RESUMEN
Polypharmacy is common in long term care facilities and frequently associated with poor outcomes. This study sought to determine if a medication management protocol completed at four month intervals by nurse practitioners (NP) could impact polypharmacy and administration times for long term care residents. The data was collected as part of a Centers for Medicare and Medicaid Services (CMS) "Initiative to Reduce Avoidable Hospitalization among Nursing Facility Residents" grant. Residents were recruited from participating long-term care facilities. NP completed a medication management protocol on admission to the program and at subsequent 4-month intervals or with an acute change in condition. A total of 2442 non-duplicated individuals were seen for at least 1 visit. Although the protocol did not result in a reduction of regularly scheduled medications, the number of scheduled medication administration times did significantly decrease. NP polypharmacy assessments and recommendations are important but were insufficient to decrease the medication burden.
Asunto(s)
Cuidados a Largo Plazo , Enfermeras Practicantes , Anciano , Hospitalización , Humanos , Medicare , Polifarmacia , Estados UnidosRESUMEN
Replicating a research study that described the work of nurse scientists in children's hospitals, the purpose of the study was to describe the role, activities, and outcomes of nurse scientists employed in a national health care organization. The characteristics of nurses filling the nurse scientist role in clinical settings and outcomes associated with the role have not been extensively described. The setting of this study is ideal since the organization includes facilities of various sizes located in rural, urban, and suburban areas in 18 states. Names and contact information of nurse scientists were obtained from nurse executives at each of the 110 affiliated organizations. Nurse scientists completed an anonymous survey. The primary role of the nurse scientists is to facilitate the work of others. Recommendations to strengthen the research infrastructure are provided.
Asunto(s)
Atención a la Salud , Perfil Laboral , Rol de la Enfermera , Investigadores/tendencias , Estudios Transversales , Humanos , Encuestas y Cuestionarios , Recursos HumanosAsunto(s)
Atención Posterior/organización & administración , Comunicación , Urgencias Médicas/enfermería , Enfermería Geriátrica/organización & administración , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Teléfono , Anciano , Humanos , Persona de Mediana Edad , Guías de Práctica Clínica como AsuntoAsunto(s)
Quimioterapia/normas , Enfermería Basada en la Evidencia , Casas de Salud/organización & administración , Calidad de la Atención de Salud , Anciano , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Enfermería Geriátrica , Humanos , Cuidados a Largo Plazo/organización & administración , Modelos Organizacionales , Polifarmacia , Factores de Riesgo , Estados UnidosAsunto(s)
Enfermeras Practicantes , Pautas de la Práctica en Enfermería , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Nebraska , Atención al Paciente , Grupo de Atención al Paciente/organización & administración , Derivación y Consulta , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricosRESUMEN
Although the 1990 Patient Self-determination Act was enacted to insure that patients' wishes regarding advance directives were known and respected, it has had little impact in quality or aggressiveness of care for patients nearing death. The purpose of this descriptive study was to explore staff attitudes related to Advance Directives. A short survey was distributed to 650 hospital, home care, hospice, assisted living, and long term professional and staff members. Analysis was completed on 413 surveys (return rate 63.3%). Findings suggest that although staff members believe that Advance Directives are an important tool, they have found both logistical and process challenges to following them. The results provide needed information for improving processes for completion and utilization of Advance Directives.
Asunto(s)
Planificación Anticipada de Atención , Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Adulto , Planificación Anticipada de Atención/organización & administración , Adhesión a las Directivas Anticipadas/legislación & jurisprudencia , Adhesión a las Directivas Anticipadas/psicología , Adhesión a las Directivas Anticipadas/estadística & datos numéricos , Anciano , Comunicación , Toma de Decisiones , Disentimientos y Disputas , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Investigación Metodológica en Enfermería , Pronóstico , Encuestas y Cuestionarios , Factores de Tiempo , Gestión de la Calidad Total/organización & administraciónRESUMEN
Relocation is traumatic for older adults. There is a paucity of literature about the characteristics of individuals who are most susceptible to negative effects of relocation. Residents of a nursing home that closed were compared with residents of a control institution to determine whether relocation had a significant effect on mortality and to identify risk factors for death. The difference in mortality was significant. A Cox regression model demonstrated that the only variable to achieve significance in predicting mortality was the relocation itself. Research must evaluate strategies that will reduce the negative effects of involuntary relocation.
Asunto(s)
Coerción , Evaluación Geriátrica , Clausura de las Instituciones de Salud , Mortalidad , Casas de Salud , Transferencia de Pacientes , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Cognición , Femenino , Evaluación Geriátrica/métodos , Investigación sobre Servicios de Salud , Humanos , Acontecimientos que Cambian la Vida , Masculino , Modelos Organizacionales , Análisis Multivariante , Nebraska/epidemiología , Evaluación en Enfermería , Casas de Salud/organización & administración , Transferencia de Pacientes/organización & administración , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Calidad de Vida/psicología , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
All providers and professionals who care for older adults have an important role to play in the process of managing medications. The evidence-based guideline "Improving Medication Management for Older Adult Clients" (Bergman-Evans, 2004) provides assessments and interventions that are useful across settings. By focusing on reducing inappropriate prescribing, decreasing polypharmacy, avoiding adverse events, and maintaining function, professionals and providers have the opportunity to improve outcomes for this important population.
