Christine Bradway

A Qualitative Analysis of an Advanced Practice Nurse–Directed Transitional Care Model Intervention

PURPOSE The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). DESIGN AND METHODS APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. RESULTS Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. IMPLICATIONS APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition.

Obesity in Nursing Homes: A Critical Review

Obesity is a significant, and increasing, health problem for older individuals, their caregivers, and healthcare professionals and delivery systems, yet few studies document how nursing homes have responded to this epidemic. To address these gaps, an extensive electronic search was conducted in the Cumulative Index of Nursing and Allied Health, MedLine, PubMed, and the Cochrane Library using key terms and phrases, including obesity, morbid obesity, obesity in elderly, long‐term care, bariatric or weight loss surgery, nursing care, and nursing homes. Subsequent critical review suggests that research on obesity in older adults has predominantly been conducted in community‐dwelling populations and that few investigations have elucidated this problem in nursing home (NH) residents. Research priorities are also proposed to fill the current void in studies of obese NH residents.

Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults

AIM This article reports the effects of three evidence-based interventions of varying intensity, each designed to improve outcomes of hospitalized cognitively impaired older adults. MATERIALS & METHODS In this comparative effectiveness study, 202 older adults with cognitive impairment (assessed within 24 h of index hospitalization) were enrolled at one of three hospitals within an academic health system. Each hospital was randomly assigned one of the following interventions: Augmented Standard Care (ASC; lower dose: n = 65), Resource Nurse Care (RNC; medium dose: n = 71) or the Transitional Care Model (TCM; higher dose: n = 66). Since randomization at the patient level was not feasible due to potential contamination, generalized boosted modeling that estimated multigroup propensity score weights was used to balance baseline patient characteristics between groups. Analyses compared the three groups on time with first rehospitalization or death, the number and days of all-cause rehospitalizations per patient and functional status through 6-month postindex hospitalization. RESULTS In total, 25% of the ASC group were rehospitalized or died by day 33 compared with day 58 for the RNC group versus day 83 for the TCM group. The largest differences between the three groups on time to rehospitalization or death were observed early in the Kaplan-Meier curve (at 30 days: ASC = 22% vs RNC = 19% vs TCM = 9%). The TCM group also demonstrated lower mean rehospitalization rates per patient compared with the RNC (p < 0.001) and ASC groups (p = 0.06) at 30 days. At 90-day postindex hospitalization, the TCM group continued to demonstrate lower mean rehospitalization rates per patient only when compared with the ASC group (p = 0.02). No significant group differences in functional status were observed. CONCLUSION Findings suggest that the TCM intervention, compared with interventions of lower intensity, has the potential to decrease costly resource use outcomes in the immediate postindex hospitalization period among cognitively impaired older adults.

Characteristics of Qualitative Descriptive Studies: A Systematic Review

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, although there were some inconsistencies, most articles included characteristics consistent with the limited available QD definitions and descriptions. Next, flexibility or variability of methods was common and effective for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD studies so that readers can determine whether the methods used were reasonable and effective in producing useful findings.

Working with families of hospitalized older adults with dementia: caregivers are useful resources and should be part of the care team.

OverviewFamilies provide a considerable amount of informal care and support for older adults living with dementia. And when an older adult with dementia is hospitalized, family caregivers should be seen as important sources of information and included as valuable members of the health care team. This article describes a best-practice approach to working with families and includes recommendations for using the Information for the Hospital Team About a Patient with Memory Problems form. For a free online video demonstrating the use of this form, go to http://links.lww.com/A301.

Innovative Collaborations: A Case Study for Academic Owned Nursing Practice

PURPOSE Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice. METHODS In this paper, we describe a case study of a ten year program, the Living Independently For Elders (LIFE) Program at the University of Pennsylvania School of Nursing that has provided community-based long-term care to high-risk older adults. FINDINGS Quality of care and financial outcomes were met with nurse faculty engagement, administrative commitment, and integration of business practices. CONCLUSIONS As a result, high risk older adults receive care in their communities rather than nursing homes, and the school- owned and -operated program is a nationally recognized innovative nursing model of care. CLINICAL RELEVANCE Strategies are described that can be used globally as more schools of nursing embrace and strengthen service partnerships.

