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3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
11.
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
12.
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
13.
J Gerontol Nurs ; 44(12): 25-34, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30484845

RESUMO

Hospitalized older adults are at high risk for complications, leading to negative outcomes such as longer lengths of stay, hospital readmissions, and functional and cognitive decline. Comprehensive Geriatric Assessment (CGA) models are effective in mitigating these syndromes but are not widespread. Nurses with expertise in gerontology who can provide consultation and care coordination can improve care processes and clinical outcomes. This pilot study capitalized on the role of the geriatric nurse consultant (GNC) to develop, implement, and test the feasibility, acceptability, and utility of a GNC-led CGA. Through repeated applications with hospitalized patients, this study demonstrated that GNCs could complete a CGA and identify clinically actionable findings. This study also uncovered clinical geriatric concerns that would not have otherwise been identified via traditional nursing assessments. The results highlight contribution of a GNC-led CGA as a mechanism to support care process improvements to address common geriatric concerns in the acute care setting. [Journal of Gerontological Nursing, 44(12), 25-34.].


Assuntos
Consultores , Assistência à Saúde/normas , Avaliação Geriátrica/métodos , Enfermagem Geriátrica/normas , Papel do Profissional de Enfermagem , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estados Unidos , Adulto Jovem
14.
J Gerontol Nurs ; 44(12): 45-52, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30484847

RESUMO

The purpose of the current study was to determine the relationship between chronic condition symptoms and treatment burden in older adults transitioning from skilled nursing facilities to home. Treatment burden is defined as the burden associated with adhering to a prescribed chronic condition self-management regimen. Analysis of correlations between chronic condition symptoms and treatment burden revealed that symptoms and treatment burden are positively correlated (p < 0.05). Multivariate analysis (adjusted R2 = 0.40, F[10, 63] = 5.96, p < 0.001), controlling for other known antecedents of treatment burden, demonstrated that fatigue (standardized beta coefficient = 0.47, p < 0.001) predicted higher levels of treatment burden. Post hoc analysis revealed caregiver presence partially mediated the effect of fatigue on treatment burden, decreasing treatment burden during transition. Findings support existing transitional care literature suggesting that clinical assessment, including symptom screening, treatment of symptoms, and/or intervention reducing the impact of symptoms on patients' health and well-being, may lower treatment burden, thus improving self-management adherence. [Journal of Gerontological Nursing, 44(12), 45-52.].


Assuntos
Doença Crônica/enfermagem , Enfermagem Geriátrica/estatística & dados numéricos , Enfermagem Geriátrica/normas , Casas de Saúde/normas , Instituições de Cuidados Especializados de Enfermagem/normas , Cuidado Transicional/estatística & dados numéricos , Cuidado Transicional/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Estados Unidos
15.
J Gerontol Nurs ; 44(11): 10-19, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30358886

RESUMO

The current study operationalized, assessed, and evaluated the feasibility and preliminary effects of implementing a person-centered approach to incontinence care for older adults with cognitive decline in residential care facilities (RCFs) in Sweden. Twenty health care workers were purposively sampled from two intervention RCFs. Process outcome was measured as number of assessments conducted for incontinence management. Impact outcome measures were quality of life, basal assessment of incontinence, incontinence actions taken, and personally chosen incontinence aids. A usual care control group RCF was matched by resident case-mix and geographic region. Introduction of a person-centered approach showed an increase in residents' quality of life in the intervention group compared to baseline and the control group. A positive effect was found on the number of urinary incontinence assessments conducted (p < 0.05). In addition, the number of person-centered caring actions (e.g., toilet assistance) was significantly higher during and 6 months after implementation of the person-centered approach. Implementing a person-centered approach in clinical practice focused on incontinence care, quality of care, and quality of life is supported for RCF residents. [Journal of Gerontological Nursing, 44(11), 10-19.].


Assuntos
Assistência à Saúde/normas , Incontinência Fecal/enfermagem , Enfermagem Geriátrica/normas , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde/normas , Incontinência Urinária/enfermagem , Idoso , Idoso de 80 Anos ou mais , Moradias Assistidas , Disfunção Cognitiva/complicações , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Casas de Saúde , Qualidade de Vida , Suécia
16.
J Hosp Palliat Nurs ; 20(3): 272-278, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30063678

RESUMO

This study aimed to develop an end-of-life (EOL) care nursing attitude scale for Japanese geriatric nurses (ELNAS-JG). The items of the ELNAS-JG were developed to cover important topics related to EOL care (eg, motivation for providing EOL care, pain and symptom management, and decision-making support care for older adults). Participants were 1663 nurses employed in 32 institutions across Japan. Of these, 1298 participants were analyzed. An exploratory factor analysis of the 26 scale items revealed a 3-factor solution describing the concepts of responsibility, willingness, and confidence: responsibility and willingness were captured in factor 1 (16 items), and confidence was split into factor 2 (6 items) and factor 3 (4 items) to capture individual and collaborative behaviors. The overall Cronbach α coefficient for the 26 items was 0.95, and the intraclass correlation coefficient was 0.83. Overall, the ELNAS-JG was confirmed to have good internal consistency, test-retest reliability, content validity, known-groups validity, and construct validity. It can comprehensively measure nurses' attitudes toward EOL care for older adults in any EOL setting. Furthermore, this scale can be used to evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.


