Housing and Health in Older Adults With Low Income in the United States: An Integrative Review.

PURPOSE: The current integrative review was conducted to understand the relationship between housing and health in older adults with low income in the United States. METHOD: A literature search yielded 20 articles that met inclusion criteria. Key data elements were extracted from each article and a five-level social ecological model (SEM) was used as a framework to analyze the findings. RESULTS: The analysis yielded themes associated with each SEM level: Interaction Between Housing and Personal Traits and Behaviors (individual level); Burdens and Benefits of Social Relationships (relational Level); Building Quality and Health (environmental level); Role of Housing Assistance (structural level); and Influence of Poverty and Structural and Systemic Racism (superstructural level). CONCLUSION/IMPLICATIONS: Results clarify housing's role as a social determinant of health affecting older adults with low income and may help nurses tailor patient assessments and treatment plans to better identify and address housing-related health risks. [Journal of Gerontological Nursing, 50(3), 25-32.].

The relationship between health and housing in low-income older adults: A secondary analysis of survey data.

OBJECTIVE: To examine the health-housing relationship in low-income older adults, and differences by income and receipt of housing assistance. DESIGN: Secondary analysis of longitudinal survey data. SAMPLE: About 10,858 adults aged 62+ who completed at least one wave of the 2014 Survey of Income and Program Participation (SIPP) (n = 37,333 observations). MEASUREMENTS: SIPP variables representing demographics and housing quality, affordability, stability, and neighborhood were analyzed. Low-income and higher-income participants were differentiated by the household income-to-poverty ratio. RESULTS: Low-income participants were significantly more likely to be in poor health and report problems with housing quality, affordability, and neighborhood safety compared to higher-income participants (p < .001). Increased household size and problems with housing quality and neighborhood safety were associated with poor health in both groups (p < .05). Low-income participants who received housing assistance were significantly poorer, less healthy, and food insecure than participants not receiving assistance (p < .001); however, the health-housing relationship was not different in the two groups. CONCLUSIONS: Results provide additional support for housing as a social determinant of older adult health. Though housing assistance programs reached a subset of low-income older adults, the results suggest a housing assistance shortfall. Implications for public health nurses and researchers are explored.

Developing a dedicated education unit in long-term care: a pilot project.

Within long-term care, the transitional care setting provides post-acute and short-stay rehabilitation to older adults, easing the transition between the acute care hospital and home or long-term care. The current nursing shortage makes it difficult for these facilities to attract and retain qualified nursing staff. In order to meet the rehabilitation needs for this patient population while at the same time addressing the challenge in nursing education of limited clinical placements and severe nurse faculty shortages, an academic-practice partnership was developed to establish a Dedicated Education Unit (DEU). The DEU is an innovative clinical education model in which experienced staff nurses serve as clinical teachers to nursing students. This paper describes the process of developing a DEU using the Partners in Caring Model as the framework. Formative and summative evaluation results and recommendations for program improvement of this pilot project are discussed.

The role of awards in promoting educational leadership in nursing: A qualitative descriptive study in gerontological nursing.

Background: As the population ages, the need for high quality nursing education in the unique health and illness needs of older people is required at undergraduate and postgraduate levels. Gerontological nursing and gerontological nursing education are critically important in this new age of human longevity and chronic disease. To facilitate high quality and engaging educational practices in gerontology, the National Hartford Center for Gerontological Nursing Excellence offered a professional recognition award program, entitled the Distinguished Educator in Gerontological Nursing Award (the Award). Objectives: Describe participants' perceptions of an awards program in gerontological nursing education. Design: Qualitative descriptive research. Settings: National Hartford Center for Gerontological Nursing Excellence, a professional body that aims to enhance and sustain the capacity and competency of nurses to provide quality care to older adults, opened the Award to international applications in 2018. Participants: Nine awardees, residing in North America and Asia. Methods: Semi-structured individual interviews followed by inductive, thematic analysis. Results: The Award was valued for its prestige and recognition; the process of applying was affirming; and achievement of the Award strengthened awardee confidence to lead and advocate for gerontological nursing education. A model for understanding the Award, focused on value, application and confidence is proposed. Conclusions: The use of award programs for gerontological education expertise may improve nurse educators' confidence and performance within educational settings. How the Award impacts student learning remains unknown. Further research into the benefits and limitations of award programs for nurse educators specializing in gerontological nursing and other fields, their managers, and students is required to fully understand the role of educational award programs in nursing.

Long-term care in the United States and Finland: policy lessons to be learned.