Lower urinary tract symptoms in women—A common but neglected problem

PurposeThe purpose of this review is to provide nurse practitioners (NPs) an understanding of female lower urinary tract symptoms (LUTS). Data sourcesScientific literature including articles on epidemiology, assessment, impact on quality of life (QoL), treatment barriers, and management. ConclusionsFemale LUTS are common and adversely affect QoL. Nevertheless, the social stigma prevents many women from seeking treatment, and healthcare providers often lack adequate time to inquire about bladder health. Although LUTS are not life threatening, the impact is tremendous, and there is an urgent need for healthcare providers to improve management of chronic conditions. Implications for practiceNPs should play a role in driving this response by increasing awareness of LUTS, taking the lead in examining barriers to treatment, and providing long-term support to patients.

Urinary Incontinence Among Older Women

For women, urinary incontinence and other related lower urinary tract symptoms (e.g., nocturia, urinary urgency, frequency) are common, often increasing as women age. Urinary incontinence, however, is more than just a physiologic loss of urine. Emotional distress is also a significant issue for incontinent individuals. Researchers and clinicians are increasingly aware of the importance of identifying urinary incontinence and, in particular, urinary incontinence that causes distress or adversely effects health-related quality of life. This article addresses the effect of urinary incontinence on health-related quality of life among elderly women. Selected methods for evaluating health-related quality of life are highlighted and discussed. Suggestions are included for gerontological nurses interested in evaluating the effect of urinary incontinence on older women.

Lower Urinary Tract Symptoms in Men With Parkinson Disease

Purpose: The aim of this study was to examine the prevalence, presentation, and predictors of lower urinary tract symptoms (LUTS) in men with idiopathic Parkinson disease (PD). Methods: Guided by the Theory of Unpleasant Symptoms, this retrospective exploratory study used data abstracted from admission clinical records of 271 male patients with idiopathic PD enrolled in a movement disorders clinic at a large metropolitan Veterans Affairs Medical Center in the eastern region of the United States. Data from the admission questionnaire, Unified Parkinson’s Disease Rating Scale, and Mini Mental State Examination were abstracted by trained research assistants. Interrater reliability for the abstraction process was 0.99 in a randomly selected 10% sample of records. Descriptive statistics were used to determine the prevalence of LUTS. Logistic regression was used to determine LUTS risk factors and predictors. Results: At least one LUTS was reported by 40.2% of participants. Incontinence was the most prevalent symptom, affecting almost 25% of participants, followed by nocturia (14.8%) and frequency (13.7%). Of the 10 identified risk factors for LUTS, four significant predictors were discovered: number of non-PD medications (p < .05), PD duration (p < .05), number of comorbidities (p < .05), and history of a hernia diagnosis (p < .05). Conclusions: Assessment for LUTS should be a component of every evaluation of a patient with PD. Our findings offer a preliminary profile of the male PD patient with LUTS, which is an important step toward effective screening, detection, and access to care and treatment. Next steps in research include further work to identify predictors of LUTS in both male and female PD populations, explore patient perspectives, begin trials of interventions for LUTS in the PD population, and analyze the economic impact.

OBESE NURSING HOME RESIDENTS: A CALL TO RESEARCH ACTION

activities. Occupational therapists are also trained in activity analysis and activity demands and can make recommendations on activity and environmental modifications to reduce pain. Occupational therapy is a great alternative or addition to the traditional approach to pain management, and doctors should recommend it to their patients to help them better manage their pain and remain independent older adults. With evidence to support that pain limits function and that there is a high prevalence of pain in older adults, there is a need to address pain management in older adults. If pain were managed better, older adults might be able to remain independent for longer, which might help lower healthcare costs and prevent or prolong the need for nursing home placement and skilled nursing care. More focus needs to be spent on assessing and managing pain in older adults. Healthcare professionals should work closely with their patients to monitor their pain and explore the variety of different pain management options available to find a pain management system that works well for each patient. My experiences working in the healthcare field as a certified occupational therapy assistant have shown me that there is not enough emphasis placed on managing pain. Too often, patients are left with a prescription for medication as their only option for relieving pain. More time needs to be spent investigating alternative approaches to pain management and pain relief such as occupational therapy.