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1.
J Am Assoc Nurse Pract ; 32(6): 416-418, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32511190

RESUMO

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


Assuntos
Competência Clínica/normas , Enfermagem Geriátrica/normas , Profissionais de Enfermagem/educação , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
2.
J Nutr Health Aging ; 24(4): 398-403, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32242207

RESUMO

OBJECTIVE: To investigate olfactory function in elderly subjects requiring nursing care to clarify its association with appetite and nutritional status. SETTING: Facility for the elderly requiring nursing care. PARTICIPANTS: The subjects were 158 elderly people requiring nursing care and 37 elderly people not requiring nursing care. MEASUREMENTS: Experiment I: Olfactory function and factors (cognitive function, appetite, and nutritional status) that may be associated with it were compared between the elderly subjects requiring nursing care and those not requiring nursing care using covariance analysis in consideration of age. For evaluation, the OSIT-J was used for olfactory function, the HDS-R for cognitive function, the CNAQ for appetite, and BMI for nutritional status. Experiment II: The subjects were the same elderly subjects requiring nursing care in Experiment I, and food intake was surveyed in addition to the OSIT-J, HDS-R, CNAQ, and BMI. A univariate linear regression analysis was performed with OSIT-J as the response variable, and age, HDS-R, CNAQ, BMI, and food intake as the explanatory variables. RESULTS: Experiment I: On covariance analysis, the OSIT-J score was significantly lower for the elderly subjects requiring nursing care than for those not requiring nursing care (p<0.01). The mean score was 8 or lower in both groups, demonstrating lower olfactory function in both groups. Regarding factors that may be associated with olfactory function, a significant difference was noted in the HDS-R (p<0.01), confirming significantly lower cognitive function in the elderly subjects requiring nursing care. No significant difference was noted in the CNAQ or BMI. Experiment II: On a univariate linear regression analysis, an association with the OSIT-J was noted for age and HDS-R. Age was inversely correlated and the HDS-R was positively correlated. Factors associated with lower olfactory function in the elderly subjects requiring nursing were age and cognitive function, whereas appetite, nutritional status, and food intake were not associated. CONCLUSION: Olfactory function in elderly subjects requiring nursing care was poorer than that in those not requiring nursing care, suggesting that aging and cognitive decline are associated with lower olfactory function. In addition, no association of lower olfactory function with appetite, nutritional status, or food intake was noted in the elderly subjects requiring nursing care.


Assuntos
Apetite/fisiologia , Enfermagem Geriátrica/normas , Estado Nutricional/fisiologia , Olfato/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
3.
Nurs Ethics ; 27(4): 979-990, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31975637

RESUMO

BACKGROUND: The international health workforce crisis had led to an increasing shortage of nurses, which has substantial implications for the quality of patient care. This shortage potentially results in nurse-perceived time pressure, which can be particularly challenging for nurses who provide care for older persons. OBJECTIVE: This study aimed to show how geriatric nurses experience working under time pressure, perceive its impact on care and deal with time pressure in daily care. RESEARCH DESIGN: A qualitative descriptive interview design was used. PARTICIPANTS AND RESEARCH CONTEXT: Purposive sampling led to the inclusion of 11 nurses from three geriatric nursing wards in two general hospitals in Flanders (Belgium). Data were collected using semi-structured in-depth interviews and analysed using the QUAGOL (Qualitative Analysis Guide of Leuven). ETHICAL CONSIDERATIONS: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven (Ethics committee of the University Hospitals Leuven). FINDINGS: In all interviews, time pressure was described as ubiquitous in the daily care of older persons. A sense of failure in providing care was the common thread in many interviews. Nurses felt compelled to 'reduce' good-quality care to basic care by focusing on the physical and visible aspects of care. Nevertheless, personal experiences with time pressure and strategies to cope with it differed among the interviewees. These variations were related to the working environment and the nurses themselves. They underscored the importance of nurses' perspectives for a good understanding of the phenomenon of time pressure. DISCUSSION AND CONCLUSION: Working under time pressure in the care of older persons leads to various important challenges for nursing ethics. The findings show that providing care that promotes the human dignity of older persons in busy working environments in which care is rationed is an important ethical challenge. As such, our study offers a baseline for further research and discussion on how to support nurses working under time pressure.


