Geriatric Nursing

2012-01-01

Editorial Board

2012-01-01

Information for Readers

2012-01-01

Information for Authors

2012-01-01

There Is Absolutely NOT a Doctor in This House!

Barbara Resnick — 2012-01-01

In October 2004, the membership of the American Association of Colleges of Nursing (AACN) adopted the Doctorate of Nursing Practice (DNP) Position Statement suggesting that entry level for advanced practice nurses should transition from the master’s degree to that of a doctorate of nursing practice. This recommendation was the result of extensive study, review, and consultation with multiple stakeholders and is based on multiple concerns. Specifically, this involved a belief that practice demands and the increasingly complex health care system (even before the Affordable Care Act!) in our country resulted in a need to expand education for those who would be practicing at an advanced level. Additional rationale included such things as the finding that the number of credits within many master’s degree programs were close to that of a doctorate and a desire to be consistent with other professions such as physical therapy and pharmacy, which had already moved to require entry level of practice to be a doctorate.

Developing a Self-Reported Tool on Fall Risk Based on Toileting Responses on In-Hospital Falls

2011-11-07

The aim of this cohort study was to determine the predictive value of a 2-item self-reported questionnaire regarding in-hospital toileting behavior for predicting falls in older inpatients and to compare its performance with an existing state-based falls assessment scale. Between May 28, 2009 and January 30, 2010, we assessed aged care inpatients for risk of falls using the standard STRATIFY fall screening tool and the 2-item self-reported questionnaire developed for this study. The participants were then followed up, with the primary outcome being the occurrence of falls. Results indicated that participants who were unable to answer the 2-item questionnaire appropriately or sensibly were 14.1 times (confidence interval [CI]: 4.4–45, p <. 001) to 17.0 times (CI: 6.7–43, p < .001) more likely to fall than those who gave an appropriate negative or positive answer. Participants who were assessed to be at high risk of falls on the STRATIFY scale were 9.5 times (odds ratio: 9.5, CI: 1.3–72, p = .03) more likely to fall than those who were low risk. In conclusion, a simple bedside questionnaire regarding patients’ toileting behavior with a careful appraisal of answers for appropriate and inappropriate answers may be used as a quick screening tool of fall risk.

The Conceptualization and Measurement of Individualized Care

Andreas Charalambous, Neena L. Chappell, Jouko Katajisto, Riitta Suhonen — 2011-11-17

Individualized nursing care, a form of person-centered care delivery, is accepted as best practice, yet its implementation into actual care is far from complete. Appropriate measures of this elusive concept are needed to better understand barriers to implementation. This study explored and tested the convergent validity and the reliability of 2 individualized nursing care measures. A cross-sectional survey design was used to collect data using the Individualized Care Scale and the Individualized Care Instrument (ICI) from a sample of nurses (n = 263, response rate 71%) working in older peoples' care settings in Finland, and the data were analyzed statistically. Cronbach's alpha coefficients for the ICI scales (.63–.80) and ICS-A and B subscales (both α = .91) demonstrated only moderate correlation between the 2 instruments (r = –.39 to .50) and possibly the complexity of measuring “individualized care.” The study acknowledges the latent influence of culture and care approach to the conceptualization of individuality. It concludes that the concept may best be measured at this point with the use of other factors in addition to instruments to capture its multiple domains.

An Internet Training to Reduce Assaults in Long-Term Care

2012-01-03

Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach nurse aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved 2 weekly visits to the online training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. Hierarchical linear models showed significant group differences at T2 in knowledge, and these levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were nonsignificant at T2 but decreased significantly from T1 to T3 with a large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.

Outcomes from the Implementation of a Facility-Specific Evidence-Based Falls Prevention Intervention Program in Residential Aged Care

2012-01-03

For residents in long-term care facilities, falling is a major concern requiring preventive intervention. A prospective cohort study measured the impact of falls reduction following the implementation of evidence-based fall prevention interventions in 9 Australian residential care facilities. An external project team provided a comprehensive audit of current practice. Facilitated by an action research approach, interventions were individualized to be facility- and patient-specific and included the following: environmental modifications such as low beds and height-adjustable chairs, movement alarms, hazard removal, and hip protectors. Participants included 670 residents and 650 staff from 9 facilities across 3 states. A significant reduction of falls were observed per site in the proportion of fallers (P = .044) and single fallers (P = .04). However, overall the number of falls was confounded by multiple falls in residents. Reduction in fallers was sustained in the 6-month follow-up phase. Positive outcomes from interventions varied between facilities. Further research is necessary to target frequent fallers.

Analgesic Warfare: Acetaminophen, Really?

Barbara J. Zarowitz — 2012-01-03

The first medication recommended in the treatment of mild-to-moderate pain in older persons is almost always acetaminophen. Acetaminophen is available over the counter (OTC) without a prescription, is inexpensive, and consumers understand how to administer it—or do they? In the United Kingdom, death associated with accidental overdose, suicide, and low-dose chronic ingestion of paracetamol (acetaminophen) resulted in the 1998 policy change in Great Britain to decrease the package size of paracetamol to no greater than 32 tablets in pharmacies and 16 tablets in other retail outlets. Independent analysis identified that the suicide rates in general declined in the United Kingdom before implementing the decreases in paracetamol package size, leading authors to question what effect, if any, was contributed by the 1998 policy change.

What’s New for 2012

Susan A. Turner — 2012-01-03

On March 23, 2010, President Obama signed the Affordable Care Act (the ACA). This law puts in place a number of health insurance reforms that have rolling effective dates. Some of the changes called for under the ACA are effective already, but a number of the law’s provisions are set to roll out between now and 2014. The following is a summary of 3 new provisions of the ACA that become effective in 2012.

