Neva L. Crogan

The Minimum Data Set Predicting Malnutrition in Newly Admitted Nursing Home Residents

The purpose of this study was to describe the prevalence of protein-calorie malnutrition (PCM) among newly admitted elderly nursing home residents and identify the most significant predictors of PCM using Minimum Data Set (MDS) variables. Using a cross-sectional design, the authors studied 306 nursing home residents. Malnutrition risk factors found on the MDS were measured for each resident. Overall, 118 (38.6%) residents met the Nutrition Screening Initiative Guidelines for PCM.MDS variables found to be significant predictors were weight loss, leaves 25% or more of food uneaten at most meals, psychiatric/mood diagnoses, deteriorated ability to participate in activities of daily living, and older age. Three additional variables (antidepressant use, diuretic use, ther apeutic diet) were found to be protective—residents with these variables were more likely to have a normal body mass index. MDS data provide an opportunity for early identification of residents who are at risk for PCM and accompanying morbidity.

Nutrition knowledge of nurses in long-term care facilities.

BACKGROUND The purpose of this study was to determine knowledge-based nutrition competencies of nurses and describe needed nutrition education relative to reducing protein-calorie malnutrition (PCM) in nursing home residents. METHOD A sample of 44 nurses (35 RNs, 9 LPNs) from five eastern Washington nursing homes completed a 50-item questionnaire that measured nutrition knowledge based on Benners Novice to Expert Model. RESULTS Nurses scored an average 65% +/- 11% on the nutrition examination. CONCLUSION An educational program addressing the identified deficient areas could improve the ability of nursing staff to assess and monitor resident food intake, thereby reducing the prevalence of PCM of residents in nursing homes.

Social and cultural construction of urinary incontinence among Korean American elderly women.

The purpose of this article is to describe the social and cultural constructions that influence help-seeking for urinary incontinence (UI) among Korean American elderly women. Many Korean American elder women do not perceive UI as a problem worthy of attention. The reason may lie in its social and cultural construction. The social construction is rooted in the collectivist nature of Korean culture, which makes UI a family, rather than an individual, problem. The cultural construction is related to Confucianism, which directs conceptions about ageism, shame, and fatalism. This article will help the gerontological nurse to better understand Korean American elderly womens sociocultural background related to UI care and could lead to appropriate family centered interventions to manage or treat UI in this population.

Storytelling Intervention for Patients With Cancer: Part 2—Pilot Testing

PURPOSE/OBJECTIVES To evaluate symptom reports and the impact of a nurse-led storytelling intervention in a supportive group setting on mood, stress level, coping with stress, pain, self-efficacy, and satisfaction with life in patients with cancer. DESIGN Descriptive pilot project using a pretest/post-test control group. SETTING Local regional medical center in the Pacific Northwest region of the United States. SAMPLE Convenience sample of 10 patients with various cancer diagnoses; 7 completed the intervention. METHODS Participants were randomly assigned to a storytelling or control group. Using a tool kit generated for this project, a nurse facilitator guided storytelling group participants in 12 1.5-hour sessions. Six instruments, symptom assessments, and a retrospective physician chart review were completed for each group. Data were analyzed using repeated measures analysis of variance. MAIN RESEARCH VARIABLES Mood, stress, coping, pain, self-efficacy, and satisfaction with life. FINDINGS Comparison of changes in group mean scores revealed a significant decrease in anxiety in the storytelling group despite disease progression. Documentation of psychosocial symptomatology by physicians is limited; however, nursing assessments were useful in determining psychosocial status before and after the intervention. CONCLUSIONS Results can be viewed only in context of a feasibility study and are not generalizable because of a limited sample size. A trained oncology nurse was able to use the storytelling intervention. Initial results are promising and warrant further study. IMPLICATIONS FOR NURSING After additional testing, the intervention could be used to enhance storytelling groups for patients with cancer or for individuals who are uncomfortable in or do not have access to storytelling groups.

Utility of the Life Course Perspective in Research With Mexican American Caregivers of Older Adults

Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.