Gerontological nurses are crucial members of long-term care (LTC) policy development teams as they work toward the provision of quality, equitable, seamless, and affordable LTC for all. When developing LTC policies in the United States, it is useful to explore such services in other countries. This policy brief provides an overview of LTC services in Finland to examine possible policy lessons for U.S. LTC service and delivery. Finland provides LTC to its older adult population under a universal program whereby services are provided as part of their universal health care and social services coverage. The U.S. system provides LTC primarily under Medicaid along with some coverage financed under Medicare. The challenges in the U.S. system include fragmented LTC delivery and financing, increasing LTC costs, and maintaining quality of care. Although difficult to compare the LTC costs in these two countries, available data suggest that Finland spends less on LTC the older adult population.

Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis.

BACKGROUND: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. OBJECTIVE: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. METHODS: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals' key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals' perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. RESULTS: We determined that COVID-19 impacted nurses' physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. CONCLUSIONS: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers.

Development of core competencies and a recognition program for gerontological nursing educators.

Despite efforts to implement learner competencies in gerontological nursing, a significant knowledge-attitude disassociation remains, with few students interested in pursuing careers in the care of older adults. One reason may be the lack of well-qualified faculty who can design engaging learning experiences with older adults and serve as positive role models for aging care. In response, the National Hartford Center of Gerontological Nursing Excellence commissioned the development of core competencies and a recognition program for educators in gerontological nursing. The goal of these competencies is to promote quality instruction in the care of older adults by describing a set of preferred skills characterizing faculty teaching gerontological content to nursing and interprofessional learners. These educator-focused competencies can guide individual career development for new and current educators who specialize in teaching about the care of older adults. They provide direction for selecting well-prepared individuals for gerontological nursing teaching positions and evaluating educator role performance. This paper describes the development of seven core competencies for nurse educators who teach in academic and professional development programs, as well as criteria for their recognition. An iterative development process was used to define the core competencies, along with descriptions and exemplars of each domain.

Using antipsychotic drugs safely in older patients.

Do you know how to monitor an older adult who's receiving an antipsychotic drug? Learn the benefits and the pitfalls so you can keep your older patients safe.

Interpreting laboratory values in the rehabilitation setting.

Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health problems faced by patients in rehabilitation settings. A case study is used to highlight the importance of laboratory testing.

Managing problem behaviors associated with dementia.

The older adult with dementia who exhibits problem behaviors is likely to be experiencing physical or psychological distress. Both can negatively affect the health, rehabilitation, and quality of life for the older adult. Managing problem behaviors can challenge the skills of the most experienced nurse. Being able to identify the origins of these behaviors can help caregivers respond in a way that will achieve behavioral management and preserve the dignity of the older adult. This article presents some practical measures to assist nurses with minimizing the negative effects of dementia-associated problem behaviors in older adults.

A Medicare Current Beneficiary Survey-Based Investigation of Alternative Primary Care Models in Nursing Homes: Cost and Utilization Differences.

The current study used the Medicare Current Beneficiary Survey-Based (MCBS) Cost and Use files for 2006-2008 to investigate whether health care costs and service utilization of nursing home residents varied with nurse practitioner (NP) and physician assistant (PA) involvement, compared to the use of medical doctors (MDs) only. The sample included Medicare beneficiaries 65 and older residing in a nursing home for the entire study year (433 annual observations). A generalized estimating equations procedure was used to assess whether health care cost and utilization measures varied by cohort. Point estimates indicated that the annual per-person cost of non-institutional services (total medical cost less the cost of the nursing home itself) was $3,847 and $3,170 more for individuals in the MD-only and MD-dominant cohorts, respectively, compared to those in the NP/PA-dominant cohort. [Res Gerontol Nurs. 2016; 9(3):115-122.].

EverCare nurse practitioner practice activities: similarities and differences across five sites.

PURPOSE: To examine the similarities and differences in the performance and frequency of performance of EverCare nurse practitioner (NP) practice activities at demonstration sites in five states. This study builds upon a previous study in which the development and testing of the EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) was conducted. DATA SOURCES: A Background Data Sheet and the ENPRAS, a 99-item tool that encompasses six role subscales-Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator, were completed by 127 EverCare NPs at demonstration sites in five states (Georgia, Maryland, Massachusetts, Colorado, and Florida). CONCLUSIONS: Performance of NP activities across the demonstration sites in five states was generally consistent, with significant differences only in the amount of time spent on activities associated with the Collaborator and Coach/Educator roles. Overall, EverCare NPs spent more time on Clinician and Communicator/Cheerleader role activities than on activities associated with the other roles. EverCare NP patient caseload was positively related to frequency of performance of the Clinician and Care Manager/Coordinator roles. IMPLICATIONS FOR PRACTICE: EverCare NPs provide proactive primary care to long-stay nursing home residents. The observed consistency reflects a strong centrally directed practice model. The identified roles and activities of the EverCare NP are consistent with previous studies and reports focused on the roles and activities of NPs who provide care to nursing home residents in other models of care delivery. Policy makers, healthcare providers, and the public should take these findings into account when considering a national model of care for this population. Future studies should examine the effect of variations in performance of activities on resident-specific and setting-specific outcomes.

