Understanding the experiences of PHC nurses in caring for older patients in the post-fifth wave of the COVID-19 pandemic: an exploratory qualitative study

Objective

To ensure the best possible care, the perspective of PHC nurse work experience during the COVID-19 pandemic should be considered when developing nursing care protocols for older patients who receive PHC services.

Method

This exploratory qualitative study was conducted with 18 nurses working continuously in PHC between the first and fifth waves of the pandemic. Semi-structured thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis.

Results

The first topic describes the nurses' experiences of physical and mental suffering in caring for older patients in response to the pandemic. The second topic covers the experience of reorganizing PHC work. The third topic focuses on the difficulties of caring for older patients. The final topic includes issues of support needs for nurses in PHC work.

Conclusion

The experience and understanding of PHC nurses in caring for older people during the COVID pandemic should lead to significant changes in the system of nursing care for geriatric patients and in the cooperative role within geriatric care specialist teams. Drawing on the experience of COVID-19, it is necessary to work on the weak points of PHC exposed by the pandemic in order to improve the quality of care and life for geriatric patients.

Application, knowledge and training needs regarding comprehensive geriatric assessment among geriatric practitioners in healthcare institutions: a cross-sectional study

BACKGROUND

This study aimed to investigate the actual application, knowledge, and training needs of comprehensive geriatric assessment (CGA) among geriatric practitioners in China.

METHODS

A total of 225 geriatric practitioners attending the geriatric medicine or geriatric nursing training were recruited for this cross-sectional study. The questionnaire included demographics, healthcare institution characteristics, the actual application, knowledge, training needs, and barriers to CGA and geriatric syndromes (GS).

RESULTS

Physicians and nurses were 57.3% and 42.7%, respectively. 71.1% were female, with a median age was 35 years. Almost two-thirds (140/225) of geriatric practitioners reported exposure to CGA in their clinical practice. The top five CGA evaluation items currently used were malnutrition risk (49.8%), fall risk (49.8%), activity of daily living (48.0%), pain (44.4%), and cognitive function (42.7%). Median knowledge scores for the management procedures of GS ranged from 2 to 6. Physicians identified medical insurance payment issues (29.5%) and a lack of systematic specialist knowledge and technology (21.7%) as the two biggest barriers to practicing geriatrics. Nurses cited a lack of systematic specialist knowledge and technology (52.1%) as the primary barrier. In addition, physicians and nurses exhibited significant differences in their knowledge of CGA-specific evaluation items and management procedures for GS (all P < 0.05). However, there were no significant differences in their training needs, except for polypharmacy.

CONCLUSIONS

The rate of CGA application at the individual level, as well as the overall knowledge among geriatric practitioners, was not adequate. Geriatric education and continuous training should be tailored to address the specific roles of physicians and nurses, as well as the practical knowledge reserves, barriers, and training needs they face.

Geriatric Nursing: Relationship Among Death Attitude, Meaning in Life, and Career Choice Motivation

BACKGROUND

Aging populations require higher quality care. However, few undergraduate nursing students choose careers in aged care. Negative death attitudes and loss of meaning in life may reduce motivation to choose geriatric nursing (GN) as a career. The relationships among these variables have yet to be clarified in the literature.

PURPOSE

The purpose of this study was to investigate the relationships among death attitude, meaning in life, and motivation to choose a career in GN among undergraduate nursing students in China.

METHODS

This cross-sectional study was conducted using an online survey. Five hundred ninety-five final-year undergraduate nursing students in four nursing schools completed the Career Choice Motivation Questionnaire for Geriatric Nursing, Death Attitude Profile-Revised, and Meaning in Life Questionnaire. A t test, analysis of variance, Pearson's correlation, and multiple linear regression model were used to analyze the data using SPSS Version 22.0.

RESULTS

The mean Career Choice Motivation Questionnaire for Geriatric Nursing item score was 3.15 ( SD = 0.49; 1-5 points), indicating the participants were moderately motivated to choose GN as a career. The multiple linear regression revealed statistically significant associations among death attitude, meaning in life, and motivation to care for older adults, explaining 14.5% of the total variance ( R2 = .15, F = 9.01, p < .001). Perceiving meaning in life, having escape acceptance, and having approach acceptance were each shown to be positively associated with choosing a career in GN. Conversely, fear of death and death avoidance were found to be negatively associated with choosing this career path.

CONCLUSIONS

Death attitude and perceptions regarding the meaning of life are associated with the motivation of nursing students to care for older adults.

Influence of materiality in professional geriatric care: Conceptual, methodological and empirical insights

Most people become more reliant on care and support as they age. The constitution of ageing people in the context of nursing support thus represents a material aspect in the daily life of these people and must be taken into account in the science of gerontology. However, theories of (geriatric) care have previously been predominantly human-centric. In light of the material turn, the goal of this paper is to highlight the potential to be found in using agential realism to critically examine geriatric care. It will begin by detailing previous perspectives on geriatric care and any use of material aspects to be found in it. It will then present a conceptual-methodical approach that allows for an examination of the act of caring, taking material aspects into account. The application of this approach to empirical material drawn from an example of acute care in Germany will, in conclusion, illustrate significant elements that, in light of agential realism, must also be taken into account when investigating what it means to provide good geriatric care.