Quality improvement practices: enhancing quality of life during mealtimes.

This article describes ten dining room problems, identified in a nursing home study, that needed quality improvement, as well as six quality practices suggested for implementation. These six quality practices provide the basis for an excellent eating experience characterized by a home-like atmosphere, high levels of staff-resident interaction, and increased attention to safety and ethical issues. The six practices also could serve as the foundation for a facility-wide, cost-effective, quality improvement program.

Storytelling Intervention for Patients With Cancer: Part 1—Development and Implementation

PURPOSE/OBJECTIVES To develop a nurse-led storytelling intervention for patients with cancer and implement the intervention using trained oncology nurses. DESIGN Descriptive pilot project using qualitative methods to assess implementation of an intervention tool kit, with investigators blinded to control and intervention group membership. SETTING Local regional medical center in the Pacific Northwest region of the United States. SAMPLE A convenience sample of 11 patients with various cancer diagnoses was used for tool kit generation. Intervention and control groups were then formed and used to study tool kit implementation. METHODS Participant exit interviews and facilitator debriefing questionnaires assessed the ability of a nurse facilitator to use a group storytelling intervention tool kit. Data from control and intervention groups were analyzed and compared with qualitative procedures. MAIN RESEARCH VARIABLES A nurse-led storytelling intervention. FINDINGS Analysis of interviews and questionnaires revealed implementation of storytelling tool kit principles and differences between storytelling and control groups in three patterns: finding a soft place to fall, understanding the cancer experience, and figuring out how (if) to get through it. CONCLUSIONS Techniques contained in the tool kit were implemented and deemed clinically useful by oncology nurses. IMPLICATIONS FOR NURSING Given the small testing groups, pilot project results must be interpreted with caution, but with additional research and instructional development, the tool kit could be useful to nurses in a variety of settings and locales.

Improving nutrition care for nursing home residents using the INRx process

Abstract The purpose of this article is to describe the Individual Nutrition Rx (INRx) assessment process and report findings on elder nutritional status, common nutrition problems identified by the INRx process, resolution outcomes from each problem, and the most efficacious approaches used to address the identified nutrition problems. The study used a two-group prospective quasi-experimental design with measures taken at baseline and at 6 months. Participants in the treatment group (n = 41) received the 6-month INRx assessment process, while residents in the comparison group (n = 40) received routine care specific to their nursing home. The most frequent nutritional problems identified were appetite change, poor positioning while eating, and problems with oral status. A total of 39 approaches were recommended by the interdisciplinary research team. Serum albumin and prealbumin, and depression scores were all significantly improved post intervention. The problems, approaches, and outcomes identified during the INRx process support the premise that interdisciplinary teams following the INRx process can assess complex nutritional problems and influence outcomes for older adults living in nursing homes.

Organizational issues related to satisfaction with food and food service in the nursing home from the resident's perspective.

Abstract This paper reviews organizational factors that potentially affect food quality and food service in the nursing home. A model is proposed for assessing the influence of organizational technology on resident satisfaction with food and food service from the residents perspective. Findings from an exploratory phenomenological case study applying the model are presented. Staff knowledge of how to prepare and serve food properly, and staff availability to serve food on time, were key constructs. Resident-staff interactions appeared to moderate resident control over food and food service. Recommendations are suggested for improved communication between residents and staff to address certain limitations and enhance empowerment of residents.

Nutrition Assessment: Experience Is Not a Predictor of Knowledge.

This study tested an evidence-based nutrition education program for licensed nurses working in nursing homes who scored an average of 56% on a pretest. Posttest scores averaged 66%, demonstrating a continuing deficit of basic nutritional knowledge despite the educational intervention. Statistical analysis revealed that less experienced nurses scored better on posttests than more experienced nurses; more experienced nurses performed nutritional assessment more often than less experienced nurses; and more experienced nurses were usually charge nurses or nurses completing Minimum Data Sets. Although the education did not eliminate all deficits in nutrition knowledge, a decrease in the percentage of residents with significant weight loss was noted.