Assuntos
Atitude do Pessoal de Saúde , Enfermeiras e Enfermeiros/psicologia , Psicometria/normas , Assistência Terminal/normas , Adulto , Idoso , Estudos Transversais , Feminino , Enfermagem Geriátrica/métodos , Enfermagem Geriátrica/normas , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Assistência Terminal/métodos , Assistência Terminal/psicologia
17.
J Gerontol Nurs ; 44(9): 21-29, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30148529

RESUMO

Older adults are vulnerable to falls that result in injury and disability, making fall prevention a national priority. The purpose of the current study was to evaluate community-dwelling older adults' perceptions about falls and fall prevention activities to guide interventions. Participants had high awareness of falls and believed that they could reduce their risk of falling. Approximately three fourths of participants reported taking actions to reduce risk of falling; however, participation in community fall prevention programs was low. The survey used provides a method to help nurses identify targets for fall prevention interventions to reduce this physical health disparity in vulnerable older populations. [Journal of Gerontological Nursing, 44(9), 21-29.].


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Enfermagem Geriátrica/normas , Guias de Prática Clínica como Assunto , Gestão da Segurança/estatística & dados numéricos , Gestão da Segurança/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Inquéritos e Questionários
18.
Injury ; 49(8): 1409-1412, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29958688

RESUMO

The challenge of caring for patients with fragility fractures is particularly acute for nursing teams who are in short supply and work with patients following fracture on a 24 h basis, coordinating as well as providing complex care. This paper considers the role of nurses within the orthogeriatric team and highlights the value of effective nursing care in patient outcomes. It explores the nature of nursing for patients with fragility fracture with a focus on the provision of safe and effective care and the coordination of care across the interdisciplinary team. It also highlights the need for specific skills in orthopaedic and geriatric nursing as well as specialist education.


Assuntos
Enfermagem Geriátrica/normas , Geriatria , Enfermeiras Clínicas/normas , Fraturas por Osteoporose/enfermagem , Equipe de Assistência ao Paciente , Qualidade da Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Pesquisa sobre Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Relações Enfermeiro-Paciente , Ortopedia , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/reabilitação
19.
J Nurs Scholarsh ; 50(5): 513-521, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30051573

RESUMO

PURPOSE: To test the relationships between the geriatric practice environment, geriatric nursing practice, and overall quality of care for older adults and their families as reported by nurses working in hospitals, while controlling for nurse and hospital characteristics. DESIGN: A cross-sectional tailored survey design was employed. A questionnaire was mailed to a randomly selected sample of nurses whose primary practice area was medicine, surgery, geriatrics, emergency, or critical care in acute care hospitals in Ontario, Canada. METHODS: Participants (N = 2,005) working in 148 hospitals responded to validated measures of the geriatric practice environment, geriatric nursing practice, overall quality of care for older adults and their families, and nurse and hospital characteristics. The relationships were tested using structural equation modeling. FINDINGS: Controlling for nurse and hospital characteristics, the geriatric practice environment had a statistically significant positive relationship of large magnitude with both geriatric nursing practice (ß = 0.52) and overall quality of care (ß = 0.92); however, the indirect relationship between the geriatric practice environment and overall quality of care, mediated by geriatric nursing practice, was not significant (ß = -0.02). Final model fit was acceptable, with the root mean square error of approximation = 0.07, comparative fit index = 0.93, and Tucker-Lewis Index = 0.87. CONCLUSIONS: A strong geriatric practice environment positively and directly influences geriatric nursing practice and overall quality of care for older adults and their families but does not appear to influence overall quality of care indirectly through geriatric nursing practice. CLINICAL RELEVANCE: The results can be used as the basis for promoting practice environments that support overall quality of care and geriatric nursing practice in acute care hospitals.


Assuntos
Enfermagem Geriátrica/normas , Serviços de Saúde para Idosos/normas , Qualidade da Assistência à Saúde/normas , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Enfermagem Geriátrica/organização & administração , Humanos , Masculino , Recursos Humanos de Enfermagem no Hospital , Ontário , Inquéritos e Questionários
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