Nurse-Led Models of Care: Practice and Policy to Support Aging in Place

PURPOSE

Research demonstrates that aging in place is the goal of most adults aged >50 years. Unfortunately, multiple barriers to aging in place continue to exist, especially for vulnerable populations. Achieving this goal will require innovative nurse-led models of care and new policies for RN reimbursement. The current article describes a nurse-led clinic implemented in one community.

METHOD

Using an evidence-based nurse-led model of care, a team of university faculty, students, and a family nurse practitioner designed and implemented a nurse-led clinic for a religious community in the Pacific Northwest.

RESULTS

Today, the nurse-led clinic offers care coordination and primary care to support aging in place and is one example of a nurse-led model well-positioned to address the aging in place needs of vulnerable populations.

CONCLUSION

Replication and sustainability of this nurse-led model requires sweeping policy change, including consideration of requiring all nurses to attain a National Provider Identification number to expand RN reimbursement and ultimately increase access to care. [Journal of Gerontological Nursing, 50(3), 13-17.].

Developing geriatric nursing micro-credentials for undergraduate nursing students based on training objectives: A modified Delphi study

BACKGROUND

China's population has begun to age rapidly in the past several years and this trend is predicted to continue. In the face of this growing older population, the existing number of aged care personnel, especially medical care professionals, can hardly meet the demand for aged care services.

AIM

To develop geriatric nursing micro-credentials (MCs) for undergraduate nursing students based on standardized training objectives and to specify the learning goals and course modules that correspond to each specific MC.

DESIGN

Modified Delphi study.

METHODS

An initial set of geriatric nursing MCs were developed based on the training objectives. Expert group discussion (n=13) reviewed the clarity and intelligibility of the statements' wording and supplemented the framework. A three-round Delphi survey (n=15) was then employed to obtain a consensus on the learning goals and course modules via an online questionnaire. Descriptive statistics were used to analyze the data.

RESULTS

The final geriatric nursing MCs consisted of six courses, namely fundamentals of geriatric nursing (8 modules), geriatric sociology (6 modules), geriatric clinical nursing (3 modules), geriatric psychological nursing (8 modules), geriatric rehabilitation nursing (8 modules) and geriatric hospice care (10 modules).

CONCLUSION

Nursing faculty can use the geriatric nursing MCs developed in this study to train current undergraduate nursing students to become backups for current, fully credentialed geriatric caregivers.

'The night is for sleeping': how nurses care for conflicting temporal orders in older person care

This paper examines the conflicting temporal orders of the regional nurse, a role which has been introduced to deal with the increasing demands of aged care and workforce shortages in regional settings. We build on ethnographic research in the Netherlands, in which we examine regional district nurses as a new professional role that attends to (sub)acute care needs, connecting and coordinating different places of care during out of office hours. We use the concept of 'temporal regional order' to reflect on the different ways caring practices are temporally structured by management and care practitioners, in close interaction with patients and informal care givers. In the results three types of disruptions of the regional temporal order are distinguished: interfering bodily rhythms and needs; (un)expected workings of technologies; and disrupting acts of patient and relatives. It was region nurses' prime responsibility to stabilise these interferences and prevent or soften a disruption of the regional order. In accomplishing this, we show how nurses craft their professional role in between various care settings, without getting involved too much in patient care, to be mobile as 'temporal caregivers'.

Gerontological nursing competencies: A scoping review

BACKGROUND

Despite decades of advocates striving to enhance gerontological content in baccalaureate nursing programs, nurses are still graduating with inadequate knowledge and skills to work with older adults. Scholars suggest that incorporating entry-to-practice gerontological competencies could be one way to improve graduating nurses' knowledge about older adults.

AIM

To examine the state of gerontological entry to practice competencies and standards for baccalaureate-prepared nurses around the world.

DESIGN

We conducted a scoping review of the literature using the Joanna Briggs Institute (JBI) framework and followed PRISMA-ScR guidelines to report findings.

METHODS

We performed searches from inception to June 20th 2022 in Medline and EMBASE via OVID, CINAHL via EBSCOhost, Scopus, and Cochrane Library via Wiley. We conducted a search on GOOGLE for grey literature. We included literature that examined 1) baccalaureate nursing programs, 2) gerontological competencies/standards, and 3) older people/adults.

RESULTS

We found 8 literature sources, 4 of which were academic papers and 4 documents describing gerontological entry-to-practice standards and competencies from national nursing associations. Gerontological competencies highlight providing person-centered care to older people and their families across many care contexts. This care includes relational and cultural competence, exhibiting professional values and screening for potential elder abuse. Scholars in two papers relayed their experiences incorporating gerontological competencies into their curricula and two studied student nurses' gerontological competency.

CONCLUSIONS

There is interest and some progress in developing and incorporating gerontological competencies in various countries but not enough. A coordinated approach to sharing information and expertise among nations is needed to develop international gerontological competencies to facilitate improved nursing care with older adults.