Infectious Disease in Assisted Living: Controlling the Enemy Is in Our Hands!

Richard G. Stefanacci, Dan Haimowitz — 2012-01-01

The Assisted Living Column has two new editors! I want to take a moment to thank Karen Love for championing the column for the past year. Karen is a speech pathologist and long-term care administrator with more than 25 years experience in aging services. She currently works as a consultant and education via her company, Pathways to Care, and serves as the managing director for the National Center for Excellence in Assisted Living (CEAL).

Gotcha! Don’t Let Ageism Sneak into Your Practice

Sarah H. Kagan — 2012-01-01

Ageism pops up in health care when you least expect it. Have you examined your own practice and that of your colleagues for implicit ageism lately? Discrimination on the basis of chronological age is perhaps the most pervasive unacknowledged prejudice in our society. Ageism is socially acceptable discrimination. Consider how many times you hear statements such as “too old for…” arise in daily conversations or receive birthday cards that lampoon old age in stereotypic or even derisive terms. Recently, a patient reminded me that ageism sneaks into health care and changes lives, and most often not for the better. In this essay, I share my patient’s story and discuss how ageism appears and what it risks, concluding with strategies to avoid ageism in your practice and on your unit.

A Dedicated Learning Unit in Long-Term Care: A Clinical Immersion for Student Nurses

Kereen F. Mullenbach, Virginia Burggraf — 2012-01-01

Clinical experience is considered essential to prepare nursing students for practice. Dedicated learning units (DLU; also known as a dedicated education unit) that partner clinical staff and academics have been a successful model to achieve this outcome in acute care settings. However, none has been attempted in the US in long-term care (LTC). The development of the DLU in LTC was undertaken to immerse students in an LTC clinical experience. It involved using RNs in the LTC facility as preceptors in collaboration with nursing faculty. The purpose is to increase transfer of learning through collaboration of faculty and clinical preceptors to facilitate the experiential learning of student nurses and identify a LTC clinical immersion as a positive student experience. The DLUs were well received by both the facilities and the students. Students’ journal entries were very positive. Anecdotal discussion with patients indicated increased satisfaction with the care and attention from the students and an improved quality of life. The model is effective for student learning in gerontological nursing and preparing for a career in this specialty.

GAPNA President Message

2012-01-01

Elizabeth Galik It is an exciting time to be involved in the care of older adults. The burgeoning aging population with declining numbers of clinicians with geriatric expertise, health care reform, and the advancement of new models of care, such as medical homes, will require advanced practice nurses who care for older adults to serve as clinical experts, work collaboratively with members of the interprofessional team, and inspire and educate the next generation of clinicians. During the past year, the Gerontological Advanced Practice Nurses Association (GAPNA) completed a strategic planning process to set goals and priorities so that we may continue to grow and be successful in an ever-changing health care environment. GAPNA’s mission is to promote excellence in advanced practice nursing that enhances the well-being of older adults. GAPNA’s goals during the next 3 to 5 years focus on: 1) increasing the visibility of advanced practice nurses who care for older adults; 2) facilitating an engaged and valued membership community; 3) providing multiple opportunities for quality education and professional development; and 4) building capacity and influence in gerontological research, health policy, and practice. A complete copy of the strategic plan is available on the GAPNA website, and we are encouraging comments and feedback.

The Intersection of Nursing and Marketing: Keys to Success for This Unique Assisted Living Challenge

Josh Allen — 2012-01-03

There are approximately 1,000,000 residents living in more than 38,000 assisted living communities across the nation. An overwhelming majority (as high as 90%) of those residents are using private funds to pay for assisted living, with some receiving assisted living services through Medicaid waiver programs. This emphasis on private pay contributes to a consumer-driven model of care, but it also places increased significance on the role of marketing and sales activities. While recognizing the value of the consumer-driven nature of the industry, it is also important to recognize the need for marketing and nursing staff to work collaboratively to ensure that a particular assisted living community/provider is able to deliver on the care and services that are promised during the sales process.

New Course: Nursing Care of the Older Adult with Cancer

Barbara Bricoli — 2012-01-01

As the population of older adults swells, so grows the number of older adults with cancer. More than 60% of all cancer diagnoses are in adults aged over 65 years, and this number is expected to grow to 70% by 2030. Treatment of older adults is complicated by comorbid conditions, functional and psychological conditions, ageism, and other confounding factors. “Providing effective and tolerable cancer treatment for the growing number of older adult patients who have cancer will require an understanding of the role of aging, comorbidity, functional status, and frailty on treatment outcomes.”

Geriatric Nursing

Table of Contents

Editorial Board

Information for Readers

Information for Authors

There Is Absolutely NOT a Doctor in This House!

Developing a Self-Reported Tool on Fall Risk Based on Toileting Responses on In-Hospital Falls

The Conceptualization and Measurement of Individualized Care

An Internet Training to Reduce Assaults in Long-Term Care

Outcomes from the Implementation of a Facility-Specific Evidence-Based Falls Prevention Intervention Program in Residential Aged Care

Analgesic Warfare: Acetaminophen, Really?

What’s New for 2012

Infectious Disease in Assisted Living: Controlling the Enemy Is in Our Hands!

Gotcha! Don’t Let Ageism Sneak into Your Practice

A Dedicated Learning Unit in Long-Term Care: A Clinical Immersion for Student Nurses

GAPNA President Message

The Intersection of Nursing and Marketing: Keys to Success for This Unique Assisted Living Challenge

New Course: Nursing Care of the Older Adult with Cancer