Mary J. Dyck

Nursing staffing and resident outcomes in nursing homes: weight loss and dehydration.

A secondary analysis of the Minimum Data Set and Online Survey, Certification, and Reporting databases was used to examine the relationships between nursing staffing and the nursing home resident outcomes of weight loss and dehydration. If a facility had 3 or more hours of nursing assistant time versus those that had less than 3 hours, there was an associated odds ratio of 0.83 (P = .0078). Nursing assistant staffing affected the quality outcome of weight loss. Residents receiving at least 3 hours per day of nursing assistant care had a 17% decreased likelihood of weight loss.

Risk for Acute Confusion in Sensory-Impaired, Rural, Long-Term-Care Elders

Acute confusion is a common geriatric syndrome in long-term care (LTC) elders with prevalence rates of 10% to 39%. Sensory impairment, specifically vision and hearing impairment, is even more common in LTC, with prevalence rates of 40% to 90%. The purpose of this study was to investigate the risk relationship between sensory impairment and the development of acute confusion in LTC elders. Each resident (N = 114) underwent sensory screening and then was followed for 28 days to monitor for the onset of acute confusion. Twenty residents (17.5%) developed acute confusion, 60 residents (52.6%) were found to be visually impaired, 49 (44.1%) were hearing impaired, and 28 (24.6%) were found to be dually impaired. Significant relationships between vision impairment, odds ratio (OR) = 3.67, confidence interval (CI) (1.13, 11.92), and dual sensory impairment, OR = 2.88, CI (1.04, 8.26), with the development of acute confusion were identified.

Comparing the Geriatric Depression Scale, Minimum Data Set, and primary care provider diagnosis for depression in rural nursing home residents

BACKGROUND: Depression has a substantial negative impact on quality of life. Underdiagnosis and undertreatment of depression are major problems in nursing home residents. OBJECTIVES: This study sought to determine the prevalence of depression among older adults in nursing homes in rural Iowa using the Geriatric Depression Scale (GDS), Minimum Data Set (MDS), and primary care provider (PCP) depression diagnosis. DESIGN: This is a secondary analysis of data collected from 279 randomly selected residents of nursing homes in rural Iowa. RESULTS: The prevalence of depression based on the GDS (score of 6 or greater) was 37.3%, the MDS was 21.3%, and the PCP depression diagnosis was 39.1%. CONCLUSION: There was only chance agreement in identifying depression among the measures. The overall prevalence of depression (as indicated by a positive depression marker in any group) was 67.1%, suggesting depression continues to be a problematic clinical and quality-of-life issue in rural nursing homes.

Nursing informatics. Applications for long-term care.

Long-term care (LTC) settings, specifically nursing homes, have found it difficult to manage the regulatory process and provide quality resident care without computerization. Clinical information systems in the current health care environment, including LTC, need to provide five functions. These five functions are providing the legal record of care; supporting clinical decision-making; capturing costs for financial purposes; accumulating a database for administrative queries, quality assurance, and research; and supporting data exchange between systems. While computerization may have occurred in LTC, the application of the informatics concepts with nursing standardized languages and financial and database usage may not have occurred. To succeed in the current health care environment, nursing informatics concepts need to be implemented in LTC. As a result, the quality of care for older adults in nursing homes will be improved. The purpose of this article is to identify application for nursing informatics use in the LTC setting.

Nursing home recruitment: Trials, tribulations, and successes

Many challenges are inherent when conducting research in the older adult population as well as in the nursing home environment. The safety and quality of care provided in nursing homes need further examination through research. The purpose of this paper is to discuss research issues and recruitment barriers experienced by a research team collecting data for a study assessing the education and learning needs of nursing home nurses in central Illinois and related resident outcomes. Research barriers identified in this study include organizational and administrative barriers in addition to staff barriers. The strategy that was most helpful in gaining access to nursing homes in central Illinois was face to face contact. Future nursing home researchers are encouraged to familiarize themselves with the nursing home environment, communicate with nursing home trade associations, and develop personal contacts with area nursing home administrators.

Evidence-based practices for the prevention of weight loss in nursing home residents.

Weight loss is common among nursing home residents. Food intake is often inadequate for elderly residents but is only one of several factors contributing to potential weight loss. Three common issues resulting in weight loss include starvation (or wasting), cachexia, and sarcopenia. Significant weight loss leads to increased mortality, increased morbidity, and decreased quality of life. The purpose of this article is to discuss the geriatric syndrome of weight loss in elderly nursing home residents and provide recommendations to decrease and prevent weight loss. A list of available evidence-based protocols related to weight loss issues is provided.

Are They Family or Friends? Social Support Instrument Reliability in Studying Older Lesbians

We know little about the support needs and health of older lesbians because participant sexual identity has typically not been identified in aging studies. The Lubben Social Network Scale, Revised (LSNS-R) is found widely reliable for testing perceived social support among elders but has never been tested with an exclusively lesbian population. This pilot tested the instrument with an exclusively lesbian population in the Midwest. Our analysis suggests it may not be reliable with this population, even with minor modifications that were made. Further examination adding a category for “family of choice” is warranted and supported by the originator of the tool.

Weight Loss Prevention in Nursing Home Residents: A Pilot Study to Determine Administrative Strategies

Weight loss is a common problem for nursing home residents. Although clinical interventions to prevent and treat weight loss are readily available, administrative interventions to prevent weight loss are not identified in the literature. The purpose of this study was to identify administrative strategies that Directors of Nursing could use to prevent weight loss in nursing home residents. A modified three-round Delphi method with a mailed survey was used to develop consensus on administrative strategies. Percentage of panel agreement was determined for each intervention on each round. Eighteen administrative strategies were determined by the panel members, with 85% agreement; these strategies were identified and categorized. The categories and implications for further research are discussed.

Antidepressant treatment of depression in rural nursing home residents

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.

Continuing Education Preferences, Facilitators, and Barriers for Nursing Home Nurses

BACKGROUND The purpose of the study was to determine the continuing education needs for nursing home nurses in rural central Illinois and to determine any potential facilitators or barriers to obtaining continuing education. METHOD Data were collected using the Educational Needs Assessment questionnaire. Descriptive statistics were computed to examine continuing education preferences, facilitators, and barriers among nursing home nurses. Independent samples t tests were used to compare preferences between administrative and staff nurses. RESULTS The sample included 317 nurses from 34 facilities. The five top needs were related to clinical problems. Administrative nurses had greater needs for professional issues, managerial skills, and quality improvement than staff nurses. Barriers included rural settings, need for vacation time for programs, and inadequate staffing. CONCLUSION Continuing education needs of nursing home nurses in Illinois are similar to previous studies conducted in Arizona and North Carolina. Continuing education barriers were mostly organizational, rather than personal. J Contin Nurs Educ. 2018;49(1):26-33.