Adaptation of the Gerontological Nursing Competence (GeroNursingCom) instrument to Turkish: Validity and reliability study

AIM

The aim of this study was to conduct a Turkish validity and reliability study of the Gerontological Nursing Competence Scale and to adapt the scale to Turkish culture.

BACKGROUND

As the number of older people increses, gerontological nursing requires specialized expertise in older people care. High-quality basic education and further education guarantee good competence in gerontological care.

DESIGN

A methodological study of instrument translation and validation.

METHODS

The study was methodological and the sample consisted of 530 university students who agreed to participate in the study. Data were collected by online interview method using the Introductory Information Form and Gerontological Nursing Competence Scale (GeroNursingCom). Before starting the study, permission was obtained from the ethics committee, the relevant institution, the scale owner and the students. Language equivalence and content validity of the scale were ensured and Confirmatory Factor Analysis Models (CFA) was conducted. Cronbach Alpha and item-total correlation analysis were used for the reliability of the scale.

RESULTS

The scale was compatible in terms of linguistic fidelity Content Validity Index (CVI) (Language)=0.97 and content fidelity CVI (Content)=0.96. The CFA results showed that the χ2/sd value was 1.861 and since this value was less than three, it can be stated that the model provided an excellent fit to the data. Comparative Fit Index (CFI) and Non-normalized Fit Index (NNFI) values were determined as 0.99 and 0.99 respectively and these values being above 0.90 indicate that the model provides an excellent fit to the data. Square Root of Standardized Errors (SRMR) index was 0.045 and Root Mean Square Error of Approximation (RMSEA) index was 0.040 and these values were less than 0.080, indicating that the model provided an excellent fit to the data. The Cronbach's alpha reliability coefficient of 0.97 was found to be highly reliable and the Cronbach's alpha reliability coefficients calculated for the sub-dimensions ranged between 0.77 and 0.91.

CONCLUSIONS

It was determined that the gerontological nursing competence scale is valid and reliable for nursing students and can be used in both student and working nurses living in Turkey.

Application of Network-Based PBL Model Combined with Role-Playing Method in Geriatric Nursing Teaching

Objective

To evaluate the effectiveness of using a combination of problem-based learning (PBL) and role-playing methods in geriatric nursing education through online networks.

Methods

The research objects of this paper were selected from nursing students, and the number of participants was 200. The research objects were selected from March 2019 to September 2021. The learning situation and related data of the above students were retrospectively analyzed. According to the teaching methods, the students were divided into groups. The students who received traditional teaching methods were included in the control group, with a total of 100 participants. The students who received network-based PBL mode combined with role-playing teaching were included in the observation group, with a total of 100 participants. The assessment results and learning effect evaluation of the two groups of students were compared, and the level of learning engagement and changes in critical thinking between the groups were compared.

Results

The scores of basic theoretical knowledge, clinical practice skills, and clinical case analysis of students in the observation group were higher than those of the control group (P < .001). The evaluation index of nursing students' learning effects was analyzed. The proportions of enhancing teacher-student interaction, improving team cooperation ability, improving autonomous learning ability and learning interest, improving analysis and problem-solving ability, improving theory combined with practice ability, improving communication and expression ability, improving work self-confidence, improving knowledge and vision, improving literature retrieval and evaluation ability in the observation group were higher than that in the control group (P < .001). After the teaching work, the overall learning input score, cognitive input score, behavior input score, emotional input score, learning harvest score, and learning satisfaction score of students in the observation group were higher than those of the control group (P < .001). After teaching, the scores of finding the truth, open mind, analytical ability, systematic ability, critical thinking self-confidence, curiosity and cognitive maturity of the students in the observation group were higher than those in the control group (P < .001).

Conclusion

The combined application of network-based PBL mode and role-playing method can significantly improve the teaching effects of geriatric nursing, with popularization value.

Synthesizing Best Practices to Promote Health Equity for Older Adults Through Community-Engaged Research

Achieving health equity requires creating evidence that reflects the nuance and diversity of experiences among populations disproportionately impacted by age- and race-related disparities. Community-engaged research (CEnR) is one way to pursue equity in research on health and aging to ensure the relevance and translational potential of findings. The current review synthesizes best practices regarding CEnR that promote health equity among older adults, including an overview of CEnR, benefits, and fundamental principles, and three research exemplars from the authors' CEnR. Finally, we discuss these best practices and considerations for advancing CEnR to reduce health disparities experienced by historically underserved older adults and their families. [Research in Gerontological Nursing, 17(1), 9-16.].

