Journal of gerontological nursing最新文献

Purpose: To increase follow up with the primary care team via telephone outreach within 3 days of emergency department (ED) discharge to schedule a follow-up visit within 14 days. Secondary aims included: identifying high utilizers of the ED (defined as more than three ED visits within 6 months), reinforcing discharge instructions from the ED via nursing education on telephone follow ups, and identifying the reasons patients used the ED.

Method: Baseline data were gathered retrospectively by reviewing charts of patients discharged from the ED. Charts were reviewed from a biweekly automated report, and RNs initiated follow-up phone calls to patients discharged from the ED, offering appointments and providing pertinent nursing education.

Results: Primary care follow ups after ED discharges increased from 38% to 71% over 10 months with the new nurse-led workflow. Patients to whom the RN outreached to were more likely to attend their follow-up appointments. However, a 14-day follow-up appointment with the primary care provider (PCP) showed no significant difference in ED revisits or hospital admissions.

Conclusion: Follow up after ED discharge led to increased coordination of care. Nurses provided education about chronic conditions and reiterated discharge instructions that might have been unclear to patients in the ED. Further studies are needed to analyze the effect of follow up with the PCP on ED utilization and hospital admissions. [Journal of Gerontological Nursing, 50(3), 33-39.].

Purpose: Nurses are graduating ill-prepared to work with older adults across care contexts. The education nursing students receive about older adults often focuses on managing illnesses rather than promoting health. To expand the education that nursing students receive regarding health promotion and older adults, we examined nursing students' perceptions of an e-learning activity on health promotion with older adults.

Method: We used a cross-sectional survey design. We included first-year baccalaureate nursing students (N = 260) at a Canadian university. Students were required to complete the module, but only those who wanted to participate in the study completed the survey (n = 167; response rate = 64.2%). We used a feedback survey to assess students' perceptions of the e-learning activity using four 5-point, Likert-type items. We also asked one open-ended question to solicit participants' feedback and suggestions for improving the e-learning activity. Descriptive statistics (frequency, mean [SD]) were used to summarize participants' perceptions and demographic characteristics. Content analysis was used to explore responses to the open-ended question.

Results: Participants reported that the module increased their knowledge about health promotion, as well as their perceptions and confidence in working with older adults. Participants also found the method of instruction interactive and enjoyable.

Conclusion: Our e-learning activity on health promotion was perceived by nursing students as helpful in sensitizing them to their role in promoting health among older adults. [Journal of Gerontological Nursing, 50(3), 19-24.].

Purpose: Research demonstrates that aging in place is the goal of most adults aged >50 years. Unfortunately, multiple barriers to aging in place continue to exist, especially for vulnerable populations. Achieving this goal will require innovative nurse-led models of care and new policies for RN reimbursement. The current article describes a nurse-led clinic implemented in one community.

Method: Using an evidence-based nurse-led model of care, a team of university faculty, students, and a family nurse practitioner designed and implemented a nurse-led clinic for a religious community in the Pacific Northwest.

Results: Today, the nurse-led clinic offers care coordination and primary care to support aging in place and is one example of a nurse-led model well-positioned to address the aging in place needs of vulnerable populations.

Conclusion: Replication and sustainability of this nurse-led model requires sweeping policy change, including consideration of requiring all nurses to attain a National Provider Identification number to expand RN reimbursement and ultimately increase access to care. [Journal of Gerontological Nursing, 50(3), 13-17.].

Purpose: Research on the concept of expressed emotion (EE) has expanded in recent years but its role in dementia still requires elucidation. Understanding the role of EE in the dementia context could help in the development of appropriate interventions.

Method: The current review synthesized relevant literature to investigate the prevalence and correlates of EE status in families of people with dementia. A comprehensive search of four databases from inception to 2022 produced 2,683 papers; 18 studies met inclusion criteria.

