Geriatric Nursing RSS feed: Current Issue. Geriatric Nursing is a comprehensive source for clinical information and management advice relating to the care of older adults. The journal's peer-reviewed articles report the latest developments in the management of acute and chronic disorders and provide practical advice on care of older adults across the long term continuum. Geriatric Nursing addresses current issues related to drugs, advance directives, staff development and management, legal issues, client and caregiver education, infection control, and other topics. The journal is written specifically for nurses and nurse practitioners who work with older adults in any care setting. Geriatric Nursing is the official journal of the American Assisted Living Nurses Association, National Gerontological Nurses Association, Gerontological Advanced Practice Nurses Association and is indexed in Medline, ISI and CINAHL.http://www.gnjournal.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Geriatric Nursing0197-4572313May 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.gnjournal.com/article/PIIS0197457210002168/abstract?rss=yesTable of Contents10.1016/S0197-4572(10)00216-8Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0153154http://www.gnjournal.com/article/PIIS019745721000217X/abstract?rss=yesEditorial Board10.1016/S0197-4572(10)00217-XGeriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0155155http://www.gnjournal.com/article/PIIS0197457210002193/abstract?rss=yesInformation for Readers10.1016/S0197-4572(10)00219-3Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0156156http://www.gnjournal.com/article/PIIS0197457210002181/abstract?rss=yesInformation for Authors10.1016/S0197-4572(10)00218-1Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0e1e2http://www.gnjournal.com/article/PIIS019745721000203X/abstract?rss=yes I have had the opportunity to be part of the Interdisciplinary Nursing Quality Research Initiative (INQRI) and, in my geriatric-centric focus, have encouraged the group to look across all the studies and consider specifically the impact of this work on care of older adults. Although many of the investigators come from acute care backgrounds and focus, the issues addressed and work being done will have a major impact on care of older adults.The Difference Nurses Are Making to Improve Quality of Care to Older Adults through the Interdisciplinary Nursing Quality Research Initiative10.1016/j.gerinurse.2010.04.001Geriatric Nursing 31, 3 (2010)2010-05-10Geriatric Nursing2010-05-10313S0197-4572(10)X0004-0From the Editor157164http://www.gnjournal.com/article/PIIS0197457210001886/abstract?rss=yesLong-term care (LTC) facilities face many challenges, including retention of qualified and caring staff and maintaining high-quality care. In 2008, the Institute of Medicine (IOM) reported widespread consensus that there are insufficient numbers of competent licensed and direct care staff to manage, supervise, and deliver high-quality care to the elderly population. Although examples of excellence in nursing home care exist, average quality of care has remained persistently low, and little progress has been made to improve safety in LTC. The Nursing Home Reform Act (which was included in the 1987 Omnibus Budget Reconciliation Act) mandates minimum staffing levels in Medicare and Medicaid certified LTC facilities. Although research has documented the importance of adequate staffing for quality of care, little attention has been placed on the productivity of staff and how this may impact care. The purpose of this article is to discuss the issue of worker presenteeism (reduced productivity due to health problems) and how this may be affecting quality of resident care. Strategies for nurse managers to recognize and address presenteeism are also discussed.The Impact of Worker Health on Long Term Care: Implications for Nursing ManagersSusan Letvak, Christopher J. Ruhm10.1016/j.gerinurse.2010.03.002Geriatric Nursing 31, 3 (2010)2010-04-26Geriatric Nursing2010-04-26313S0197-4572(10)X0004-0Feature Articles165169http://www.gnjournal.com/article/PIIS0197457210002004/abstract?rss=yesIntensive care unit (ICU) nurses occupy an essential role in facilitating patient communication and preventing the detrimental effects experienced by critically ill patients who are unable to speak, yet most are not equipped with the tools or training to enable communication most effectively with patients who are unable to speak. The goal of the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS-2) is to explore the impact of an innovative, Web-based