Resilient Adaptation Strategies: Unveiling Older Adults' Coping Dynamics Amidst the COVID-19 Pandemic

Older adults, who are particularly vulnerable to coronavirus disease 2019 (COVID-19), exhibit less stress and greater well-being than their younger peers. However, there have been no in-depth explorations of adaptive coping strategies among this population, nor has the role of frailty status been addressed. The current study examined stress and coping in 30 U.S. older adults (mean age = 81 years, range = 68 to 95 years) amidst the COVID-19 pandemic, uncovering themes of: (1) Pandemic Stresses: stresses experienced during the pandemic centered around social isolation and concern for others' well-being; (2) Resilience: older adults proved highly adaptable, with lifetime experience as a stress buffer; and (3) Silver Linings: older adults reported positive by-products, such as reconnecting with and a renewed appreciation for life and nature. Motivation for change and change itself centered around creating value and meaning in the present, especially around social isolation. Findings challenge existing ageist stereotypes, give insight into interventional design, and highlight the importance of ensuring infrastructural and societal support. [Journal of Gerontological Nursing, 49(12), 32-39.].

Transitions of Care: Strategies for Medication Optimization and Deprescribing in Older Adults

Older adults have an increased risk of adverse drug events related to polypharmacy and potentially inappropriate medication (PIM) use. These patients are even more vulnerable as they transition through different health care settings. In 2023, the American Geriatrics Society published an updated version of the Beers Criteria®, providing updated guidance on identifying and managing PIMs. Nurses and nurse practitioners play important roles in medication management across the continuum of care. The current article aims to illustrate key concepts regarding medication safety and deprescribing for older adult patients during transitions of care. [Journal of Gerontological Nursing, 49(12), 5-10.].

Leveraging Regulation and Legislation to Improve the Care of Older Adults Through Home- and Community-Based Services

An increase in demand for health care services for older adults is being negatively impacted by lack of a sufficient nursing workforce with competence in home- and community-based services (HCBS). The current article examines the unique challenges and opportunities in caring for older adults in HCBS settings, outlines the core competencies nurses must possess to provide this care, and proposes strategies to leverage legislative and regulatory initiatives to incorporate these competencies into nursing education and practice. Examining the American Association of Colleges of Nursing's Essentials Competencies through the HCBS lens, it is an ideal time to create a roadmap for nurses in practice, policy, and education to shape the health care workforce to meet the needs of a diverse and vulnerable population: older adults who depend on home- and community-based care for maintaining or improving their health outcomes and overall quality of life. [Journal of Gerontological Nursing, 49(12), 11-16.].

Dementia and Postoperative Delirium in Surgical Hip Fracture Patients: Unveiling Contrasting Risk Factors and Implications

Postoperative delirium is a serious complication, particularly in older adults with hip fractures. Using the 2019 American College of Surgeons National Surgical Quality Improvement Program data file, we performed multiple regression analyses to compare risk factors for postoperative delirium in hip fracture patients with and without dementia. Preoperative delirium and mobility aid use were common risk factors in both groups. However, differential effects were observed for other factors. Pathological fracture increased delirium risk in patients with dementia but had a protective effect in those without dementia. In patients with dementia, American Society of Anesthesiology score IV/V was identified as a risk factor, whereas advanced age, severe chronic obstructive pulmonary disease, weight loss, sepsis, elevated international normalized ratio, and serum creatinine level were additional risk factors in patients without dementia. These findings enhance our understanding of the complex relationship among dementia, hip fractures, and postoperative delirium. Identifying specific risk factors for each group can inform tailored interventions and preventive strategies. Further research is needed to validate and expand these findings, ultimately improving care and outcomes. [Journal of Gerontological Nursing, 49(12), 25-30.].

Acute Care for Elders and Nurses Improving Care for Health System Elders Models in Acute Care: Are We Still Using These Geriatric Models of Care?

Care models for older adults have been studied for more than 30 years. Several models of care for older adults were created in the acute care setting to prevent hospital-acquired disability and decline-a phenomenon frequently observed among older patients admitted in the acute care setting. The Acute Care for Elders (ACE) model and the Nurses Improving Care for Health System Elders program were 2 such models that sought to improve the quality of care for older adults and reduce their cost for care. Where are they today? Are we still using these care models in the acute care setting?

"They Don't Have Time, But It Would Be Wonderful": Residents' Views of Their Relationships With Staff

Resident-staff relationships is a component of person-centered care (PCC); positive relationships are associated with positive outcomes. The current article explores the finding that residents living in different types of long-term care assigned the lowest ratings of importance to the PCC domain "relationships with staff " (one of eight domains studied). Thematic analysis of spontaneous comments made by residents during interviews identified two themes, Relationship Preferences (for privacy, boundaries, engagement) and Lived Experience With Staff (staff busyness, staff interactions). Low ratings of relationship importance may reflect preferences for privacy and maintaining boundaries with staff. Ratings by some residents may be related to staff busyness, an overarching theme. Staff busyness was associated with lack of personal interaction with staff, including for those who expressed preferences for engagement and those who described positive interactions with staff. Some residents may reappraise their views about the importance of relationships to reduce cognitive dissonance. Improving job quality is necessary to assure quality time with residents. [Journal of Gerontological Nursing, 49(11), 8-14.].