Results: The use of EE criteria differed not only across cultural contexts, but even within the same cultural context. Overall, the prevalence of EE in families with dementia compared with other psychiatric conditions was not high.

Conclusion: Specific changes in EE over time remain to be explored, and findings emphasize the need to carefully discriminate High EE status based on the cultural background of family members with dementia. [Journal of Gerontological Nursing, 50(2), 17-25.].

Purpose: The older adult population continues to increase, resulting in greater use of health care resources. Nurses will be at the forefront of providing competent care to this population, but many nurses do not wish to work with the aged population after graduation. The current study sought to explore whether the addition of a clinical shift at an assisted living community promoted positive attitudes by nursing students toward older adults and exposed them to healthy aging.

Methods: Students (N = 70) in a required undergraduate course at a large university in the West received clinical experience at local assisted living communities in which they independently interviewed a resident and provided an educational session to residents.

Results: Students, communities, and clinical instructors had a positive experience in this clinical, finding it rewarding and meaningful and a mechanism for observing healthy aging.

Conclusion: The incorporation of a clinical experience at an assisted living facility into a stand-alone gerontology course created a positive shift in nursing student attitudes toward older adults, dispelled myths and stereotypes, and was reported to be a meaningful experience. [Journal of Gerontological Nursing, 50(2), 11-15.].

Purpose: To assess implementation context prior to the implementation of Dementia Collaborative Coaching (DCC), a person-centered, communication coaching intervention for speech-language pathologists, certified nursing assistants, and people living with dementia in nursing homes.

Methods: This was a pre-implementation, content analysis of focus groups. Focus group questions and subsequent analysis were guided by the Practical, Robust Implementation and Sustainability Model.

Results: Employees (N = 27) from three nursing homes participated in five focus groups. Five themes from directed content analysis included (a) Dementia Care Needs Improvement; (b) Dementia Collaborative Coaching Appears Promising; (c) Awareness of Necessary Implementation and Sustainability Plans; (d) Regulations Need Accurate Interpretation and Local Dissemination; and (e) Appropriate Staffing Concerns.

Conclusion/implications: Key factors related to the implementation of DCC included a perceived tension for change from staff to improve dementia care, concerns about appropriate staffing, and the need for explicit implementation and sustainability plans. The importance of continuing education with specific attention to temporary staff was also found to be a necessary element to support better uptake of the person-centered intervention. [Journal of Gerontological Nursing, 50(2), 5-9.].

Purpose: To identify factors contributing to the need for informal care among community-dwelling older adults with functional impairment in Chile.

Method: A secondary data analysis was conducted using cross-sectional data from 540 Chilean older adults aged ≥60 years (mean age = 72.2 years, SD = 6.22 years).

Results: Informal care need was reported by 24.3% (n = 131) of participants. Among the variables that most influenced the need for informal care among older adults were hospitalization in the past 1 year, functionality, comorbidities, and multidimensional frailty (all p < 0.05).

Conclusion: This study identified factors that clinicians and nurses should be aware of when caring for this population to prevent or manage the need for informal care. [Journal of Gerontological Nursing, 50(2), 43-52.].

Purpose: Social isolation and loneliness are social determinants of health (SDOH) that can negatively affect the well-being of older adults. Using technology has the potential to reduce social isolation; thus, increasing safe use of technology among older adults can positively impact their health and promote aging in place.

Method: Older adults (N = 730) were surveyed regarding their use of, access and barriers to, satisfaction with, and anticipated future needs related to technology.

Results: Survey respondents found technology was a significant resource for staying connected; however, low levels of satisfaction with devices and fear of scams indicate the need for additional training on the best and safest use of technology.

Conclusion/implications: By screening older adults for SDOH, identifying their current and anticipated needs, and advocating for changes in health care and communities to meet these needs, nurses can help facilitate safe and healthy aging in place for their patients. [Journal of Gerontological Nursing, 50(2), 26-31.].

Purpose: Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals.

Method: We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle.

Results: Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers.

Conclusion: Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].