based Approach, Iyo Kubota

Doctor of Nursing Practice (DNP) Projects

Background: In order to provide evidence-based preventive care to the aging population, Medicare began providing free annual wellness visits (AWVs) to its beneficiaries in 2011. The AWVs are a great opportunity for primary care providers to develop personalized preventive care as well as health promotion. However, many primary care practices especially those with limited resources struggle to incorporate AWVs into their busy primary care practice. Centers for Medicare and Medicaid Services allows other providers than physicians, NPs and PAs to perform those visits including registered nurses, health educators, and registered dietitians.

Methods: A pilot project was conducted with 12 patients …

Dnp Final Report: Pressure Injury Prevention Patient Initiative (Pippi), Melissa A. De Los Santos

DNP Final Reports

Background: Pressure injuries have been known to affect approximately 2.5 million patients each year, with roughly 60,000 patients dying as a direct result of a pressure injury. Associate healthcare costs are between $9.1-$11.6 billion per year in the United States. The cost of individual patient care was estimated between $20,900 and $151,700 per pressure injury. During the last three years, pressure injury prevalence has risen within the local long-term care organization. Pressure injury prevention interventions have been developed to improve healthcare outcomes, cut costs, and increase revenue for long-term care organizations.

Purpose: Deliver evidence-based educational intervention that incorporates strategies for …

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 …

Oral Care And Ventilator Associated Pneumonia Prevention, Rachel Baber

MSN Capstone Projects

With rising healthcare costs and increasing demands placed on healthcare workers, it is no wonder that decreasing hospital length of stay for patients is high priority for hospitals today. Hospital acquired infections are one of the culprits keeping so many patients hospitalized. Specifically, in intensive care units (ICU) and intermediate care (IMC) units that care for mechanically ventilated patients, ventilator associated pneumonia secondary to intubation is a complication and cost that is being sought to be avoided. Hospitals have been pro-active to prevent ventilator associated pneumonia from occurring by placing oral care bundles or protocols in place to care for …

A Compilation Of Written Instructional Practice Reflections On The Acue (Association Of College And University Educators) Course In Effective Teaching Practices, Sheryll Go

Q2S Enhancing Pedagogy

This is a compilation of written instructional practice reflections on The ACUE (Association of College and University Educators) Course in Effective Teaching Practices, from January – April 2020. This online course has prepared Nurse Educators like me in gaining a foundation in evidence-based teaching practices that increase student motivation, engagement, and learning. The attached assignment include reflections from completed modules.

Hospital To Home: Fall Prevention Interventions For The Discharging Patient, Joy Bridewell

Nursing Masters Papers

Falls is a major public health problem globally, with an estimated 646,000 fatal falls per year. This makes falls the second leading cause of unintentional injury death. Falls are very costly with non-fatal fall injuries costing about $50 billion per year and fatal falls with an estimated $754 million. Many risk factors contribute to a person’s risk of falling. Risk factors include age, gender, muscle strength, underlying medical or disabling conditions, and unsafe environments. Patients who have been hospitalized are also among those at risk. Most hospitalized patients are assessed frequently to determine their risk of falling so that care …

Barriers To Patient-Centered Care For Dementia Clients In The Long-Term Living Setting, Shaina Gaba

Nursing | Senior Theses

When caring for people with severe dementia, the concept of the person being central is increasingly advocated in clinical practice. Person-centered care acknowledges autonomy in all facets of care. Recent studies examine behavioral changes in individuals with dementia and how health care teams address these alterations. Health care providers are vital for effective holistic management. Therefore, this review focuses on the current knowledge regarding care goals, practices, and perceptions of the client battling with cognitive decline. A literature review ascertains that clients with dementia respond to interventions and have decreased negative health outcomes, when providers ensure values and needs are …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

Fear Not...No Falls, Jennifer A. Rabenold Msn, Rn, Cdn

Patient Care Services / Nursing

No abstract provided.

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.