Using Virtual Reality in the Care of Older Adults With Dementia: A Randomized Controlled Trial

There is a shortage of personnel to provide care for older adults with dementia, and traditional teaching methods could be improved. The teaching method used in the Care for Older Adults With Dementia course is mainly theoretical, lacking real-life care scenarios and practical procedural training. In the current study, we developed a virtual reality (VR) teaching system and designed a randomized controlled trial aimed at testing the availability of the VR-assisted teaching system, filling the gap in teaching through care scenarios, enabling students majoring in intelligent health and oldage care service management to have a more positive attitude toward learning, and improving students' knowledge and course satisfaction. This study showed that the developed VR system can meet the initial needs of daily teaching, help students have a more positive attitude toward learning, and improve their academic performance and course satisfaction. [Journal of Gerontological Nursing, 49(11), 25-32.].

[The nurse, recurrent cries]

Recurrent screaming and vocal agitation complicate geriatric and psychogeriatric care. They are among the psychobehavioral symptoms that accompany neurocognitive diseases. Reputedly difficult to manage, they require a comprehensive pharmacological and non-pharmacological approach. How can the care team deal with these disorders in the absence of a doctor?

Connecting Dementia Caregivers to Recommended Services: Care to Plan

The current mixed methods, embedded study evaluated the use of an online tool (Care to Plan [CtP]) that generates tailored service and support recommendations for dementia caregivers as well as information that can connect dementia caregiver users to recommended resources. Forty-three dementia caregivers identified in a health care system were randomly assigned to receive either CtP or usual care. The embedded, mixed methods design resulted in no quantitative, direct evidence for CtP's efficacy. Qualitative data revealed important insights into facilitators of and barriers to CtP use. Qualitative data also demonstrated that CtP helped caregivers obtain a better awareness of their needs and experiences. Clinicians may find CtP useful as an initial tool to spur memory care/case management and facilitate conversations about caregivers' needs and resources to meet individualized challenges. [Journal of Gerontological Nursing, 49(10), 5-11.].

The role of nurses in inpatient geriatric rehabilitation units: A scoping review

AIMS

(1) To review and synthesize research on the contributions of nurses to rehabilitation in inpatient geriatric rehabilitation units (GRUs), and (2) to compare these reported contributions to the domains of international rehabilitation nursing competency models. The roles and contributions of nurses (e.g. Registered Practical Nurses, Registered Nurses and Licensed Practical Nurses) in GRUs are non-specific, undervalued, undocumented and unrecognized as part of the formal Canadian rehabilitation process.

DESIGN

Arksey and O'Malley's methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used.

METHODS

Six databases were searched for relevant literature: MEDLINE, PsychINFO, CINAHL, EMBASE, SCOPUS and Nursing and Allied Health. English articles were included if they examined nursing roles or contributions to inpatient geriatric rehabilitation. Integrated synthesis was used to combine the qualitative and quantitative data, and thematic analysis was used for coding. Three sets of international competency models were amalgamated to explore how different nurse roles in geriatric rehabilitation were portrayed in the included literature.

RESULTS

Eight studies published between 1991 and 2020 were included in the review. Five main geriatric rehabilitation nursing roles were generated from synthesis of the domains of international rehabilitation nursing competency models: conserver, supporter, interpreter, coach and advocate.

CONCLUSIONS

Nurses working in inpatient geriatric rehabilitation are recognized more for their role in conserving the body than their roles in supporting, interpreting, coaching and advocacy. Interprofessional team members appear to be less sure of the nurses' role in the rehabilitation unit. Nurses themselves do not acknowledge the unique rehabilitation aspects of care for older adults. Enhancing formal education, or adding continuing education courses, to facilitate role clarity for nurses in geriatric rehabilitation could improve nurses' and interprofessional healthcare team members' understandings of the possible contributions of nurses working in rehabilitation settings.

Engaging Older Adults and Families Using the IDEAL Discharge Protocol: A Quality Improvement Initiative to Improve Outcomes and Reduce Readmissions

Older adults have challenges understanding newly prescribed medications after discharge and must be more adherent with medications and follow up with their primary care provider. A collaborative discharge process is critical to improving patient outcomes and reducing avoidable readmission rates. This quality improvement (QI) initiative engaged 44 patients and families in the IDEAL Discharge Protocol-an evidence-based collaborative care process focused on discussion, education, and post-discharge follow up. Post-discharge follow up resulted in the completion of 52.2% of follow-up calls and 45.5% of follow-up appointments scheduled, and a 4% reduction in readmission rates. Medication adherence was assessed and found to be 93.3%, and 100% of participants received education while engaged in the study. The IDEAL Discharge Protocol aided in improving the discharge process to better equip patients with the tools to transition home successfully after discharge. [Journal of Gerontological Nursing, 49(10), 13-19.].

Similarities and Differences of Interventions to Promote Physical and Psychological Health Between Prefrail and Frail Older Women: A Systematic Review

The current review aimed to explore similarities and differences in the properties of interventions that promote physical and psychological health between prefrail and frail older women. Ten databases were searched for studies published from database inception to May 2023. Two Cochrane tools were used to assess the risk of bias in experimental and quasi-experimental studies. Twenty-three studies were selected, including 11 studies on prefrailty and 12 studies on frailty. Exercise interventions were predominant, but the contents and standards of exercise intensity were inconsistent between prefrail and frail women. For the main outcomes of the interventions, balance ability and biochemical factors were measured more frequently for frail older women than prefrail older women. Psychological health was less measured for prefrail and frail older women compared to physical health. Future research needs to consider balance training, as well as the evaluation of biochemical factors and psychological health among prefrail or frail older women. [Journal of Gerontological Nursing, 49(10), 20-28.].