instructional package for ICU nurses with pocket reference guides, an instructional manual, and the provision of “low-tech” augmentative and alternative communication materials on nursing care quality and patient clinical outcomes. We hypothesize that this intervention will 1) improve nurses' skills in assessing and communicating with ICU patients who are unable to speak and 2) increase the collaboration between nursing and speech-language pathology in addressing complex patient communication needs in the ICU.SPEACS-2: Intensive Care Unit “Communication Rounds” with Speech Language PathologyMary Beth Happ, Brooke M. Baumann, Jennifer Sawicki, Judith A. Tate, Elisabeth L. George, Amber E. Barnato10.1016/j.gerinurse.2010.03.004Geriatric Nursing 31, 3 (2010)2010-05-10Geriatric Nursing2010-05-10313S0197-4572(10)X0004-0Feature Articles170177http://www.gnjournal.com/article/PIIS0197457210002016/abstract?rss=yesAdults aged 65 and older account for one third of all hospitalizations in the United States. Almost one fifth (19.6%) of Medicare beneficiaries discharged from an acute care hospital are readmitted within 30 days. High readmission rates have been attributed to inadequate discharge preparation, lack of patient and family caregiver readiness, poor discharge transition coordination, and unsuccessful coping with the demands of daily living. Discharge needs may be different for older adults than for the general population because of the increased likelihood of multiple comorbidities, illness-induced limitations, impaired mobility, fatigue, anxiety, cognitive impairment, hearing impairments, health literacy deficits, and living alone.The purpose of this study was to investigate differences in perceptions of the quality of discharge teaching and readiness for hospital discharge and their relationship to postdischarge utilization of emergency department (ED) visits and readmissions across the older adult age spectrum. Of particular interest is the applicability of quality of discharge teaching and discharge readiness assessment tools for the older adult population.Age-Related Differences in Perception of Quality of Discharge Teaching and Readiness for Hospital DischargeKathleen L. Bobay, Teresa A. Jerofke, Marianne E. Weiss, Olga Yakusheva10.1016/j.gerinurse.2010.03.005Geriatric Nursing 31, 3 (2010)2010-05-10Geriatric Nursing2010-05-10313S0197-4572(10)X0004-0Feature Articles178187http://www.gnjournal.com/article/PIIS0197457210002028/abstract?rss=yesCare transitions are clinically dangerous times, particularly for older adults with complex health problems. This article describes the most common medication discrepancies identified by nurses during patients' (n = 101) hospital to home transition. Findings indicated that medication discrepancies were astoundingly widespread, with 94% of the participants having at least 1 discrepancy. The average number of medication discrepancies identified was 3.3 per participant. Medication discrepancies were identified in virtually all classes of medications, including those with high safety risks. Evidence-based best practices to reduce transition-related medication discrepancies are presented.Nurse Identified Hospital to Home Medication Discrepancies: Implications for Improving Transitional CareCynthia F. Corbett, Stephen M. Setter, Kenn B. Daratha, Joshua J. Neumiller, Lindy D. Wood10.1016/j.gerinurse.2010.03.006Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0Feature Articles188196http://www.gnjournal.com/article/PIIS0197457210002120/abstract?rss=yesIn the ongoing Interdisciplinary Nursing Quality Research Initiative Program study, we are testing the impact of Function-Focused Care, which is an approach to care in which we work with assisted living (AL) residents and staff to optimize the functional and physical activities of residents during daily activity. The purpose of this article is to evaluate life satisfaction of AL residents with a focus on the impact of physical activity. In a sample of 171 older adults from 4 ALs, it was found that depression, social support from friends and experts, time in caregiving, and fear of falling all had a significant relationship with life satisfaction in AL. Physical activity was not related to life satisfaction in this study. Ongoing research is necessary to explore whether changing attitudes about physical activity among older adults and increasing social support related to physical activity can improve life satisfaction.Satisfaction with Assisted Living: The Unexplored Role of Physical ActivityBarbara Resnick, Elizabeth Galik, Ann