Humna Elahi's Portfolio, Humna Elahi

Honors College Portfolios

As a student in the four-year Registered Nurse-Bachelor of Science in Nursing (RN-BSN) program, you are immersed in an education beyond the vital scientific facts and nursing skills. Throughout the undergraduate studies, one is challenged to rise to the skills of thorough assessments, critical thinking, and evaluations. Not only are you prepared for the clinical setting, you are given the tools to go above and beyond with your career. Your time and efforts as a nursing student creates a pathway to success and leadership.

A major goal in nursing is to practice cultural competence and provide holistic care to those …

Pilot Project: Developing A Standardized Evidence-Based Education Process For Nurses To Enhance New Medication Eduction Of Hospitalized Patients With Heart Failure, Michele Ann Crotteau

Doctor of Nursing Practice Projects

Problem Description: Research has shown that health information is difficult for the average adult to understand while clear communication helps patients feel involved and increases adherence to treatment. The Joint Commission recommends Health Literacy (HL) assessment and the use of the Teach Back Method (TBM). Medication errors that occur between the RN and elderly patient are preventable when the RN communicates effectively about the patient’s medications. A paucity of research exists evaluating TBM for nurse-patient communications. This Quality Improvement (QI) Pilot Project (PP) took place over 3-months, aimed to improve new medication education to elderly patients with Heart Failure (HF). …

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 …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

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 …

Keeping The Older Adult Steady With Steadi; A Fall Reduction Program, Payton Lawrence, Emily Hargrove, Rachel Collins, Aliya Leslie, Brittany Stricklin

Research Horizons Day Posters

No abstract provided.

An Actigraphy-Based Validation Study Of The Sleep Disorder Inventory In The Nursing Home, Gunnhild J. Hjetland, Inger Hilde Nordhus, Ståle Pallesen, Jeffrey Cummings, Rochelle E. Tractenberg, Eirunn Thun, Eirin Kolberg, Elisabeth Flo

School of Medicine Faculty Research

Background: Disrupted sleep is common among nursing home patients with dementia and is associated with increased agitation, depression, and cognitive impairment. Detecting and treating sleep problems in this population are therefore of great importance, albeit challenging. Systematic observation and objective recordings of sleep are time-consuming and resource intensive and self-report is often unreliable. Commonly used proxy-rated scales contain few sleep items, which affects the reliability of the raters' reports. The present study aimed to adapt the proxy-rated Sleep Disorder Inventory (SDI) to a nursing home context and validate it against actigraphy. Methods: Cross-sectional study of 69 nursing home patients, 68% …

Ethical Considerations When Conducting Research With Older Adults, Karen Arrant

Journal of Interprofessional Practice and Collaboration

The ethical issue exists between the researcher’s passion for the study focus and the human rights of the participant. This manuscript provides a case study, an actual illustration, but names were changed to protect anonymity. Objectives include examining the researcher’s perspective and personal beliefs, identifying the process to recruit participants, the ethical manner to disseminate information, and identifying ethical principles during the study process.It is mandatory that minute attention is given to the details of caring for the safety and welfare of study participants.

End-Of-Life Care And The Use Of An Integrated Care Pathway, Marianne Brattgjerd, Rose Mari Olsen, Inger Jorun Danielsen

The Qualitative Report

Liverpool Care Pathway is an integrated care pathway (ICP) designed to ensure the provision of high-quality end-of-life care. However, the ICP has come under substantial criticism, suggesting that its use is related to poor care. This study explores nurses’ use of the ICP to dying patients in Norwegian nursing homes. We conducted a qualitative study using an abductive, mystery-focused method to analyze the experiences of 12 registered nurses. Our findings show that the nurses experienced the ICP as a very useful tool in end-of-life care, although they were actually working independently of the ICP in the provision of ongoing bedside …

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

Obesity In The Geriatric Population, Candace Glaze

MUSC Theses and Dissertations

This retrospective cross-sectional study focused on patients who were 65 years and older who have Medicare and an ICD10 code of obesity. The study uses archival billing data from the 2017 Medicare 5% Limited Data Set to examine use of bariatric surgery. This study examined the different characteristics (geographic region, age, sex, co-morbidities) for all patients with a BMI greater than 40 who had bariatric surgery in 2017 compared to patients with a BMI greater than 40 who did not receive a surgical intervention. Results found that patients who are female are associated with higher odds of receiving bariatric surgery. …