Geriatric Nursing Commons^™

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 …

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 …

Challenges Facing The Elderly Care Industry In Hong Kong: The Shortage Of Frontline Workers, Sin Tung, Stella Kwok, Wai Ning Kris Wong, Shun Lai Yang

Practical Social and Industrial Research Symposium

No abstract provided.

An Evaluation Of Fall Prevention Interventions Among Older Adults In A Long Term Care Facility, Courtney Anita Bennett

Doctoral Projects

Falls are serious unwanted events that are a common occurrence among older adults in long term care facilities (LTC). Fall prevention in LTC facilities requires the efforts of an interprofessional team that promotes safety within an organization. The purpose of this capstone project is to implement and evaluate evidence-based fall prevention interventions at a LTC facility. Specific objectives of the project include: (a) providing education to healthcare professionals on evidence-based practices to recognize, assess, and prevent falls among older adults in a long term care facility and (b) replacing the existing fall prevention policy and program with a falls and …

Evaluating The Perceptions Of Quality Of Life In Informal Caregivers Caring For Hospice Patients, Rashandra Fisher Laws

Doctoral Projects

Maintaining or improving quality of life for informal caregivers is important as they endure the burden of providing care to terminally ill loved ones on a daily basis. Caregivers are at a greater risk for depression, deteriorating physical health, financial difficulties, and premature death than demographically similar non-caregivers (Demiris et al., 2010). The goal of this capstone project was to determine the effectiveness of the creativity, optimism, planning, and expert information (COPE) intervention, which address specific needs of the family and caregiver.

Twenty informal caregivers completed the Quality of Life (QoL) Index tool, which measured their perceptions of five different …

Relationships Among Uncertainty, Coping, And Psychological Distress In Older Adults With Mild Cognitive Impairment, Jennifer Sjostedt Avery

Dissertations (1934 -)

Mild cognitive impairment (MCI) has an average prevalence of 18.9% and most often affects people 60 years of age or older. It is a cognitive stage between normal functioning and dementia (Petersen, 2003; Petersen, 2011; Petersen et al., 2014). MCI can be broken into two subtypes classified by the presence of memory impairment (amnestic MCI) or the lack thereof (nonamnestic MCI). Medical diagnostic criteria are commonly used to guide research with older adults with MCI. A theoretical framework that addresses the antecedents and consequences of MCI, specifically one examining the relationships among MCI, uncertainty, coping and psychological distress, is essential …

The Association Of Health Literacy With Self-Care Agency In Older Adults In Jamaica, Heather F. Fletcher

Loma Linda University Electronic Theses, Dissertations & Projects

Older adults are the fastest growing segment of the population in Jamaica. With an increase from 10% (252,225) of the total Jamaican population in 1995 to 11% (279,051) in 2005, the rate is expected to rise to 25% by 2025. Thus, it will be critically important to understand factors that may contribute to health maintenance, disease prevention, and wellness promotion. Two such factors – not studied extensively in this country - are health literacy and self-care. The purposes of this study were to (a) generate health literacy profile data with the newly-developed Health Literacy Questionnaire for community-dwelling older adults in …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Primary Care At Home: Nurse Practitioners' Perceptions And Practices, Tonya Bragg-Underwood

Doctor of Nursing Practice Technical Reports

Background: Primary care at home is not a new idea, but rather a reinvention of an old and almost forgotten practice. Today, only 1% of primary care visits are provided in a home setting; despite the increasing aging homebound population in the United States. Current primary care at home research relates improved patient outcomes with primary care at home visits. Primary care at home is reemerging in the United States, but currently is not generating many positive reviews. There is a gap in the current primary care at home literature regarding nurse practitioner home visit practices and perceptions. Methods: A …

Results And Lessons Learned From A Nurse Practitioner-Guided Dementia Care Intervention For Primary Care Patients And Their Family Caregivers, Richard H. Fortinsky, Colleen Delaney, Ofer Harel, Karen Pasquale, Elena Schjavland, John Lynch, Alison Kleppinger, Suzanne Crumb

