Program evaluation of a new interprofessional geriatrics curriculum for advanced practice nursing and master of social work learners.

The Indiana Geriatrics Workforce Enhancement Program (GWEP) implemented a new longitudinal geriatrics curriculum for advanced practice registered nurse (APRN) and master of social work (MSW) learners to prepare them for interprofessional collaborative practice in the care of older adults. This paper reports program outcomes of a novel longitudinal interprofessional geriatrics curriculum involving immersive learning for these learners. Outcomes are described in terms of learner reaction, modification of attitudes/perceptions, acquisition of knowledge/skills, behavior change, impact on the organization, and impact on the patient or client using the Freeth/Kirkpatrick evaluation model. Program participation influenced graduates' knowledge of and their perceived ability to participate in team care and job selection in geriatric-focused positions.

Substance Use Disorder Education: A Statewide Assessment of Core Content in Nursing Schools.

Of individuals who need treatment for substance use disorder (SUD), 12.6% do not receive it. One reason for this failure to treat is an inadequately prepared health care workforce, including nurses. To establish a state-wide baseline of SUD curricular content, we collected information about topics taught and barriers to teaching important topics using an anonymous survey sent to all 55 nursing programs in Indiana. Topics deemed important were taught more frequently, such as opioid withdrawal (60.6%). Lack of expertise was more commonly reported as a barrier than lack of time (25.3% vs. 7.1%). Findings suggest that nursing students in Indiana are not taught requisite content related to SUD. We have provided pragmatic recommendations to enhance content in schools of nursing and address lack of expertise among faculty. Leaders need to actively evaluate and augment the content of their curriculums to include SUD. [Journal of Psychosocial Nursing and Mental Health Services, 61(9), 15-23.].

A Crosswalk Analysis Between Magnet® Standards and Clinical Nurse Specialist Practice Competencies.

OBJECTIVE: The purpose of this study was to determine the alignment between the American Nurses Credentialing Center's Magnet Recognition Program® standards and clinical nurse specialist (CNS) practice competencies. BACKGROUND: Despite documentation of CNS contributions to achieving and sustaining Magnet Recognition®, there is a lack of evidence clearly aligning Magnet® standards and CNS practice competencies. METHODS: Using a crosswalk method, an expert panel of CNSs and chief nursing executives analyzed alignment of the 50 Magnet standards with the 44 National Association of Clinical Nurse Specialists core practice competencies. RESULTS: CNS practice competencies are aligned closely with Magnet standards: 86% of the 50 Magnet standards aligned with at least 1 CNS competency and 81.8% of CNS competencies aligned with at least 1 Magnet® standard. CONCLUSIONS: The alignment between Magnet standards and CNS competencies supports evidence of CNS contributions to organizational achievement of Magnet Recognition and will assist nurse executives in identifying a full scope of opportunities for CNSs to contribute to nursing excellence.

State-level Medicaid 1915(c) home and community-based services waiver support for caregivers.

BACKGROUND: Informal caregivers encounter emotional distress, worsening personal health, and financial strain. The Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver programs provide an array of services including support for caregivers. PURPOSE: This policy analysis examined Medicaid waiver services offered to persons 65 and older among the 50 states and District of Columbia (DC). METHODS: Data were obtained from Medicaid waiver applications for adults age 65 and older available at Medicaid.gov. Data elements included number of waiver programs and services for supporting caregivers. Descriptive statistics were applied. FINDINGS: Forty-three states including DC (84%) offered a Medicaid waiver for older adults; seven states (14%) offer two waiver programs; eight states (16%) had no Medicaid waiver. Payment to a relative or legal guardian caregiver was the most common service offered in 39 (76%) states. Other services included in-home respite care and adult day health care (35 states; 67%), out-of-home respite care (32 states; 63%), skilled nursing (28 states; 55%), paid spousal caregivers (18 states; 35%), caregiver training (15 states; 29%), and adult day care for socialization (7 states, 14%). DISCUSSION: This study identifies wide variability in caregiver support across state-based Medicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.

Preparing advanced learners for geriatric team care: A short-term curricular model that works.

