Lisa Abdallah

Development and psychometric testing of the EverCare Nurse Practitioner Role and Activity Scale (ENPRAS)

Purpose To develop and test an instrument measuring the frequency of the performance of role activities by EverCare nurse practitioners (NPs), who provide primary care to nursing home residents. Data sources One hundred thirty‐one EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) activities were identified through telephone interviews (n= 11), participant observation (n= 5), and a focus group (n= 4). Conclusions Two content validity tests (n= 11; n= 15) (Content Validity Index ≥ .78 for all retained items) and internal consistency reliability testing (n= 127; Cronbachs alpha = .78–.96) yielded 99 activities arranged in six role subscales—Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator. Implications for practice The ENPRAS can be used to measure similarities and differences in NP practice activities performed by EverCare NPs working at different EverCare program sites and to compare practice activities performed by EverCare NPs and other NPs. The EverCare program is sponsored by United Health Care, which leads the field in collaborative NP/MD primary care in nursing homes. Future studies should be directed toward testing the generalizability of the ENPRAS with NPs working in other collaborative models, as well as NPs in noncollaborative models of care delivery in the long‐term care setting.

Dehydration Reduction in the Community Dwelling Older Adult: Perspectives of Community Health Care Providers

Dehydration is a common problem among older adults and can negatively affect their health. This cross-sectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participants identify dehydration as a problem affecting older adults, and 94% noted the need for a public campaign on dehydration awareness and reduction. Four major themes emerged: Intentional Avoidance and Caution, Lack of Awareness/Education/Understanding, Poor Access to Fluids, and Social and Environmental Influences. Strategies identified to promote hydration in community-dwelling older adults included community partnerships, community education, community engagement, and interdisciplinary approaches. This study provides useful information and detailed strategies recommended by health care providers for designing interventions to promote hydration for community-dwelling older adults.

Making healthy connections: introducing nursing as a career choice to middle school students

The current economic climate has resulted in many experienced nurses returning to the workforce. Despite this, the nursing shortage is looming in our future and the recruitment of a diverse nursing workforce reflective of the population remains a high priority. The Merrimack Valley in northeastern Massachusetts has two large cities, Lawrence and Lowell, in which the Hispanic and the Southeast Asian populations are disproportionately higher than state and national levels. Through the University of Massachusetts Lowells Bring Diversity to Nursing Project, partnerships with both city school systems were developed and after-school programs aimed at highlighting nursing as a career choice were initiated. Mr. Thompsons Heart is the focus of a middle school, pre-entry program developed by faculty. Introducing career choices in middle school gives students fundamental information about careers and how to begin investigating them. Mr. Thompsons Heart introduces nursing as a career choice combining career information with a focus on developing healthy lifestyle habits. Multiple hands on activities create excitement and interest in the nursing profession.

A Medicare Current Beneficiary Survey–Based Investigation of Alternative Primary Care Models in Nursing Homes: Functional Ability and Health Status Outcomes

This study assessed how the health status and functioning of Medicare beneficiaries residing in nursing homes varies systematically with nurse practitioners (NPs) and physician assistants (PAs) providing primary care services. A secondary analysis was conducted using data from the 2006, 2007, and 2008 Medicare Current Beneficiary Surveys. The study sample included 433 participant-year observations within one of three cohorts: (a) medical doctor (MD)-only, those who received primary care services exclusively from a physician; (b) MD-dominant, those who received some primary care services from an NP or PA, but those visits accounted for less than one half of total primary care visits; and (c) NP/PA-dominant, those who received more than one half of their primary care visits from an NP or PA. Participants in the MD-only cohort had significantly less orientation and independence in activities of daily living compared to participants in the NP/PA-dominant cohort. Other study variables did not vary significantly by practice model. Although the study provides some evidence that NP/PA involvement is associated with improved functioning, it is premature to draw strong inferences.

Developing a dedicated education unit in long-term care: a pilot project

Within long-term care, the transitional care setting provides post-acute and short-stay rehabilitation to older adults, easing the transition between the acute care hospital and home or long-term care. The current nursing shortage makes it difficult for these facilities to attract and retain qualified nursing staff. In order to meet the rehabilitation needs for this patient population while at the same time addressing the challenge in nursing education of limited clinical placements and severe nurse faculty shortages, an academic-practice partnership was developed to establish a Dedicated Education Unit (DEU). The DEU is an innovative clinical education model in which experienced staff nurses serve as clinical teachers to nursing students. This paper describes the process of developing a DEU using the Partners in Caring Model as the framework. Formative and summative evaluation results and recommendations for program improvement of this pilot project are discussed.

Interpreting laboratory values in the rehabilitation setting.

&NA; Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health problems faced by patients in rehabilitation settings. A case study is used to highlight the importance of laboratory testing.

A Medicare Current Beneficiary Survey-Based Investigation of Alternative Primary Care Models in Nursing Homes: Cost and Utilization Differences

The current study used the Medicare Current Beneficiary Survey-Based (MCBS) Cost and Use files for 2006-2008 to investigate whether health care costs and service utilization of nursing home residents varied with nurse practitioner (NP) and physician assistant (PA) involvement, compared to the use of medical doctors (MDs) only. The sample included Medicare beneficiaries 65 and older residing in a nursing home for the entire study year (433 annual observations). A generalized estimating equations procedure was used to assess whether health care cost and utilization measures varied by cohort. Point estimates indicated that the annual per-person cost of non-institutional services (total medical cost less the cost of the nursing home itself) was

Long-Term Care in the United States and Finland: Policy Lessons to be Learned

3,847 and

Using Antipsychotic Drugs Safely in Older Patients

3,170 more for individuals in the MD-only and MD-dominant cohorts, respectively, compared to those in the NP/PA-dominant cohort. [Res Gerontol Nurs. 2016; 9(3):115-122.].

Faculty Institute For Gerontological Nursing: a partnership for clinical education in long-term care.

Gerontological nurses are crucial members of long-term care (LTC) policy development teams as they work toward the provision of quality, equitable, seamless, and affordable LTC for all. When developing LTC policies in the United States, it is useful to explore such services in other countries. This policy brief provides an overview of LTC services in Finland to examine possible policy lessons for U.S. LTC service and delivery. Finland provides LTC to its older adult population under a universal program whereby services are provided as part of their universal health care and social services coverage. The U.S. system provides LTC primarily under Medicaid along with some coverage financed under Medicare. The challenges in the U.S. system include fragmented LTC delivery and financing, increasing LTC costs, and maintaining quality of care. Although difficult to compare the LTC costs in these two countries, available data suggest that Finland spends less on LTC the older adult population.