Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

The Impact Of Social Interaction On Patient Well-Being With Transition Into Long-Term Care Settings: A Review Of Interventions For Improved Patient Outcomes, Helen Whitney Harmon

Epsilon Sigma at-Large Research Conference

Abstract

Purpose: When individual patients are transitioned from home or acute care settings to more long-term care environments such as skilled nursing units or assisted living facilities, the residents are at an increased risk of experiencing loneliness, which is linked to depression, anxiety, and increasing cognitive decline, and other detrimental outcomes.

Aims: Combinations of peer-reviewed qualitative and quantitative research studies were analyzed to determine what factors contributed to changes in patient well-being, mental health and overall quality of life during these transitions.

Methods: One article focusing on preventable healthcare transitions in patient population was able to link higher medical acuity …

Breaking Barriers: Advancement Toward Practical Nursing Licensure For Certified Medication Assistants In Long-Term Care--A Descriptive Study, Aleshia L. Maxwell

ATU Theses and Dissertations 2021 - Present

The persistent nursing shortage across the United States, particularly in Long-Term Care (LTC) settings, has complicated the healthcare system’s ability to meet the needs of an aging population. While existing research often examines progression from Licensed Practical Nurse (LPN) to Registered Nurse (RN), limited research explores factors influencing progression from entry-level LTC healthcare workers to Practical Nursing (PN) licensure. This quantitative descriptive study examined the barriers and supporting factors influencing advancement toward PN licensure for Medication Assistants-Certified (MA-Cs) in Arkansas LTC facilities. A convenience sample of N=100 participated in the study. Results indicated that financial and structural barriers often …

What Matters To Residential Long-Term Care Residents: Contextualizing Perceptions Of Person-Centered Care, Luis J. Cordero, Sarah Dys, Diana White

Institute on Aging Publications

This study combines the CRITIC and DEMATEL methods and introduces a new hybrid scenario analysis approach that identifies cross-scenario strategies. We use Taiwan's wind energy industry as a case study to validate the process. Although scenario analysis has been applied across various fields and organization types—including strategic planning, education, training, and recent environmental issues—scholars have highlighted problems such as the subjectivity of qualitative analysis and the lack of quantitative evidence. To address this, this study integrates scenario analysis with quantitative multi-criteria decision analysis to support decision makers in conducting scenario evaluations. We achieve this by applying a multi-criteria approach to …

Enhancing Sepsis Prevention In Long-Term Care Facilities: Development Of An Infection Prevention Sepsis Toolkit, Emmalyn A. Tuhin

Student Scholarly Projects

Objectives: The purpose of this Doctor of Nursing Practice (DNP) project was to create, validate, and refine an Evidence-Based Sepsis Prevention Toolkit to enhanced early sepsis recognition and interprofessional coordination of care within long-term care facilities (LTCFs).

Background: Sepsis remains a leading cause of mortality and preventable transfer to the hospital for the elderly residents within the LTCFs. A significant practice gap persists because sepsis in this population often presents atypically, resulting in delayed or inaccurate diagnosis and treatment.

Methods: This project was guided by the following PICOT question: For healthcare professionals caring for patients aged 65 years and older …

Fall Prevention In Long-Term Care, Steven Zissler

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls among older adults residing in long-term care facilities continue to rise, resulting in injuries that contribute to adverse outcomes, a reduced quality of life, and increased healthcare costs. Despite existing safety interventions, falls persist, indicating a gap in effective, sustainable fall prevention strategies. Repeated failures to reduce falls among adults aged 65 years and older highlight the need for a structured, evidence-based approach aimed at addressing this critical patient safety issue.

Aim of the Project: The aim of this project was to reduce falls and fall-related injuries by 25% for older adults residing in a long-term care facility …

Assessment Of Self-Efficacy And Practice Change Following Pressure Injury Education In A Long-Term Care Facility, Charity L. Booker

Electronic Theses and Dissertations

The purpose of this scholarly project was to evaluate if pressure injury education improved nursing knowledge and self-efficacy in the prevention and management of pressure injuries with the intent to improve practice. A literature review was conducted to evaluate educational interventions for adult learners and nursing roles in the care process. Existing studies indicated that patient outcomes are improved when nurses have adequate knowledge in pressure injury prevention. This quality improvement project was implemented in a long-term care facility with 28 nursing staff. The Agency for Healthcare Research and Quality pressure injury best practices presentation was the basis for the …

Long-Term Care In The United States: History, Financing, And Directions For Reform, George A. (Sandy) Mackenzie

Upjohn Press

This book is a concise survey of the development of U.S. long-term care and its financing, with comparisons with other rich countries. It also includes a brief comparative account of the impact of the COVID-19 pandemic in the United States and several other countries. The study finds much that is amiss with American long-term care and proposes three sets of progressively more ambitious reforms.

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 …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

Effects Of Therapeutic Music On Improving Depressive Symptoms Among Long-Term Care Facility Residents, Yi Jin

Evidence-Based Practice Project Reports

Depression is a common mental disorder that can contribute to both physical and psychological suffering (Skinner, 2014). The prevalence rate of depression is especially high among long-term care facility residents (CounsultGeri, 2018; Lolk & Andersen, 2015). The purpose of this EBP project was to establish a protocol incorporating therapeutic music as an adjunct therapy for managing depressive symptoms among residents of a long-term care facility in the Midwest. Roy adaptation model (Roy, 2009) was utilized as the theoretical framework, and the model for evidence-based practice change (Rosswurm & Larrabee, 2009) guided the project implementation. A total of 13 subjects were …

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.

