Mathy Mezey

Life-sustaining treatment decisions by spouses of patients with Alzheimer's disease

OBJECTIVE: To examine the anticipated decisions to consent to or to forgo life‐sustaining treatment by spouses of patients with Alzheimers disease and to describe the relationship of spouse and patient characteristics to predicted decisions.

Gerontological nursing content in baccalaureate nursing programs: Findings from a national survey

Given the prevalence of elderly people in the health care system, it behooves the nursing community to assure that every nurse graduating from a baccalaureate nursing program has a defined level of competency in care of the elderly. To accomplish this, it is necessary to establish a baseline of the current status of geriatric content in the baccalaureate curriculum. This article provides such baseline data using the findings of a national study of geriatrics in baccalaureate nursing programs. The study, conducted in 1997, was distributed to the universe of baccalaureate nursing programs (n = 598). The findings are based on a respondent pool of 480 programs (80.3 per cent response rate). The survey covered a range of educational topics, including curriculum, content, faculty preparation, and how programs define their needs for further curriculum and faculty development. The data analysis included the identification of baccalaureate nursing programs with exemplary offerings in geriatric care. Finally, in the discussion section, recommendations are advanced for the full integration of geriatric content into baccalaureate nursing programs.

A Panel Data Analysis of the Relationships of Nursing Home Staffing Levels and Standards to Regulatory Deficiencies

OBJECTIVE To examine the relationships between nursing staffing levels and nursing home deficiencies. METHODS This panel data analysis employed random-effect models that adjusted for unobserved, nursing home-specific heterogeneity over time. Data were obtained from Californias long-term care annual cost report data and the Automated Certification and Licensing Administrative Information and Management Systems data from 1999 to 2003, linked with other secondary data sources. RESULTS Both total nursing staffing and registered nurse (RN) staffing levels were negatively related to total deficiencies, quality of care deficiencies, and serious deficiencies that may cause harm or jeopardy to nursing home residents. Nursing homes that met the state staffing standard received fewer total deficiencies and quality of care deficiencies than nursing homes that failed to meet the standard. Meeting the state staffing standard was not related to receiving serious deficiencies. CONCLUSIONS Total nursing staffing and RN staffing levels were predictors of nursing home quality. Further research is needed on the effectiveness of state minimum staffing standards.

Decision-making capacity to execute a health care proxy: development and testing of guidelines.

OBJECTIVE: To evaluate the reliability and validity of guidelines to determine the capacity of nursing home residents to execute a health care proxy (HCP).

Healthcare professional training: a comparison of geriatric competencies.

Health professionals specializing in geriatrics are a unique but scarce resource who nevertheless play a critical role in shaping the care of older adults. An interdisciplinary didactic and clinical training milieu would have the potential to maximize training opportunities for geriatric healthcare professionals. The fact that little is known about the concordance between discipline‐specific geriatric competencies hampers the creation of interdisciplinary geriatric training opportunities. Discipline‐specific geriatric experts compared the geriatric competencies specified by geriatric‐certifying bodies of five healthcare professions: dentistry, medicine, nursing, pharmacy, and social work. Overlap and differences in geriatric competencies across disciplines are presented, and opportunities and barriers to interdisciplinary geriatric education are discussed.

Nutrition and Health Status Assessment of Community-residing Elderly in New York City: A Pilot Study

Ninety-five percent of persons over the age of 65 years live in the community and benefit from community-based health and nutrition services. The purpose of this project was to evaluate diet, function, and mental health in 40 men and women aged 65 years and older who were residing in a large metropolitan community. Nutritional status was assessed using two 24-hour recalls, 5 days of food records, a food frequency, and anthropometric measurements. Participants responded to standardized activities of daily living and instrumental activities of daily living instruments and an investigator-developed, performance-based appraisal of food preparation and management. Cognition and mood were assessed using the Folstein Mini-Mental Examination and the Yesavage Depression Scale. The nutrient intakes for individuals were compared with the Recommended Dietary Allowances (RDAs) and the Food Guide Pyramid. Mean energy intake was 1,625 kcal (range = 787 to 2,910 kcal); 7 persons consumed more than 2,000 kcal. The mean vitamin and mineral intake for participants met the RDAs except for calcium, vitamin D, zinc, and magnesium intakes. The average percentages of carbohydrate, protein, and fat were 53%, 16%, and 30%, respectively. Nutritional assessments of subjects with and without congregate meals were contrasted. Six of the 13 congregate-meal participants were at nutritional risk, compared with 6 of 27 not receiving congregate meals. The interrelationships of diet, functional status, and mental health factors were examined along with recommendations for future data collection in similar studies.