Assuntos
Atitude do Pessoal de Saúde , Enfermagem Geriátrica/normas , Enfermeiras e Enfermeiros/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Qualidade da Assistência à Saúde/normas , Gerenciamento do Tempo/psicologia , Carga de Trabalho/psicologia , Adulto , Bélgica , Feminino , Teoria Fundamentada , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Local de Trabalho , Adulto Jovem
7.
J Adv Nurs ; 75(11): 3078-3087, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31222778

RESUMO

AIM: During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. METHODS: The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. DISCUSSION: There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. IMPACT: This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. TRIAL REGISTRATION NUMBER: ISRCTN: 74345449.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Enfermagem Geriátrica/normas , Enfermagem Holística/normas , Planejamento de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Colaboração Intersetorial , Masculino , Pesquisa Qualitativa , Inquéritos e Questionários
9.
J Clin Epidemiol ; 113: 58-63, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31129259

RESUMO

BACKGROUND: A systematic review (SR) was conducted to evaluate the comparative effectiveness of geriatrician-led models of care, and an integrated knowledge translation (iKT) approach facilitated SR relevance. Activities to engage knowledge users (KUs) in the SR were evaluated for perceived level of engagement. STUDY DESIGN AND SETTING: KUs included patients, caregivers, geriatricians, and policymakers from three Canadian provinces. Activities included 1) modified Delphi to select outcomes; 2) cross-sectional survey to select outcome measures, and 3) in-person meeting to discuss SR findings. KU engagement was assessed using the Patient Engagement Evaluation Tool (PEET) after the second and third activities. KUs rated the extent of successful engagement using a 7-point Likert scale ranging from "no extent" to "very large extent." RESULTS: In total, 15 KUs completed the PEET: eight geriatricians, four policymakers, two patients, and one caregiver. Median engagement scores across all activities (median range: 6.00-6.50) indicated that KUs felt engaged. Differences were observed for activity type; perceived engagement at in-person meeting resulted in higher meta-criteria scores for trust (P = 0.005), legitimacy (P = 0.003), fairness (P = 0.013), and competency (P = 0.035) compared with online activities. CONCLUSIONS: KUs can be engaged meaningfully in SR processes. Their perceived engagement was higher for in-person than for online activities.


Assuntos
Cuidadores/psicologia , Enfermagem Geriátrica/normas , Geriatras/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente/psicologia , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Canadá , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Enfermagem Geriátrica/estatística & dados numéricos , Geriatras/estatística & dados numéricos , Humanos , Masculino , Participação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Pesquisa Médica Translacional/estatística & dados numéricos
10.
Nurse Educ Today ; 78: 19-24, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029954

RESUMO

BACKGROUND: Malnutrition is a debilitating and highly prevalent condition in acute hospital settings especially in older person; however international literature revealed negative attitudes in providing nutritional care among nurses and health professionals. Few studies have investigated attitudes towards nutritional care among nursing students, there are no data regarding the Italian context. OBJECTIVES: The aim of this study was to explore nursing students' attitudes towards nutritional care in older people. DESIGN: A multicentre cross-sectional survey incorporating a pre post design. SETTING AND PARTICIPANTS: A convenience sample of nursing students of the bachelor's degree in Nursing in the three hospitals were recruited. METHODS: Nursing students completed "The Staff Attitudes to Nutritional Nursing Care Geriatric Scale (Italian version) (SANN_GITA scale)"; first year students completed the scale before (T0) and after (T1) lectures about nutrition and nutritional care. RESULTS: 245 students were enrolled (response rate 88.4%). The overall score of sample attitudes was Median(Me) = 66 (IQR = [60; 72]); at the variation of the year the neutral attitudes are prevalent with a significant tendency to increase the positive attitudes (p < .003) and there is a statistically significant difference (p < .05) in all dimensions except the "habits" dimension "(P = .1126). After two months from the end of the lessons regarding nutritional care there is an increase in subjects with neutral attitudes and a decrease in those with negative attitudes (P = .05). CONCLUSIONS: This study revealed a progressive improvement of the attitudes during the three-year course, underling the importance of nutritional contents provided; understanding the most critical aspects about nutritional care can be helpful in understanding in which areas university education should be improved, in order to train nurses able to assess and face with each patients' assistance need.