Health outcomes for complex older adults are enhanced by interprofessional collaboration. Funded by a Geriatrics Workforce Enhancement Program (GWEP), an interprofessional team of educators developed a short-term geriatrics experience, including four hours of pre-clinical education and 12-20 hours of immersion in team-based care for advanced learners in nursing (n = 70 APN), social work (n = 48 MSW), and medicine (n = 122 medical students). Content focused on five areas: medication management, dementia, depression, falls, and myths about aging. Learners completed pre/post surveys measuring knowledge of geriatrics, attitudes toward geriatric patients and team care, and post-surveys regarding perceptions of the overall clinical experience. Results showed significant improvement in knowledge and attitudes toward older adults and interprofessional (IP) team practice. Qualitative comments reflected increased empathy toward and enthusiasm for working with older adults, valuing IP teams, and a desire for geriatrics content earlier in their respective curricula.

Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines.

PURPOSE: The aim of this study was to update the clinical practice guidelines for the use of basic oral care (BOC) interventions for the prevention and/or treatment of oral mucositis (OM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention in each cancer treatment setting was assigned an evidence level. The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible. RESULTS: A total of 17 new papers across six interventions were examined and merged with a previous database. Based on the literature, the following guidelines were possible. The panel suggests that the implementation of multi-agent combination oral care protocols is beneficial for the prevention of OM during chemotherapy, head and neck (H&N) radiation therapy (RT), and hematopoietic stem cell transplantation (Level of Evidence III). The panel suggests that chlorhexidine not be used to prevent OM in patients undergoing H&N RT (Level of Evidence III). No guideline was possible for professional oral care, patient education, saline, and sodium bicarbonate, and expert opinion complemented these guidelines. CONCLUSIONS: The evidence supports the use of multi-agent combination oral care protocols in the specific populations listed above. Additional well-designed research is needed on the other BOC interventions prior to guideline formulation.

Description of work processes used by clinical nurse specialists to improve patient outcomes.

BACKGROUND: Advanced practice registered nurses (APRN) are expected to contribute to improved patient outcomes. Traditionally, clinical nurse specialists (CNS) have been the APRN role that led system-level nursing practice initiatives to advance care for specialty populations. Little is known about the work processes used by CNSs to achieve outcomes. PURPOSE: This study identified common processes used by CNSs working in a variety of practice settings and specialties to advance nursing practice and achieve improved clinical outcomes. METHODS: Qualitative descriptive methods were used; a purposeful sample of CNSs with completed system-level projects participated in focus groups. Data were analyzed using standard content analysis process. FINDINGS: CNSs engaged in intricate interactions identified as articulation work involving the management of intersections between people, technology and organizations. This expert work is largely invisible. Self-agency, trust, and influence are a nexus upon which CNS work processes revolve. DISCUSSION: The findings provide insight into CNS work processes, lend credibility to the CNS's leadership abilities, and help explain why the CNS role and practice is often considered invisible and ambiguous.

Patient and family description of receiving care in acuity adaptable care model.

AIM: To explore patient and family perspectives of hospital care in an acuity adaptable care model implemented in an urban, public safety-net hospital. BACKGROUND: Specialty care units result in reactionary bed management. Changes in acuity generate costly, disruptive, intra-hospital patient transfers, which negatively affect clinical outcomes while increasing nurse workload. The acuity adaptable care model is a universal bed model structured to support patients in one room while providing staff, equipment and other resources across varying levels of acuity. METHOD: Qualitative descriptive methods were used to analyse the narratives of a purposive sample of patients and family members about receiving care in an acuity adaptable care delivery model. RESULTS: Three content areas emerged from the narratives and were categorized as feeling safe, perceiving continuity of care and valuing family, which culminated in a sense of comfort and healing while in the hospital. CONCLUSION: By bringing care services to the patient instead of taking the patient to the services, the acuity adaptable care model facilitated a perception of a healing environment for patients and family members. IMPLICATIONS FOR NURSING MANAGEMENT: The acuity adaptable care model should be considered when hospital facilities are undergoing major renovation or replacement.

Systematic review of basic oral care for the management of oral mucositis in cancer patients.