The Hartford Geriatric Nursing Initiative experience in geriatric nursing education: Looking back, looking forward

This article traces the impact of the John A. Hartford Foundations (JAHF) Hartford Geriatric Nursing Initiative (HGNI) on the geriatric preparation of nursing students. With over 2.6 million practitioners, nurses play a critical role in assuring the health care of older adults. Older adults make up the majority of patient days in hospitals, home care, and nursing homes. Yet, when the JAHF began its investment in geriatric nursing, specific content on care of older adults was woefully absent in academic programs preparing entry- and graduate-level nurses. Clearly, the JAHF HGNI investment in nursing education has paid huge dividends. Baccalaureate nursing students are now likely to graduate with competencies in care of older adults. In the next 5 years, ongoing JAHF HGNI initiatives should yield similar outcomes in associate degree-prepared graduates and in advanced practice registered nurse graduates. This article traces the impact of the JAHF HGNI on nursing education.

Nursing Homes as a Clinical Site for Training Geriatric Health Care Professionals

Nursing homes can be ideal clinical teaching and learning environments for acquiring geriatric specialty and interdisciplinary team skills, particularly those regarding assessment, care planning, management, monitoring, and collaborating in an interdisciplinary milieu. Little is known as to how geriatric specialty training programs use nursing homes to meet expected specialty competencies, or the types of clinical experiences in nursing homes required by academic geriatric training programs. This article describes the expectations of 5 clinical health care disciplines (dentistry, medicine, nursing, pharmacy, and social work) and nursing home administration regarding desirable nursing home characteristics that support gaining geriatric competencies. The issues involved in using nursing homes as supportive educational environments in geriatric education are discussed.

Expanding the knowledge base of resident and facility outcomes of care delivered by advanced practice nurses in long-term care: expert panel recommendations.

In 2003, a panel of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care convened to examine and make recommendations about care quality and safety issues related to advanced practice nurses (APNs) in nursing home practice. This article reports on the panel recommendation that addressed expanding the evidence base of resident and facility outcomes of APN nursing home practice. A review of the small but important body of research related to nursing home APN practice suggests a positive impact on resident care and facility outcomes. Recommendations are made for critically needed research in four key areas: (a) APN nursing home practice, (b) relative value unit coding, (c) outcomes related to geropsychiatric and mental health nursing services, and (d) outcomes related to geriatric specialization. The APN role could be significantly enhanced and executed if its specific contribution to resident and facility outcomes was more clearly delineated through the recommended rigorous research.

Ensuring a nurse practitioner workforce prepared to care for older adults: Findings from a national survey of adult and geriatric nurse practitioner programs

Abstract Purpose: To present the findings from a needs assessment of adult primary care (ANP), gerontological (GNP), and adult acute care (ACNP) nurse practitioner faculty regarding the transition to adult-gerontology NP (A-GNP) programs. Data sources: Data were obtained from two sources: (a) an online survey to identify the facultys primary needs in order to facilitate success in this transition and (b) telephone focus groups to explore survey responses in greater depth. Conclusions: The survey and the focus group findings indicate that there is a strong need for (a) access to a set of nationally recognized competencies for A-GNPs; (b) teaching/learning resources to support faculty in implementation of A-GNP programs; and (c) formal faculty development opportunities to facilitate faculty efforts to engage in curricular redesign and innovations and assure that NP students acquire strong competence in gerontology content. Implications for practice: The transition to A-GNP has implications not only for NP faculty but also for practicing NPs. Almost all NPs care for older adults in a variety of settings. However, most of these NPs are not specialists in geriatrics. This article provides a context for self-assessment by these NPs of their own needs related to this transition.Purpose: To present the findings from a needs assessment of adult primary care (ANP), gerontological (GNP), and adult acute care (ACNP) nurse practitioner faculty regarding the transition to adult‐gerontology NP (A‐GNP) programs. Data sources: Data were obtained from two sources: (a) an online survey to identify the facultys primary needs in order to facilitate success in this transition and (b) telephone focus groups to explore survey responses in greater depth. Conclusions: The survey and the focus group findings indicate that there is a strong need for (a) access to a set of nationally recognized competencies for A‐GNPs; (b) teaching/learning resources to support faculty in implementation of A‐GNP programs; and (c) formal faculty development opportunities to facilitate faculty efforts to engage in curricular redesign and innovations and assure that NP students acquire strong competence in gerontology content. Implications for practice: The transition to A‐GNP has implications not only for NP faculty but also for practicing NPs. Almost all NPs care for older adults in a variety of settings. However, most of these NPs are not specialists in geriatrics. This article provides a context for self‐assessment by these NPs of their own needs related to this transition.