A Clinical Nurse Leader Initiative: Promoting Mobility Among Long-Term Care Facility Residents, Ulyses Reamico

Master's Projects and Capstones

Maintenance of mobility during hospitalization or stay in long-term care facility result in improved patient outcomes including but not limited to decreased incidence of falls, non-pharmacological pain intervention, and prevention of further functional decline. In a 45-bed rehabilitation unit of a Veterans Affairs (VA) health care facility, a clinical nurse leader (CNL) initiative was done to promote mobility among the patients to mitigate functional decline. The patients, also referred to as clients or residents in long-term care facilities, were aged between 20s and 90s. The resident population consisted of patients admitted for physical rehabilitation after a stroke or surgical procedure, …

Comparing Total Expenditures By Source Of Long-Term Services And Supports., Maresa R. Corder

Electronic Theses and Dissertations

This study compares total expenditures between beneficiaries enrolled in traditional Long-Term Care (LTC) and beneficiaries enrolled in Home and Community Based Services (HCBS) in a Quasi-Experimental Simple Ex Post Facto study utilizing multiple linear regression with inverted propensity score weighting. The results demonstrated, during the two years of the study period, that total expenditures were on average $14,565.03 (with a p-value oflessfor the total two years of the study, for HCBS beneficiaries when compared to their LTC counterparts. There remains today a belief that expenditures of elderly, dual beneficiaries electing to age-in-place for supported self-care expend less than that of …

Antimicrobial Stewardship: Incentives And Barriers To Implementation In Skilled Nursing Facilities, Gloria M. Escalona

Doctoral Projects

This study was part of a quality improvement effort of a Skilled Nursing Facility (SNF) to develop and establish an antimicrobial stewardship program to comply with recently enacted California State Senate Bill 361 (SB 361), which went into effect January l, 2017 (Skilled nursing facilities, 2015). The division of the facility into two sections, one staffed largely by Licensed Vocational Nurses (L VNs) and another staffed largely by Registered Nurses (RNs) provided an study opportunity that easily differentiated the licensed nurses. This study used three methods: 1) an educational intervention to licensed nurses, 2) a post-educational intervention survey of licensed …

A Resident-Centered Dementia Care Staff Education Project To Reduce Challenging Behaviors At A Long-Term Care Facility, Margaret Huryk

Seton Hall University DNP Final Projects

Frequent use of antipsychotic medication (APM) for behavioral and psychological symptoms of dementia (BPSD) persists at high levels in long- term care (LTC) facilities despite extensive evidence of modest clinical benefits, serious adverse effects, public health advisories and a national initiative to improve dementia care. There is a gap between best-practice evidence and actual clinical practice related to pharmacological and nonpharmacological care for persons with dementia (PWD) and BPSD and/or neuropsychiatric symptoms (NPS) of dementia. The literature shows that clinicians often ignore FDA (Food and Drug Administration) warnings, CMS (the Centers for Medicare and Medicaid Services) initiatives and expert opinion …

Professional Learning And Knowledge Transfer To Practice In Unregulated Care Provider Training In Resident-Centred Care, Sarah Pottier

Theses and Dissertations (Comprehensive)

Ongoing training for unregulated care providers (UCPs) in Ontario is required to meet the care needs of the aging population. Inconsistencies in standards and options for formal training for UCPs as well as the evolving complex needs of the aging population are factors contributing to needing training programs for UCPs in the workforce. This thesis examined the delivery and transfer of professional learning for UCP training in resident centred care. Increasing resident-centred care behaviours and knowledge were the primary aims of the training. One 128-bed long-term care home in southwestern Ontario volunteered to participate in this study while providing the …

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 …

Understanding Infection Prevention And Control In Nursing Homes: A Qualitative Study., Patricia W. Stone, Carolyn T.A. Herzig, Monika Pogorzelska-Maziarz, Eileen Carter, Ragnhildur I. Bjarnadottir, Patricia K. Semeraro, Catherine C. Cohen, Jasmine Travers, Steven Schweon

College of Nursing Faculty Papers & Presentations

Infections have been identified as a priority issue in nursing homes (NHs). We conducted a qualitative study purposively sampling 10 NHs across the country where 6-8 employees were recruited (N = 73). Semi-structured, open-ended guides were used to conduct in-depth interviews. Data were audiotaped, transcribed and a content analysis was performed. Five themes emerged: 'Residents' Needs', 'Roles and Training' 'Using Infection Data,' 'External Resources' and 'Focus on Hand Hygiene.' Infection prevention was a priority in the NHs visited. While all sites had hand hygiene programs, other recommended areas were not a focus and many sites were not aware of available …

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

A New Approach To An Old Problem: Defining Nursing’S Role In Successful Transitions To Long-Term Residential Care, Kyleen Aldrich

Honors College Theses

A growing body of nursing research addresses the transitional period for older adults entering long-term residential care. However, gaps exist in our understanding of nursing’s role in the transition process. Our aim is to examine the available evidence and develop a model of nursing strategies and interventions to ease the transition to long-term care. This model describes interventions that nurses can incorporate into everyday practice.

A literature review was conducted to examine the transitional care needs and interventions for older adults with a goal of developing a model addressing transitions to long-term care.

Most nursing studies provided descriptive information about …

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

Long-Term Care, Emma Kontzamanis, Keville Frederickson

Publications and Research

In chis chapter, the need for long-term care services is explained from the perspective of the explosive growth of the older population as well as the increase in disability and chronic illness in the general population. A definition of long-term care within the contexts of inpatient and community-based services is also explained. In the United States the focus of long-term care is on nursing homes. This will be discussed as well as alternatives co nursing home care which involve integrated services such as case management, social health maintenance organizations, and programs of all inclusive care for elders. Solutions to the …