March 03, 2016

journals - Journal of Gerontological Nursing

Volume 41, Number 12, December 2015

Effects of the Patient-Centered Environment Program on Behavioral and Emotional Problems in Home-Dwelling Patients With Dementia
Park, et al. (pp. 40-48).
The current pilot study examined the effects of the Patient-Centered Environment Program (PCEP) on agitation, cognition, stress, pain, sleep, and activities of daily living for home-dwelling patients with dementia. Nine individuals participated in the study. The PCEP included visual, auditory, olfactory, and tactile areas based on participants' preferences. PCEP sessions were held for 30 minutes twice per week and a total of 16 sessions were performed at participants' homes. Findings showed that agitation and pain improved with the PCEP (t = 2.91, p < 0.02; t = 4.51, p < 0.002, respectively). Findings suggested that a better study design, repeated with a reasonable sample size, must be considered for participants' health statuses to meet the PCEP contents.
They Are Called Nursing Homes for a Reason: RN Staffing in Long-Term Care Facilities
Harden, et al. (pp. 15-20)
According to the Centers for Medicare and Medicaid Services (CMS), the Consolidated Medicare and Medicaid regulations have not been systematically reviewed and updated since 1991. Existing regulations require that, with certain exceptions, an RN provide services in a facility for 8 consecutive hours per day, 7 days per week; licensed practical nurses (LPNs) 24 hours per day; and sufficient staff to meet residents' needs. The requirements to determine "sufficient" staff remain undefined by CMS. Several national organizations support RN staffing 24 hours per day each day of the week (24/7). These organizations provided evidence refuting CMS' position that it does not have sufficient information at this time to require a specific number of staff or hours of nursing care per resident. Consideration should be given to the Institute of Medicine recommendation affrming the need for and requiring the presence of at least one RN within every nursing home facility at all times. Currently, there is a bill in the House of Representatives that supports 24/7 RN coverage in nursing homes, which must become both bipartisan and bicameral to be passed.

Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes
Bowen, et al. (pp. 21-29)
Older adults are disproportionately affected by diabetes, which is associated with increased prevalence of cardiovascular disease, decreased quality of life (qol), and increased health care costs. The purpose of the current study was to assess the relationships between social support, self-efficacy, and qol in a sample of 187 older african american and caucasian individuals with diabetes. Greater satisfaction with social support related to diabetes (but not the amount of support received) was significantly correlated with qol. In addition, individuals with higher self-efficacy in managing diabetes had better qol. In a covariate-adjusted regression model, self-efficacy remained a significant predictor of qol. Findings suggest the potential importance of incorporating the self-efficacy concept within diabetes management and treatment to empower older adults living with diabetes to adhere to care. Further research is needed to determine whether improving self-efficacy among vulnerable older adult populations may positively influence qol.
Certified Nurse Aides and Scope of Practice: Clinical Outcomes and Patient Safety
McMullen, et al. (pp.32-39).
To understand the impact of scope of practice and allowable certified nurse aide (CNA) tasks across states, the current study compared clinical outcomes in states with a basic scope of practice versus those that allowed for an expanded scope. The current study used data from the Minimum Data Set as well as staffing data from the Centers for Medicare and Medicaid Services. Clinical outcomes included: (a) percent of residents whose need for help with daily activities has increased, (b) percent of high-risk residents with pressure ulcers, (c) percent of residents who self-report moderate to severe pain, (d) percent of residents experiencing one or more falls with major injury, and (e) CNA staffing hours. There was no difference in clinical outcomes between states with expanded or basic scopes. Many factors influence clinical outcomes among residents and additional staffing and facility characteristics should be considered in future studies.

Managing Heroin Addiction in an Outpatient Setting: A Case Study
Malliarakis, K. D. (pp. 10-14).
Heroin use may be under-recognized among older adults. Baby Boomers are the largest age as well as the largest drug-using cohort in modern history. Although some drug users age out of their addiction, others do not. Nurses caring for older adults may come into contact with heroin users due to associated conditions or sequelae of their drug use that cause them to seek care. Few nurses are prepared to provide the care needed when heroin use accompanies other health problems. Using an individual example, the current article provides guidance for identifying heroin addiction, essential information about heroin use, and resources for guiding patients to experts for the comprehensive care needed for recovery.









































































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