Articles - Patient Care

Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients …

Honor The Molst, Teresa Guarino

Senior Honors Projects

End of life is a topic many people would rather avoid discussing. Even many healthcare providers are uncomfortable with the topic, and they are at the front line in terms of providing information to patients about their care options. Nevertheless, it is a topic of utmost importance. Regardless of what one values and what choices have been made, preferences and desires at the end of life should be honored. This was the aim of documents such as advanced directives, living wills, and durable power of attorneys for healthcare, but they have been found to not be consistently honored. Seeing this …

Awareness, Education, And Prevention Of Chronic Kidney Disease In The Older Adult, Torrel R. Bridges

Honors Theses

Chronic kidney disease (CKD) has become a major issue in our nation. Many of our neighbors, family, and friends have concerns and a call for our attention is necessary. CKD does not have a specific target, but individuals with diseases such as diabetes mellitus, cardiovascular disease, and obesity are all at increased risk. Adults older than 65 years of age are especially at increased risk for developing CKD due to decrease in kidney function and other physiologic changes. In light of this, awareness, education, and prevention of CKD in the older adult population is important.

The number of older individuals …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

A Program For Review Of Residents On Anti-Psychotic (Ap) Medications In A County Owned Nursing Facility, Catherine M. Glew Bm, Bs, Cmd, Beth Berklite Rn, Adon, Terri Bauer Rn

Department of Medicine

No abstract provided.

An Assessment Of Nurses' Knowledge And Attitudes Toward End Of Life Care Pain Management, Amy Davis

Nursing Theses and Capstone Projects

This study was completed to help determine if nurses had a true understanding of how to provide pain management to patients in their care who were at the end of their life. A review of literature was completed and it revealed that nurses have a fear of opioid overdose and respiratory depression in their patients when providing proper pain management. It also revealed that patients have a fear of dying in pain at the end of their life especially if they have been diagnosed with a terminal illness. The study also revealed that when patients die in pain it actually …

Non-Pharmacological Interventions Project: Treatment For Dementia, Mandy Richards

Nursing Theses and Capstone Projects

In response to the Office of Inspector General's research report on atypical antipsychotic off label treatment of elderly dementia residents in long-term care, the Centers for Medicare and Medicaid Services developed a non-pharmacological intervention known as the Hand In Hand training tool. This projects focus was on training the direct care nursing staff with the Hand In Hand tool and evaluating for decrease in behavior and psychological symptoms in their patients. A retrospective chart review was utilized for the Minimum Data Sets tool Brief Interview of Mental Status (BIMS) and Mood interview. Pre training and post training scores were analyzed …

Betsy: A Case Study Of A Client With Down's Syndrome And Dementia, Cheryl D. Schlamb, Christine D. Moriconi

Nursing Faculty Publications

No abstract provided.

Changing Places: Adult Children And The Transition Of Aging Parents, Sarah Martin Gilbert

MUSC Theses and Dissertations

Purpose: This dissertation analyzed measurement of relocation transition in older adults, assessed research for the manner in which older adults make the decision to move, and the adult child's role in the transition of their aging parents. Design: Using Hawker, Payne, Kerr, Hardey, & Powell's (2002) mixed research review method, two integrative reviews were conducted. The first examined how relocation transition is measured in the literature while the second applied the Theory of Planned Behavior (Ajzen, 1985) to determine the behavioral beliefs, subjective norms, and perceived behavioral control of older adults as they contemplate a relocation from independent living to …

Home Health Nurses' Knowledge And Beliefs Of Suffering, Artificial Nutrition And Hydration In People With Late Stage Dementia, Lenora Ward Smith

MUSC Theses and Dissertations

Purpose: This dissertation examined the concept and dimensions of suffering in individuals with late stage dementia and the knowledge and perceptions of home health nurses with regard to artificial nutrition and hydration and suffering in individuals with late stage dementia. Design: Using Caron and Bowers' method of dimensional analysis, the concept of suffering in people with late stage dementia was examined. A pilot study was conducted on home health nurses in Western North Carolina to test the reliability of the instrument used in the study, and a mixed methods exploratory study was conducted to measure home health nurses' knowledge and …