PURPOSE: The purpose of this project was to evaluate research in basic oral care interventions to update evidence-based practice guidelines for preventing and treating oral mucositis (OM) in cancer patients undergoing radio- or chemotherapy. METHODS: A systematic review of available literature was conducted by the Basic Oral Care Section of the Mucositis Study Group of MASCC/ISOO. Seven interventions--oral care protocols, dental care, normal saline, sodium bicarbonate, mixed medication mouthwash, chlorhexidine, and calcium phosphate--were evaluated using the Hadorn (J Clin Epidemiol 49:749-754, 1996) criteria to determine level of evidence, followed by a guideline determination of one of the following: recommendation, suggestion, or no guideline possible, using Somerfield's (Classic Pap Cur Comments 4:881-886, 2000) schema. RESULTS: Fifty-two published papers were examined by treatment population (radiotherapy, chemotherapy, and hematopoietic stem cell transplant) and by whether the intervention aimed to prevent or treat OM. The resulting practice suggestions included using oral care protocols for preventing OM across all treatment modalities and age groups and not using chlorhexidine mouthwash for preventing OM in adults with head and neck cancer undergoing radiotherapy. Considering inadequate and/or conflicting evidence, no guidelines for prevention or treatment of OM were possible for the interventions of dental care, normal saline, sodium bicarbonate, mixed medication mouthwash, chlorhexidine in patients receiving chemotherapy or hematopoietic stem cell transplant, or calcium phosphate. CONCLUSIONS: The evidence for basic oral care interventions supports the use of oral care protocols in patient populations receiving radiation and/or chemotherapy and does not support chlorhexidine for prevention of mucositis in head and neck cancer patients receiving radiotherapy. Additional well-designed research is needed for other interventions to improve the amount and quality of evidence guiding future clinical care.

A national survey of oncology content in prelicensure registered nurse programs.

The current and projected increase in newly diagnosed cancer patients and survivors supports the nation's need to prepare a nursing workforce that is skilled to meet the health care needs of these individuals. It is likely that cancer patients, especially survivors, will receive care from nurses without specialized oncology education who work in various nononcology clinical settings. Because of the lacking practice standards and educational guidelines for nurses who care for cancer survivors in nononcology settings, this article describes findings of a national survey that identified the importance and depth of cancer-care content included in accredited prelicensure registered nurse programs (diploma, associate and baccalaureate degrees). Findings revealed that a gap exists between respondents' reported importance and depth of cancer-care content currently taught and that importance rated consistently higher than depth taught. Lack of time was the most frequently cited barrier. Results will be used to design generalist oncology resources for nurse educators.

Relationship between occurrence of falls and fall-risk scores in an acute care setting using the Hendrich II fall risk model.

INTRODUCTION: Falls are a common clinical problem in the acute care setting, and fall-related injuries can include fractures, subdural hematomas, excessive bleeding, and even death (Hitcho et al., 2004). Several instruments are used clinically to estimate a patient's risk of falling. The STRATIFY (Oliver, Britton, Seed, Martin, & Hopper, 1997), the Morse Fall Scale (Morse, Black, Oberle, & Donahue, 1989), and the Hendrich II Fall Risk Model (Hendrich, Bender, & Nyhuis, 2003) are three instruments widely used in clinical practice by nurses. To be clinically useful, a fall risk assessment instrument should be easy to use with only a small number of items, perform consistently across target populations, and have evidence-based scoring and good inter-rater reliability. Oliver (2008), author of the STRATIFY tool, questioned the merits of any instrument used to assess fall risk in hospital inpatients in the absence of interventions to modify the risk factors. Too often, patient assessment and assignment of a score become required tasks and resulting data do not drive interventions. PURPOSE: The purpose of this study was to explore the relationship between scores on the Hendrich II Fall Risk Model (HIIFRM) and fall occurrence as recorded in the medical record for patients diagnosed with diabetes mellitus, stroke, or heart failure in an acute care inpatient setting. METHOD: To determine if a relationship existed between the occurrence of a fall and the HIIFRM score, the study used a random sample of patients who fell during admission and a matched control group of patients who did not fall. Fall cases were identified based on an admission Medical Severity-Diagnosis Related Group (MS-DRG) (Schmidt & Stegman, 2008) of stroke or secondary International Classification of Diseases (9th revision) (ICD-9) code (Hart, Stegman, & Ford, 2009) of heart failure or diabetes. Non-faller matched controls were selected at random from the same admission MS-DRG or secondary ICD-9 code as the fall case and matched for admission month/year. DISCUSSION: This study found HIIFRM scores to be related significantly to falls in the sample of patients with diabetes, but not in the sample of patients with heart failure. Although the HIIFRM demonstrated statistically significant mean differences in scores between patients who fell and those who did not, clinically the instrument failed to identify 44% of patients who did fall as being at high risk for falling. Given the negative consequences associated with falling, not identifying 44% of high-risk patients can have significant clinical implications. CONCLUSIONS: In this study, HIIFRM scores were related to falls among inpatients in an acute care hospital who had a diabetes diagnosis, but not a heart failure diagnosis. The differ ences between patient groups based on medical diagnoses suggest the instrument does not perform equally across patient groups, nursing skill levels, or clinical units. Though the findings are statistically significant, the clinical concemrn remains that a large percentage of patients who fell were scored as low risk using the HIIFRM instrument. At some level, every patient admitted to an acute care hospital is at risk for falls. Patients sick enough to be in the hospital have underlying disease, are receiving physiologically altering medications and treatments, and are likely experiencing pain, fatigue, anxiety, sleep disturbance, and other symptoms that interfere with cognitive and physical functioning. The key to preventing falls among hospitalized patients may lie in addressing how the hospital environment creates risk. Nurses should continue to improve the ability to assess fall risk and implement interventions that modify or eliminate risk when possible.