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Nurses Improving Care for Health Systems Elders (NICHE): An evidence-based professional practice model for an aging nation

Nurses Improving Care for Healthsystems Elders (NICHE), one of the original geriatric care models, enhances the overall quality and safety of nursing care provided to older adults in hospital and post-acute care settings. NICHE is a relatively low-cost, high-impact investment in the nursing workforce to improve performance on the nurse-sensitive quality indicators including falls, pressure injuries, medication safety, urinary incontinence, restraint reduction, delirium identification and management, reducing preventable readmissions, among others. NICHE also serves as a foundation to enhance nursing care to achieve national accreditation standards for a number of geriatric and nursing quality programs.

Optimizing Pharmacotherapy for Direct Oral Anticoagulants in Older Adults: Strategies for Managing Drug Interactions

Direct oral anticoagulants (DOACs) have been increasingly used by older adults. Although these medications offer several therapeutic advantages over traditional anticoagulants, such as warfarin, they have limitations. One significant concern associated with DOACs is their potential for drug-drug interactions. These interactions may compromise the safe and effective use of DOACs and can potentially lead to serious adverse events and complications, particularly major bleeding. Polypharmacy is common among older adults with chronic diseases, which can increase the risk of drug-drug interactions with DOACs. The current article discusses the impact and risks of drug-drug interactions with DOACs in the context of older adults and explores ways to improve and manage these interactions through the collaboration of an interprofessional team. [Journal of Gerontological Nursing, 49(9), 7-13.].

Social Connectedness Resource Preferences of Older Adults in Assisted Living: A Scoping Review Based on the WHO-ICF Framework

The current scoping review identified emerging evidence on social connectedness resource preferences of older adults in assisted living facilities (ALFs) and the community. A literature search was performed using several databases. We included review articles published between January 2000 and September 2022 in English and related to social connectedness resources in ALFs and the community. Of 134 titles and abstracts, eight studies were included. Study participants comprised 2,482 older adults from 233 ALFs in the United States. Themes were framed using the World Health Organization's International Classification of Functioning, Disability, and Health. For social activities, older adults preferred facility-based recreation and leisure resources. For community social connectedness, residents preferred participation in civic life activities. Participants of older age preferred facility resources, whereas those of younger age preferred more demanding physical activities. Those from larger enrollment facilities preferred facility-based resources compared to community resources. For moderately and less active residents, participation was limited to less demanding activities. Older adults' preferences varied based on age, physical limitations, and size and location of the facility. Findings suggest opportunities for further research on developing ALF- and community-based resources for older adults' social well-being and quality of life. [Journal of Gerontological Nursing, 49(9), 35-42.].

Qualitative Research on Self-Transcendence in Older Adults: A Scoping Review

The current scoping review describes qualitative research on self-transcendence (ST) in older adults. Articles from five databases were independently screened and data were extracted from predetermined categories. Results were compared and consensus reached through discussion. The two leading theorists guiding the chosen studies were Pamela Reed and Lars Tornstam. Experiential language in the studies most often touched on intrapersonal and interpersonal ST. Two main gaps identified in the literature were: (a) limited coverage of transpersonal aspects of ST, and (b) limited inclusion of experiential language of study participants. More qualitative research, phenomenology in particular, can shed light on the topic of ST. A deeper understanding of all aspects of ST, including experiential language used to describe it, can lay a foundation for nursing to advance with theory formation, scale construction, and interventions to better promote spiritual and psychological well-being in older adults. [Journal of Gerontological Nursing, 49(9), 43-48.].

Treatment Fidelity of the Family-Centered Function-Focused Care Intervention

The purpose of the current study was to evaluate treatment fidelity (i.e., the extent to which an intervention is provided as intended) in the Family-Centered Function-Focused Care (Fam-FFC) intervention. This was a descriptive study using data collected during intervention activities throughout the course of the Fam-FFC study. Specific measures included Environment and Policy Assessments, Fam-FFC Knowledge Test, Goal Attainment Scale, Function-Focused Care Behavior Checklist, and completion of the FamPath Audit. Delivery was provided as intended. Staff demonstrated intervention skills with only one Fam-FFC research nurse needing retraining. Receipt was based on Fam-FFC Knowledge Test scores >80%, with the majority of participants reporting goal achievement as expected or higher than expected and slight improvement in environments and policies to better support Fam-FFC. Lastly, enactment was based on evidence that in 67% of observations staff provided at least one function-focused care intervention. Findings from this study will be used to adapt the intervention to reach all staff, increase ways to change environments and policies, consider ways to more comprehensively evaluate enactment of function-focused care during real-world interactions, and consider the characteristics of nursing staff and whether a relationship exists between staff characteristics and providing function-focused care. [Research in Gerontological Nursing, 16(4), 165-171.].