L. Gruber-Baldini, Sheryl Zimmerman10.1016/j.gerinurse.2010.04.010Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0Feature Articles197205http://www.gnjournal.com/article/PIIS0197457210002041/abstract?rss=yes The potential for interaction between dietary supplements and medications has been reported to range from as low as 21% to as high as 46% in recent studies evaluating concomitant use. Despite a high rate of dietary supplement interactions with medications, it may be as few as 29% that have clinical significance, and these can be attributed to a small number of dietary supplements that account for 68% of all interactions identified in one report. Familiarity with this information is important to geriatric care givers and providers, because of the increasing prevalence of dietary supplement use with age and disposable income.Complementary and Alternative Medicine: Dietary Supplement Interactions with MedicationBarbara J. Zarowitz10.1016/j.gerinurse.2010.04.002Geriatric Nursing 31, 3 (2010)2010-05-10Geriatric Nursing2010-05-10313S0197-4572(10)X0004-0Pharmacy Column206211http://www.gnjournal.com/article/PIIS0197457210002053/abstract?rss=yes In 2009, several field offices of the Drug Enforcement Agency (DEA) began enforcement actions against a number of pharmacies serving long-term care facilities (LTCFs) in Ohio, Michigan, Wisconsin, and Virginia, alleging that the practice of using “chart orders”—LTCF nurses calling or faxing prescriptions for Class II–V drugs to the pharmacies—violated certain DEA regulations. Long-term care pharmacies in these states have already been targeted by the DEA for inspection, and many now face huge fines. For example, 1 independent pharmacy was cited with more than 3,000 violations and faces fines of more than $32 million. Other pharmacies have changed their policies to reflect DEA regulations, resulting in significant delays in the delivery of pain medication to nursing facility residents.Medication Chart Orders and the DEA: Long–Term Care Facility Residents Caught in the MiddleSusan A. Turner10.1016/j.gerinurse.2010.04.003Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0Legal Column212213http://www.gnjournal.com/article/PIIS0197457210002065/abstract?rss=yesThe Drug Enforcement Agency (DEA) may be restricting the ability of RNs and LPNs in assisted living communities (ALCs) in some states to provide pain relief for residents. The DEAs enforcement of the requirements of the Controlled Substances Act (CSA) to reduce diversion of controlled substances (particularly Schedule II meds) for criminal or nefarious reasons, has generated a variety of responses by pharmacies, ALCs, and practitioners. Residents are at risk for—and some residents have already experienced—inadequate pain management. The argument seems to turn on whether an ALC (or nursing home or home health nurse) is an “agent” of the physician. The term “agent” is poorly defined in section 1300 of the CSA. It neither confirms that an ALC/long-term care (LTC) nurse/medical aide may function as an agent of the provider nor does the definition preclude the ALC/LTC nurse/medical aide as the agent of the provider. This article is an alert to ALCs to examine their controlled drug procurement and pain management procedures and is also a call to advocacy by ALC nurses.Pain Management and the U.S. Department of JusticeKimberley Garrison, Ethel Mitty10.1016/j.gerinurse.2010.04.004Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0Assisted Living Column214219http://www.gnjournal.com/article/PIIS0197457210002077/abstract?rss=yes In 2008, the Institute of Medicine report Retooling for an Aging America noted the chasm between the growing number of older Americans and the quantity of clinicians with sufficient geriatric expertise to care for them. In response to this provider shortfall, several initiatives were created to encourage the education of more geriatric specialists and to incorporate geriatric clinical competencies within the basic and continuing education of all nongeriatric disciplines.An Electronic Geriatric Specialist Workforce: Is It a Viable Option?Elizabeth Capezuti10.1016/j.gerinurse.2010.04.005Geriatric Nursing 31, 3 (2010)2010-05-10Geriatric Nursing2010-05-10313S0197-4572(10)X0004-0Acute Care of the Elderly Column220222http://www.gnjournal.com/article/PIIS0197457210002089/abstract?rss=yesType 2 diabetes is a serious medical condition that disproportionately affects older African Americans. The population of older African Americans is projected to increase, and so will the incidence of type 2 diabetes and its