Older Adult Caregivers' Perspectives on Wound Care Resources: A Qualitative Study.

With an aging population, increasing numbers of older adults are assuming a caregiving role, including performing complex care procedures, such as wound care. Access to and use of resources are associated with better physical and mental health for caregivers. A thematic analysis of qualitative interviews with adult caregivers aged ≥65 years performing wound care identified seven resources supportive of the caregiver role, including: (a) access to expert guidance from health care professionals; (b) written instructions; (c) relationships with health care professionals for obtaining wound care supplies; (d) need for additional medical equipment; (e) financial resources; (f) coverage for caregiver personal time; and (g) select persons for caregiver social and emotional support. Given that older adults are increasingly cast into caregiver roles in the home setting, providing resources to sustain care recipients and their caregivers is critical. [Research in Gerontological Nursing, 16(4), 194-201.].

Pushing Through: How Older Adult Caregivers Manage Wound Care.

Older adults are taking on caregiving roles and are performing complex care procedures, such as wound care, in the home setting yet there is a dearth of knowledge about how older adult caregivers manage the performance of wound care on a day-to-day basis. The theoretical framework developed in this research describes this process of managing the caregiving role. Interviews with 18 caregivers aged 65 years and older who were performing wound care in the home for a care recipient yielded a theoretical framework from their narratives using a qualitative grounded theory analysis. The resultant theoretical framework, Pushing Through, consisted of five phases: (a) accepting the role, (b) lacking confidence, (c) creating a system, (d) trusting in self, and (e) owning the outcomes. An understanding of the older adult caregiver's process creates opportunities for healthcare professionals to develop and implement evidence-based interventions.

Mobility and Functional Status Among Hospitalized COPD Patients.

Older adults with chronic obstructive pulmonary disease (COPD) are at known risk for deconditioning and functional decline during hospitalization. The purpose of this study was to examine correlations between in-hospital mobility activities and functional status indicators in hospitalized older adults with COPD. A predictive correlational, secondary analysis design using multivariate analyses assessed the relationship between mobility events and functional status indicators in patients with COPD (n = 111) and non-COPD (n = 190) diagnoses. Ambulation to the bathroom, ambulation outside the room, and number of days to first out-of-bed activity predicted discharge to home versus extended care facility (ECF; p ≤ .05); days to first out-of-bed activity and out-of-room ambulation predicted reduced length of stay (LOS; p ≤ .05); no variables predicted 30-day readmission. COPD patients experienced more nonweight-bearing activity and longer lengths of stay than non-COPD patients. Specific early weight-bearing activities were associated with positive functional status-related outcomes in hospitalized COPD patients.

Oncology Resources for Students Enrolled in Pre-Licensure and Graduate Nursing Programs in the United States: A Scoping Review of the Literature.

OBJECTIVES: This scoping review summarizes oncology resources for pre-licensure and graduate nursing programs in the United States. DATA SOURCES: PubMed, CINAHL, and Scopus databases were searched to identify resources (2008-2019) published in peer-reviewed journals. While 1,503 papers were initially identified, 49 met inclusion criteria. CONCLUSION: Thematic analysis revealed five themes with subthemes: (1) didactic courses; (2) clinical opportunities; (3) didactic and clinical resources; (4) simulation resources; and (5) other. IMPLICATIONS FOR NURSING PRACTICE: Academic educators are charged with preparing a nursing workforce capable of providing safe and quality evidence-based care across the cancer continuum. Findings offer examples that overcome curriculum barriers.