Asunto(s)
Quimioterapia/normas , Enfermería Geriátrica/normas , Guías de Práctica Clínica como Asunto , Anciano , Interacciones Farmacológicas , Monitoreo de Drogas/enfermería , Monitoreo de Drogas/normas , Quimioterapia/enfermería , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Medicina Basada en la Evidencia , Evaluación Geriátrica , Humanos , Rol de la Enfermera , Evaluación en Enfermería/normas , Evaluación de Resultado en la Atención de Salud , Planificación de Atención al Paciente/normas , Educación del Paciente como Asunto/normas , Polifarmacia , Medición de Riesgo/normas , Autoadministración/enfermería , Autoadministración/normas , Gestión de la Calidad Total/organización & administraciónRESUMEN
Medication regimens for older adults are often complex and costly. Designing, implementing, and maintaining an appropriate treatment regimen is challenging. The AIDES method is built on the principles of completing a comprehensive medication Assessment; partnering with patients to ensure Individualization of the regimen; choosing appropriate Documentation; providing accurate and ongoing Education tailored to the age group and needs of the individual; and continuing Supervision after initiation.
Asunto(s)
Evaluación Geriátrica/métodos , Modelos de Enfermería , Evaluación en Enfermería/organización & administración , Cooperación del Paciente/psicología , Educación del Paciente como Asunto/organización & administración , Autoadministración/psicología , Anciano , Conducta de Elección , Comunicación , Conducta Cooperativa , Monitoreo de Drogas/enfermería , Quimioterapia/enfermería , Quimioterapia/psicología , Enfermería Geriátrica/organización & administración , Humanos , Evaluación de Necesidades , Rol de la Enfermera/psicología , Relaciones Enfermero-Paciente , Participación del Paciente/métodos , Participación del Paciente/psicología , Polifarmacia , Sistemas Recordatorios , Autoadministración/enfermeríaRESUMEN
In Life Worth Living, Thomas (1996) proposed that in long-term care facilities for elderly individuals, loneliness, helplessness, and boredom are out of control and are steadily decaying the residents' spirits, adversely affecting quality of life. While Thomas' contention appeals to common sense, no empirical evidence is offered in its support. The purpose of this quasi-experimental study was to assess the impact of implementation of the Eden Alternative model on levels of loneliness, boredom, and helplessness of older residents of a long-term care facility. The model was introduced into the experimental facility on May 1, 1998. The final sample for the experimental group included 21 cognitively intact older adults from a state veterans home (13 men, 8 women, mean age = 76.1). The final control group was composed of 13 residents in a private long-term care facility (11 women, 2 men, mean age = 85.7). A Background Data Sheet, the Geriatric Depression Scale (includes yes or no questions related to helplessness and boredom), and the UCLA Loneliness Scale (Version 3) were administered by an interviewer at baseline and 1-year post-implementation of the Eden Alternative model. Data analysis from the post-implementation phase revealed significant differences between the groups on levels of boredom (z = -2.6, p = .01) and helplessness (z = -2.2, p = .03). Lower levels of distress were found in the experimental group on both boredom and helplessness, but not loneliness. Findings suggest health care professionals and researchers have an opportunity to take a leading role in impacting services related to quality-of-life issues for this important, but often overlooked, population.
Asunto(s)
Enfermería Geriátrica/métodos , Modelos de Enfermería , Calidad de Vida , Anciano , Anciano de 80 o más Años , Depresión , Femenino , Ambiente de Instituciones de Salud , Humanos , Soledad , Cuidados a Largo Plazo , Masculino , Investigación Metodológica en Enfermería , Escalas de Valoración PsiquiátricaRESUMEN
BACKGROUND: Pharmaceutical sales representatives and direct-to-consumer advertising may influence physician practices, particularly prescribing. Identifying the relevant knowledge and attitudes students possess about the pharmaceutical industry may help professional curricula address these influences. PURPOSES: To assess knowledge and attitudes toward pharmaceutical industry marketing, ethical principles guiding drug company interactions, pharmaceutical sales representatives as a source of drug information, and confidence level in addressing consumers seeking a prescription from a direct-to-consumer advertisement among senior-level medical, PharmD, and nurse practitioner students. METHODS: A cross-sectional survey design was used to assess student knowledge and attitudes of four domains associated with the pharmaceutical industry. RESULTS: Significant deficiencies were noted in student knowledge of pharmaceutical marketing expenditures, professional ethics regarding interactions with drug companies, and accuracy of drug information from sales representatives. CONCLUSIONS: Health professional students' knowledge and attitudes toward the pharmaceutical industry are formed prior to graduation. Professional curricula must address the influences of sales representatives before postgraduate training.