related complications. An important consideration in the care of community-dwelling older African Americans with type 2 diabetes is cognitive assessment and optimization of screening for cognitive impairment when working with older African Americans. This article describes the role of the gerontological nurse in the assessment of cognition in older African Americans diagnosed with diabetes mellitus type 2 and recommends the Mini-Cog as a quick, reliable and culturally appropriate tool available for use in the screening process.Diabetes in African Americans: The Critical Importance of Cognitive AssessmentChristine A. Ganzer, Neva L. Crogan10.1016/j.gerinurse.2010.04.006Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0NGNA Section223227http://www.gnjournal.com/article/PIIS0197457210002090/abstract?rss=yesIn February, several GAPNA members, including myself, Patty Kang, our first Health Affairs scholar; Charlotte Kelley, representing the NP Roundtable; and Pat Kappas-Larson, GAPNA's current president and health policy chair for American College of Nurse Practitioner (ACNP), attended the ACNP's Summit in Washington, DC. This annual meeting is an opportunity for advanced practice nurses (APNs) to gather, prioritize important legislative issues, and meet in person with congressional legislators or their aides. On March 21, 2010 the Heath Care Reform bill was passed by Congress. This law provides an ambitious attempt to make health care accessible to all Americans. We as Nurse Practitioners will continue to work diligently to make sure that the health care needs of older adults are met and that we, as APNs, are included as providers of that care.GAPNA Health Affairs Update March 2010Anna Treinkman10.1016/j.gerinurse.2010.04.007Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0GAPNA Section228233http://www.gnjournal.com/article/PIIS0197457210002107/abstract?rss=yesEnd-of-life treatment decisions are among the most personal choices an individual will make in his or her lifetime. Many factors will affect whether a person wants to receive life-sustaining treatment and the degree of medical interventions desired. One's faith, spiritual beliefs, personal preferences, family history, medical condition, and other issues must all be considered. The individual, his or her family, spiritual advisors, legal decision makers, the primary physician, and other medical professionals are often involved in the process of making end-of-life decisions.The POLST: Advocating for Assisted Living Residents' End-of-Life WishesJosh Allen10.1016/j.gerinurse.2010.04.008Geriatric Nursing 31, 3 (2010)2010-05-10Geriatric Nursing2010-05-10313S0197-4572(10)X0004-0AALNA Section234235http://www.gnjournal.com/article/PIIS0197457210002119/abstract?rss=yesOver the next several issues, we will be highlighting innovations at our NICHE hospitals. In this edition, we want to spotlight our own innovations. NICHE (Nurses Improving Care for Healthsystem Elders), has grown tremendously over the past 2 years, from 150 to 300 hospitals throughout North America. Today, health care reform is a reality, and NICHE's efforts to provide access to the most effective and efficient means to achieve systematic change in the quality of care to older adults are also reaching fruition. NICHE set out in 2007 to provide a Web-based platform to disseminate information and house the core components of the program. NICHE soon recognized the need to parlay the organization's nascent Web presence into a robust, online “training and education” center that would help NICHE hospitals ramp up their ability to meet the needs of the largest consumers of health care—older adults. Recent times have been turbulent but also hopeful. It is within this challenging climate that NICHE has sought ways to provide the highest quality of resources, deal with the harsh economic realities stemming from the 2008 recession, and help hospitals prepare for the quality imperatives underway via Centers for Medicaid and Medicare Services (CMS), Joint Commission, and other regulations as well as the impending health care reform legislation. Few would argue that quality improvement is key to providing exemplary care as well as lowering costs. Ultimately, NICHE faced the challenge of improving the delivery of the program while broadening its impact and reaching more hospitals.Evolution of a Web Presence: NICHE Launches New Web Site to Meet the Quality ImperativeBarbara Bricoli10.1016/j.gerinurse.2010.04.009Geriatric Nursing 31, 3 (2010)2010-05-01Geriatric Nursing2010-05-01313S0197-4572(10)X0004-0NICHE Section236238