Development and psychometric testing of the EverCare Nurse Practitioner Role and Activity Scale (ENPRAS).

PURPOSE: To develop and test an instrument measuring the frequency of the performance of role activities by EverCare nurse practitioners (NPs), who provide primary care to nursing home residents. DATA SOURCES: One hundred thirty-one EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) activities were identified through telephone interviews (n= 11), participant observation (n= 5), and a focus group (n= 4). CONCLUSIONS: Two content validity tests (n= 11; n= 15) (Content Validity Index > or = .78 for all retained items) and internal consistency reliability testing (n= 127; Cronbach's alpha = .78-.96) yielded 99 activities arranged in six role subscales-Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator. IMPLICATIONS FOR PRACTICE: The ENPRAS can be used to measure similarities and differences in NP practice activities performed by EverCare NPs working at different EverCare program sites and to compare practice activities performed by EverCare NPs and other NPs. The EverCare program is sponsored by United Health Care, which leads the field in collaborative NP/MD primary care in nursing homes. Future studies should be directed toward testing the generalizability of the ENPRAS with NPs working in other collaborative models, as well as NPs in noncollaborative models of care delivery in the long-term care setting.

A Medicare current beneficiary survey-based investigation of alternative primary care models in nursing homes: functional ability and health status outcomes.

This study assessed how the health status and functioning of Medicare beneficiaries residing in nursing homes varies systematically with nurse practitioners (NPs) and physician assistants (PAs) providing primary care services. A secondary analysis was conducted using data from the 2006, 2007, and 2008 Medicare Current Beneficiary Surveys. The study sample included 433 participant-year observations within one of three cohorts: (a) medical doctor (MD)-only, those who received primary care services exclusively from a physician; (b) MD-dominant, those who received some primary care services from an NP or PA, but those visits accounted for less than one half of total primary care visits; and (c) NP/PA-dominant, those who received more than one half of their primary care visits from an NP or PA. Participants in the MD-only cohort had significantly less orientation and independence in activities of daily living compared to participants in the NP/PA-dominant cohort. Other study variables did not vary significantly by practice model. Although the study provides some evidence that NP/PA involvement is associated with improved functioning, it is premature to draw strong inferences.

Bedside assessment of enteral tube placement: aligning practice with evidence.

Since the flexible Levin tube was introduced in 1921, enteral feeding has become ubiquitous. From the out-set, nurses have been responsible for confirming the correct placement of enteral feeding tubes prior to their use for alimentation or medication administration, but current nursing practice doesn't always reflect the best evidence. Although research has established the inadequacy of auscultation to determine proper tube placement, this method is still commonly practiced. The authors examine the research that's been conducted over the past 25 years and compare the accumulated evidence with current practice, as reflected in a convenience sample of 28 New England hospitals. In addition, they evaluate various methods for assessing enteral feeding tubes and make evidence-based practice recommendations.

Making healthy connections: introducing nursing as a career choice to middle school students.

The current economic climate has resulted in many experienced nurses returning to the workforce. Despite this, the nursing shortage is looming in our future and the recruitment of a diverse nursing workforce reflective of the population remains a high priority. The Merrimack Valley in northeastern Massachusetts has two large cities, Lawrence and Lowell, in which the Hispanic and the Southeast Asian populations are disproportionately higher than state and national levels. Through the University of Massachusetts Lowell's Bring Diversity to Nursing Project, partnerships with both city school systems were developed and after-school programs aimed at highlighting nursing as a career choice were initiated. Mr. Thompson's Heart is the focus of a middle school, pre-entry program developed by faculty. Introducing career choices in middle school gives students fundamental information about careers and how to begin investigating them. Mr. Thompson's Heart introduces nursing as a career choice combining career information with a focus on developing healthy lifestyle habits. Multiple hands on activities create excitement and interest in the nursing profession.

Dehydration reduction in community-dwelling older adults: perspectives of community health care providers.

Dehydration is a common problem among older adults and can negatively affect their health. This cross-sectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participants identify dehydration as a problem affecting older adults, and 94% noted the need for a public campaign on dehydration awareness and reduction. Four major themes emerged: Intentional Avoidance and Caution, Lack of Awareness/Education/Understanding, Poor Access to Fluids, and Social and Environmental Influences. Strategies identified to promote hydration in community-dwelling older adults included community partnerships, community education, community engagement, and interdisciplinary approaches. This study provides useful information and detailed strategies recommended by health care providers for designing interventions to promote hydration for community-dwelling older adults.