Individuals Who Developed Delirium While Enrolled in the Hospital Elder Life Program: An Exploratory Study

Delirium prevention in hospitalized older adults is important due to delirium's high prevalence and negative impact on outcomes. Today, there are evidence-based programs with well-documented effectiveness aimed at preventing delirium, such as the Hospital Elder Life Program (HELP); however, approximately 4% to 5% of patients develop delirium regardless of implemented prevention interventions. It remains unknown why some patients develop delirium. The current retrospective exploratory chart review analyzed 98 records for clinical risk factors and outcomes of patients who developed delirium while enrolled in the HELP. On admission, immobility (86.7%) was the most common risk factor. Patients developed delirium approximately 70 hours after admission. Average length of stay was 8 days. Approximately one half (44.9%) of patients died within 1 year. Immobility (97.7% vs. 77.8%, p = 0.005) and renal disease (52.3% vs. 24.1%, p = 0.008) were more often found in patients who died. This study identifies risk factors that seem to require heightened attention during hospitalization to prevent the negative outcomes associated with delirium in older adults. [Journal of Gerontological Nursing, 49(5), 19-29.].

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons

BACKGROUND

Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations.

OBJECTIVES

To examine nursing practice with older people through the lens of unconscious bias.

METHODS

In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care.

RESULTS

Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow.

CONCLUSIONS

Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice.

IMPLICATIONS FOR PRACTICE

Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.

State Variation in the Utilization of Nurse Practitioner-Provided Home-Based Primary Care: A Medicare Claims Analysis

Nurse practitioners (NPs) provide an increasing proportion of home-based primary care, despite restrictive scope of practice laws in approximately one half of states. We examined the relationship between scope of practice laws and state volume of NP-provided home-based primary care by performing an analysis of 2018 to 2019 Medicare claims. For each state we calculated the proportion of total home-based primary care visits by NPs and the proportion of all NPs providing home-based primary care. We used the 2018 American Association of Nurse Practitioners classification of state practice environment. We performed chi-square tests to assess the significance between volume and practice environment. We found that 42% of home-based primary care is delivered by NPs nationally, but substantial variation exists across states. We did not find a discernible or statistically significant pattern of uptake of NP-provided home-based primary care across full, reduced, or restricted states. [Journal of Gerontological Nursing, 49(5), 11-17.].

Elder veteran program: A description of a nurse practitioner-led inpatient geriatric consult model

ABSTRACT

This article describes the Elder Veteran Program (EVP), a nurse practitioner (NP)-led inpatient consult service at one Midwestern Veterans Administration (VA) hospital. The EVP was designed to address the needs of older hospitalized veterans and serves as a model that uses geriatric expert clinicians as mentors to grow geriatric expertise. Unique to EVP, nurses are coached to identify high-risk older veterans, initiate the consult process to drive geriatric medical and nursing review, and implement best geriatric nursing practice. As a result of EVP implementation, there was a 13-fold increase in the number of older hospitalized veterans receiving geriatric evaluation. The EVP highlights how NPs lead implementation of an evidence-based program that creates a path for engaging, educating, and growing geriatric nursing knowledge and skill while improving veteran access to geriatric sensitive care.

Adapting Geriatric Day Hospital Care From an In-House to Outreach Process

Outpatient programs have been challenged to find ways to deliver services while adhering to coronavirus disease protocols. Our Geriatric Day Hospital (GDH) Falls Clinic changed from a 6-week in-house program to an outreach program incorporating telephone assessments and home visits. We evaluated whether the outreach program was effective in improving patient outcomes in 23 serially enrolled clients. Statistically significant gains were achieved with falls, Berg Balance Scale scores, functional reach measurements, and pain management scores. Access to social support from family or friends led to higher implementation of recommendations. There was an inability to predict which clients would improve from an outreach program, but it was evident that the program benefited some clients and provided a viable alternative to an in-person program. [Journal of Gerontological Nursing, 49(4), 33-38.].

"It Isn't the Same": Experiences of Informal Caregivers of Older Adults Enrolled in a Home-Based Senior Care Program During COVID-19

The coronavirus disease 2019 (COVID-19) pandemic placed new strains on informal caregivers, who are already vulnerable to negative psychosocial effects due to demands of the caregiving role. The current study aimed to explore the early impact of COVID-19 on caregivers living with and apart from care recipients. Semi-structured qualitative interviews with seven cohabitating and 10 distanced caregivers of patients in a home-based primary care program were conducted from April to November 2020. A framework matrix was used to identify patterns in caregiver experiences. Cohabitating and distanced caregivers reported shared concerns about COVID-19 and unique concerns dependent on cohabitation status. Cohabitating caregivers reported financial worries, care recipients with dementia being unable to understand restrictions, and concerns about community business changes. Distanced caregivers reported communication challenges with cognitively impaired care recipients and challenges with visitation policies. During pandemics, caregivers' clinical and policy support needs may differ depending on their place of residence relative to care recipients. [Journal of Gerontological Nursing, 49(3), 19-26.].