Assuntos
Atitude do Pessoal de Saúde , Apoio Nutricional/métodos , Estudantes de Enfermagem/psicologia , Adulto , Estudos Transversais , Feminino , Enfermagem Geriátrica/métodos , Enfermagem Geriátrica/normas , Humanos , Itália , Masculino , Apoio Nutricional/normas , Inquéritos e Questionários
12.
J Gerontol Nurs ; 45(5): 5-10, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31026326

RESUMO

The objective of the current study was to investigate the perspectives of nursing home (NH) providers regarding the requirements to achieve reimbursement for nursing restorative care (NRC) services and propose recommendations to state agencies to assist NH providers to conduct NRC programs that are person-centered and able to achieve full reimbursement. Methods included a survey of NH providers in one state and a stakeholder focus group to discuss survey findings and develop recommendations. Key findings are that NH providers perceive value to residents from the provision of NRC; providers do not associate these benefits with the stringent reimbursement requirements; and NHs often provide NRC that is individualized, based on resident goals and activity tolerance, as well as realistic given competing demands on staff, even when doing so means giving up reimbursement for NRC services. Recommendations include basing reimbursement for NRC on outcomes rather than the process; reconsideration of the frequency and intensity requirements for NRC components; and increased availability of NRC training/education and resources for providers and case-mix reviewers. [Journal of Gerontological Nursing, 45(5), 5-10.].


Assuntos
Enfermagem Geriátrica/economia , Enfermagem Geriátrica/normas , Assistência de Longa Duração/economia , Assistência de Longa Duração/normas , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/normas , Enfermagem em Reabilitação/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/economia , Doença Crônica/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/economia , Casas de Saúde/normas , Guias de Prática Clínica como Assunto , Estados Unidos
13.
J Gerontol Nurs ; 45(5): 17-22, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31026328

RESUMO

Older adults with Down syndrome (DS) and dementia are an emerging sub-population. With much longer life spans than decades ago, issues have arisen as to where these aging adults will live and how nurses and other staff in facilities can provide effective care to these individuals. The current article presents a research study that examined the learnings of nurses and staff members working within a western Canadian program for older adults with DS and dementia. These learnings include: the importance of learning from each other; importance of collaboration; how individuals with developmental disabilities communicate; older adults with DS and dementia differ from older adults with dementia; and residents' impact on staff. [Journal of Gerontological Nursing, 45(5), 17-22.].


Assuntos
Demência/enfermagem , Deficiências do Desenvolvimento/enfermagem , Síndrome de Down/enfermagem , Enfermagem Geriátrica/normas , Assistência de Longa Duração/normas , Enfermagem em Neurociência/normas , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Humanos , Masculino
14.
J Gerontol Nurs ; 45(5): 23-29, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31026329

RESUMO

The purpose of the current project was to determine the effectiveness of training and communication tools used as intervention strategies to reduce unnecessary emergency department transfers of assisted living facility (ALF) residents. Two communication protocols (SBAR and STOP and WATCH) were introduced to standardize clinical communication among licensed practical nurses (LPNs) and clinical providers. Twenty-nine LPNs working in an ALF with 172 units were recruited. LPNs participated in an intervention intended to improve knowledge on geriatric syndromes. Pre- and postintervention testing revealed improved LPN knowledge of geriatric syndromes. A satisfaction survey indicated positive LPN acceptance of the standardized communication tools. Through daily auditing of charts, adherence with use of the SBAR tool was 87%. This evidence-based, educational intervention project aimed to improve nursing staff geriatric knowledge, monitor nurse adherence to using the SBAR and STOP and WATCH tools, and assess overall satisfaction with use of SBAR. [Journal of Gerontological Nursing, 45(5), 23-29.].


Assuntos
Moradias Assistidas/normas , Serviços Médicos de Emergência/normas , Enfermagem Geriátrica/educação , Enfermagem Geriátrica/normas , Recursos Humanos de Enfermagem no Hospital/educação , Transferência de Pacientes/normas , Melhoria de Qualidade/normas , Adulto , Idoso , Comunicação , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
15.
J Contin Educ Nurs ; 50(3): 127-133, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30835323

RESUMO

BACKGROUND: Many nurses working in hospitals are not prepared to provide appropriate care for older people. This qualitative study aimed to identify factors influencing the development of gerontological nursing competence in Iranian hospitals. METHOD: Twenty-six participants (nine nurses, 12 nurse managers, four clinical instructors, one physician) who worked in four teaching hospitals and nursing schools were interviewed by semistructured interview method. Conventional content analysis was used. RESULTS: Two main categories emerged from the data: (a) management factors with the subcategories of meritocracy in elderly nursing, leadership style of nursing managers, educational system, the quality of working life, and performance management; (b) organizational factors with the subcategories of organizational learning, and organizational support. CONCLUSION: These findings can help nurse managers and clinical instructors identify, develop, and implement strategies for further development of gerontological nursing competence. [J Contin Educ Nurs. 2019;50(3):127-133.].


