Fall prevention through patient partnerships Day, Jennifer R; Ramos, Lourdes C; Hendrix, Cristina C
The Nurse practitioner,
2012-July-10, Letnik:
37, Številka:
7
Journal Article
Recenzirano
ABSTRACTFalls in community-dwelling older adults are often preventable, yet remain the leading cause of deaths due to injury and a major cost to the healthcare system. Primary care nurse ...practitioners who care for older adults can minimize the risk for falls by using specific assessment and prevention strategies.
Clinical practice guidelines have been developed to improve patient care and outcomes. Guideline implementation is often stymied by the complexity of patients’ conditions, complex care environments, ...and limited advanced clinical training of nursing staff. To translate key elements of heart failure guidelines into practice in a nursing home, the Connected Learning Model was developed based on the diffusion of innovations framework. An advanced practice nurse in geriatrics fostered greater interaction and collaboration among key administrative, medical, and nursing staff to promote awareness of heart failure guidelines and to translate key practices from those guidelines into the nursing home setting. Direct care staff skills for early recognition and reporting of signs and symptoms of acute heart failure were enhanced through a learner-centered educational program which included classroom and unit-based instruction and bedside clinical teaching. The Connected Learning Model is a promising method to mobilize advanced nursing expertise to bridge research/practice gaps through implementation of clinical practice guidelines that are systematically adapted to accommodate diverse health care contexts.
Supportive approaches for Alzheimer Disease Davis, Nicole J; Hendrix, Cristina C; Superville, Jemma G
The Nurse practitioner,
2011-August, Letnik:
36, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Alzheimer disease (AD) accounts for most dementia diagnoses. Acetylcholinesterase inhibitors and antipsychotics are first-line drug therapies for cognitive decline and to manage neuropsychiatric ...symptoms, respectively. Because AD is relentlessly progressive, NPs will need to provide long-term support to patients and their caregivers.
Continuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors ...associated with interpersonal continuity of care (ICoC) among Veteran's Health Administration (VHA) primary care patients with diabetes.
This patient-level cohort study (N = 656,368) used electronic health record data of adult, pharmaceutically treated patients (96.5% male) with diabetes at national VHA primary care clinics in 2012 and 2013. Each patient was assigned a "home" VHA facility as the primary care clinic most frequently visited, and a primary care provider (PCP) within that home clinic who was most often seen. Patient demographic, medical and social complexity variables, provider type, and clinic contextual variables were utilized. We examined the association of ICoC, measured as maintaining the same PCP across both years, with all variables simultaneously using logistic regression fit with generalized estimating equations.
Among VHA patients with diabetes, 22.3% switched providers between 2012 and 2013. Twelve patient, two provider and two contextual factors were associated with ICoC. Patient characteristics associated with disruptions in ICoC included demographic factors, medical complexity, and social challenges (example: homeless at any time during the year OR = 0.79, CI = 0.75-0.83). However, disruption in ICoC was most likely experienced by patients whose providers left the clinic (OR = 0.09, CI = 0.07-0.11). One contextual factor impacting ICoC included NP regulation (most restrictive NP regulation (OR = 0.79 CI = 0.69-0.97; reference least restrictive regulation).
ICoC is an important mechanism for the delivery of quality primary care to patients with diabetes. By identifying patient, provider, and contextual factors that impact ICoC, this project can inform the development of interventions to improve continuity of chronic illness care.
To determine whether depression in the elderly in institutionalized settings could be identified using the mood indicators in the Minimum Data Set (MDS) 2.0 (Section E1, Items A-P).
Descriptive ...study.
Three nursing homes in the southeastern part of the country.
Residents aged 65 and above.
The items in "Indicators of Depression, Anxiety and Sad Mood" on the MDS 2.0 were used to identify observable features of depression in the elderly. The Cornell Scale for Depression in Dementia (CSDD) was used to validate the MDS indicators. Consensus analysis, which controls raters' bias, raters' ability, and item difficulty, was used to analyze data.
No depressive patterns were detected using the MDS indicators. On the CSDD, distinct depressive features were identified: anxiety, sadness, lack of reaction to pleasant events, irritability, agitation, multiple physical complaints, loss of interest, appetite loss, and lack of energy.
The incongruent findings on the MDS indicators the CSDD may be reflective of the assessment process used with the MDS rather than its ability to identify features of elderly depression. The practice of allowing nondirect caregivers to complete the MDS may have serious implications for the accuracy of the data collected.
ABSTRACT
Pillars for the Care of Older Persons in the Caribbean: A Comprehensive Community‐Based Framework (Pillars) is a hybrid of multiple public health frameworks developed through community‐based ...participatory research processes. Health and social service professionals, governmental organizations, elderly persons, and others from across the English‐speaking Caribbean countries developed the Pillars framework to address the growing elderly population and with an aim to increase the number of healthy and active years of life. The Pillars framework consists of four interrelated pillars organized across multiple sectors of society: primary care with care management; integrated services coordination; population‐based health promotion and disease prevention; and planning and accountability. Pillars is enabled by an envisioned integrated system of information technology that will increase community‐based services delivery, interprofessional communication and coordination, and will aggregate data with all identifiers removed for surveillance, planning, forecasting, policy making, evaluation, and research.
Abstract
More than half of Korean Americans living in the US are immigrants, these immigrants hold unique cultural perspectives, including collectivism and filial piety that originates from Korean ...culture. Every older adult has life experiences and background that build and shape their own wishes and values for their health care goals. Thus, a qualitative descriptive study was conducted using the Life Course Theory as a guiding framework to examine older Korean immigrants’ health care goals and the influence of their life courses. Twenty six interviews from 13 participants were analyzed using content thematic analysis. Study rigor was ensured by audit trail, peer debriefing, and prolonged engagement. Data were organized under five overarching themes: health care priorities, time, location, linked lives, and turning point. Older Korean immigrants valued painlessness and being independent as health care goals (Health care priorities). They experienced a dynamic historical period in Korea before immigrating to the US (Time). Once they reached the US, they were disconnected from their social support and traditional values (Location). Children and Korean churches constitute older Korean immigrants’ primary support system once in the US (Linked lives). Their tumultuous life experiences contributed to their current perspectives on health care goals and priorities (Turning point). In studies of older immigrant populations, it is important to acknowledge individual differences while simultaneously understanding the general life history and cultural background behind individuals’ values and perspectives. Life course approach provides both a contextual understanding of older adults’ backgrounds and the trajectories of their individual life courses.
Unfortunately, however, these guidelines are not "self-implementing" (Berta et al., 2005). ... clinicians need to have the "how to" information in order to translate this evidence into clinical ...practice (Leeman, Jackson, & Sandelowski, 2006).
Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines ...whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio OR = 0.83, 95% confidence interval CI: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.
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