Caring for the Rapidly Aging Incarcerated Population: The Role of Policy

The population of incarcerated adults in the United States is aging rapidly. Incarcerated adults experience accelerated aging, the process in which exposure to incarceration speeds up biological aging. The current article highlights unique structural factors and care practices that incarcerated older adults face in correctional and community health systems. These factors and practices are often in direct opposition to age-friendly care. Opportunities exist to expand research, modify existing policies, and change current care practices. Given their expertise in health system processes, gerontological nurses in correctional and community health care systems can play a pivotal role in improving the care of this growing and vulnerable population. [Journal of Gerontological Nursing, 49(3), 7-11.].

Residential Aged Care Facilities During the COVID-19 Pandemic: A Staff Survey on Impact and Resources

The current study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on staff in residential aged care facilities (RACFs). A hardcopy, voluntary, anonymous survey was circulated to local RACFs (June-July 2020), exploring challenges, staffing effects, mood within RACFs, and staff perceptions of supports. Overall, 105 staff members responded, which were mainly nursing personnel (67.6%) and owners/managers (10.5%). Seventy percent believed they were equipped to handle patients with COVID-19. One quarter reported personal protective equipment shortages. Respondents reported pressures to accept patients with COVID-19 from hospitals and/or keep residents in the RACF. One third reported staff "calling in sick" related to COVID-19/quarantine. Common compensatory strategies included increasing part-time workers' hours. Reported mood was largely positive. Most (86.4%) respondents felt supported by general practitioner and local geriatric outreach services. Opportunities to best support RACF staff require further research and dialogue. [Journal of Gerontological Nursing, 49(3), 13-17.].

Experiences of a Nursing Team Working in a Residential Care Facility for Older Adults During the COVID-19 Pandemic

Experiences of staff working in residential long-term care facilities (LTCFs) during the coronavirus disease 2019 (COVID-19) pandemic are likely to differ from that of staff working in acute hospitals. The aim of the current study was to describe the experiences of the nursing team supporting frail older adults with high medical and care needs living in a LTCF. Using a descriptive qualitative design, data were gathered via one-to-one semi-structured interviews and thematically analyzed. Four themes emerged: Providing Care During COVID-19, Impact of COVID-19 on Staff, Organizational Management of COVID-19, and Training and Education. Visitation restrictions and staff shortages impacted all aspects of work life. Staff reported increased stress and exhaustion with COVID-19 infection resulting in long-term health issues. It is important to learn from these experiences to inform and empower staff to manage future outbreaks of infectious diseases. [Journal of Gerontological Nursing, 49(3), 40-46.].

Nursing Care Management of Responsive Behaviors for Persons Living With Dementia in Acute Care Settings: An Integrative Review

The current integrative review was performed to understand how acute care nurses manage responsive behaviors among persons living with dementia (PLWD) in acute care settings. Eight studies were included, and three themes were developed: Person-Centered Approach, Non-Person-Centered Approach, and Facilitators and Barriers to Care Approaches. Nurses expressed difficulties in caring for hospitalized PLWD due to lack of knowledge of dementia care, pressure to work more efficiently, and prioritization of acute medical concerns. Nurses frequently used nonpharmacological approaches that required less time spent with patients. Results suggest that nurses in acute care settings require further education regarding dementia and person-centered care approaches for PLWD. Nursing management can support nurses' learning needs through education and policies to improve patient outcomes. [Journal of Gerontological Nursing, 49(2), 19-25.].

Readiness to Plan for Aging and Frailty: Examining Contextual Factors

As older adults live longer, individual and societal efforts must be directed toward strategies to promote healthy and successful aging. Planning for aging and frailty offers an opportunity for older adults to optimize their well-being and proactively prepare across their aging trajectory. The current study evaluated the relationship between contextual factors (functional status, frailty, health status, social support) that influence older adults' readiness to engage in planning in five domains of aging (communication, environmental, financial, physical care, cognitive) through the transtheoretical stages of change. Results showed that factors influencing active planning include older age, vulnerability, living situation, and social support. These results add to the discourse on future care planning through a comprehensive approach to planning across a life course perspective, while highlighting the importance of future research at individual and societal levels. Gerontological nurses are well-positioned to lead planning efforts for older adults that promote well-being, patient-centered care, and healthy aging. [Journal of Gerontological Nursing, 49(2), 27-35.].

Inclusive Care Practices and Policies Among Sexual and Gender Minority Older Adults

As the health care and well-being of sexual and gender minority (SGM; i.e., lesbian, gay, bisexual, and/or transgender or gender non-binary) people in the United States receive federal and local-level attention, SGM older adults and caregivers continue to be left out of important health policy and care conversations. The current article describes policy issues and affirmative strategies related to inclusive care practices among SGM older adults and caregivers. In addition to the broader policies considered related to health and well-being, we include a discussion of local-level policy strategies to mitigate discrimination and promote inclusive care for SGM older adults and caregivers. [Journal of Gerontological Nursing, 48(12), 6-15.].