Assuntos
Competência Clínica/normas , Educação Continuada em Enfermagem/normas , Enfermagem Geriátrica/educação , Enfermagem Geriátrica/normas , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/normas , Adulto , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
16.
J Gerontol Nurs ; 45(3): 21-30, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30789986

RESUMO

The goal of this quality improvement project is to improve care planning around preferences for life-sustaining treatments (LST) and daily care to promote quality of life, autonomy, and safety for U.S. Department of Veterans Affairs (VA) Community Living Center (CLC) (i.e., nursing home) residents with dementia. The care planning process occurs through partnerships between staff and family surrogate decision makers. This process is separate from but supports implementation of the LST Decision Initiative-developed by the VA National Center for Ethics in Health Care-which seeks to increase the number, quality, and documentation of goals of care conversations (GOCC) with Veterans who have life-limiting illnesses. The current authors will engage four to six VA CLCs in the Mid-Atlantic states, provide teams with audit and feedback reports, and establish learning collaboratives to address implementation concerns and support action planning. The expected outcomes are an increase in CLC residents with dementia who have documented GOCC and LST plans. [Journal of Gerontological Nursing, 45(3), 21-30.].


Assuntos
Demência/enfermagem , Enfermagem Geriátrica/normas , Casas de Saúde/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/normas , United States Department of Veterans Affairs/normas , Veteranos/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
17.
J Gerontol Nurs ; 45(3): 31-42, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30789987

RESUMO

Given the high co-occurrence of age and hypercholesterolemia, there is a critical need for age-appropriate evidence for achieving normal cholesterol levels. The purpose of the current review was to map recent evidence (i.e., past 5 years) on hypercholesterolemia management in older adults and identify gaps in the evidence. Electronic searches in PubMed, CINAHL, and Scopus were conducted. Inclusion criteria were age 65 or older and lipid panel outcome. Exclusion criteria were a mixed age sample and familial hypercholesterolemia. An initial pool of 3,176 unique records resulted in 26 articles that met inclusion criteria. Arksey and O'Malley's scoping study framework was used. Sample sizes ranged from 12 to 1,010 (N = 8,509) adults ages 65 to 96. Evidence supports the use of exercise, diet, and statins in older adults. Laboratory, intervention, and methodological gaps were identified. Much remains to be examined in safely managing older adults with hypercholesterolemia, including determining time to behavior change in nonpharmacological interventions and contextual factors influencing adherence. [Journal of Gerontological Nursing, 45(3), 31-42.].


Assuntos
Enfermagem Geriátrica/normas , Hipercolesterolemia/enfermagem , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
19.
J Healthc Qual ; 41(1): 23-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29794813

RESUMO

The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms. Completion of the geriatric assessments by nursing staff in patients aged 65 years and older and measures of patient mobility and prevalence of an abnormal delirium screening score were compared preintervention and postintervention. Postintervention, the completion of the assessments for current functional status and delirium improved (62.5% vs. 88.5%, p < .001) and (4.2% vs. 96.5%, p < .001). In a subsample analysis, in the postintervention period, more patients were up to the chair in the past day (36.4% vs. 63.5%, p = .04) and the prevalence of an abnormal delirium screening score was lower (13.6% vs. 4.8%, p = .16). The Virtual ACE Intervention is a feasible model for disseminating ACE Unit principles to non-ACE Units and may lead to increased adherence to care processes and improved clinical outcomes.


Assuntos
Cuidados Críticos/normas , Avaliação Geriátrica/métodos , Enfermagem Geriátrica/normas , Enfermagem Médico-Cirúrgica/normas , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto
20.
J Gerontol Nurs ; 44(12): 11-16, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30484843

RESUMO

Care plans guide and document achievement of short- and long-term goals. However, most care plans are discipline oriented, document medical problems, and lack person-centered information such as care preferences. The current authors' goal was to explore the status of comprehensive care plans and the future application of sharing data among health care providers and settings. Semi-structured interviews were conducted among a variety of professionals in six geographically diverse settings to learn the status and performance of care plans. Various biases, regular and irregular omissions, and lack of long-term perspectives in the care plan generation processes were found. These deficits support the need for developing comprehensive standardized care plans to improve access, coordination, and quality of care for older adults. Nurses are in an ideal position to lead local, state, and national initiatives to drive policies for comprehensive care plans that will improve access to and quality of care delivery to older adults. [Journal of Gerontological Nursing, 44(12), 11-16.].


Assuntos
Enfermagem Geriátrica/normas , Liderança , Papel do Profissional de Enfermagem , Planejamento de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
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