...Student ID# 277419 XTT Task 1 BSN to MSN A Currently in my facility, we do not have a policy regarding geriatric and/or demented patients and pain control. I believe this needs to be changed because although we have an initial assessment protocol, we do not have any kind of protocol to control a geriatric or demented patients pain. Since demented patients are quite often left unable to communicate their feelings, I believe there would be, less adverse effects and better patient outcomes for this group of people and better satisfaction with their families. B There are many people associated with proposing the change within the facility. First would be to go through the assistant nurse manager and nurse manager who would then bring the proposal to the nursing and medical directors for the ER. The ANM and NM would have to decide whether the proposed change would be beneficial for the patients and their outcomes and do further research which they would then propose to the directors. From there, they would decide whether the research was sufficient enough to implement a change. C Full APA citation for at least 5 sources | Evidence Strength (1-7) and Evidence Hierarchy | 1. H., Bell, J., Karttunen, N. M., Nykänen, I. A., M., & Hartikainen, S. A. (2013). Analgesic Use and Frailty among Community-Dwelling Older People. Drugs & Aging, 30(2), 129-136. doi:10.1007/s40266-012-0046-8 | 2 and Experimental | 2. Haasum, Y., Fastbom, J., Fratiglioni, L....
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...Health Care Reform Paper Medical care for an aging population has a negative outcomes and the aging population are the most significant consumers of health resources across both acute and community settings. Both formal systems and families are involved in this care of elders. This paper reviews health care issues for older adults and addresses the impact of frailty on the future health care system. It also presents challenges for future care, creative solutions that are currently being tested and explored, and suggestions for future nursing priorities. Challenges in the care of frail elders include: the organization and sustainability of the continuum of services, resource allocation, and cultural competence in service delivery. Creative solutions include intensive case management programs, targeting at risk older adults, partnerships with families, Medicare and the health care reform. In the coming years, there will be unprecedented demand for all goods and services required by individuals in their seventh through tenth decades of life. To meet the growing need, both the impressive heterogeneity of the aging population, and the diversity of preferences, requirements, and trajectories of health and life must be appreciated. Consider the real possibility that a family might include three generations, all over the age of 65. Imagine a centenarian woman with an 84 year-old daughter, and a 65 year-old grandson. This is not an unrealistic scenario for the 50,545 centenarians currently...
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...and coordinating the ethical review applications and letters of support. The team decided to use the existing practices of community service providers. To facilitate referrals of participating patients, the team first identified the existing service pathways. The hospital medical director distributed an overview document to inform emergency department physicians of the project, and the clinical nurse specialist reviewed the referral process, protocols and documentation with nursing staff. ore than ever, health-care providers need to communicate with each other to stay informed about the services clients receive. Working in collaboration is essential to the delivery of effective, efficient and timely care (D'Amour, Ferrada-Videla, San Martin Rodriguez, & Beaulieu, 2005; Interprofessional Care Steering Committee, 2007). We all had roles on the Geriatric Emergency ManagementFalls Intervention Team (GEM-FIT) project, which was aimed at evaluating an alternative service-delivery pathway to reduce the number and consequences of falls in adults aged 65 and older who presented to an inner-city hospital emergency department. The project was based on the Falls Intervention Team (FIT) study, which had evaluated a best practice, multifactorial fall-prevention program for community-dwelling older adults (Baycrest Centre for...
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...Comprehensive geriatric assessment is defined as a multidisciplinary diagnostic and treatment process that identifies medical. Psychological and functional limitations of a frail older person in order to develop a coordinated medical management of illness. It requires evaluation of multiple issues including physical, cognitive, affective, social, financial, environmental and spiritual components that influences an older persons by a team of health professionals may identify a variety of treatable health problems and lead to a better outcome. However, it is initiated through the primary care clinician or by a clinician caring for a patient in the hospital setting. The content of assessment varies depending on the settings of care. CGA is not available in all settings due to issues related to the tie required for evaluation, need for coordination of multidisciplinary specialties and lack of reimbursement for some components. Overall elements of comprehensive geriatric assessment includes: Physical Health-This focuses on medication use and the risk for malnutrition, falling, incontinence and immobility. The physical examination seeks to identify specific diseases or conditions for which curative, restorative, palliative or preventive treatment may be available. Special attention is directed towards visual or hearing impairment, nutritional status and conditions that may contribute to frailty and falling or difficulty in ambulation. Mental Health-Cognitive, behavioral and emotional...
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...As much as I am not looking forward to getting wrinkles and becoming even more forgetful then I already am, I know that it is unavoidable. Everyone gets older and it is nothing to be ashamed of. Ageism In my opinion, ageism is too often the way that society chooses to deal with the elderly population. Age becomes an excuse for society to treat older adults as though they are less of a human being. The videos discuss some ways that we can work past ageism and provide our elderly population with adequate care and respect. The first video, Culture Competence Self-Test, focused on the importance of being culturally sensitive when interacting with patients. This is something that is very important when pursuing a nursing career. Every patient will have different beliefs and values and they need to know that those beliefs are being valued and taken into consideration (JCPSEmployee, 2012). The second video, How Do We Help Elderly Frail Americans? explained how elderly often depend on assistance of a caregiver for activities of daily living. There are also rising rates of elder abuse, which is failure to...
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...agencies are responsible for licensing long-term care facilities to ensure compliance of laws and regulations. Regulatory agencies also receive and investigate complaints that are related to the facility and the services in which the facility provides (Walsh, 2014). All long-term care facilities are expected to abide by these regulations in an effort to ensure long-term care patients proper care, ethical treatment, safe living environments, and health care reimbursement. These agencies expect long-term care facilities to maintain an environment that will emphasize the importance of one’s quality of life and quality of care (Walsh, 2014). This paper will discuss three regulatory agencies including the Centers for Medicare and Medicaid Services, the Department of Licensing and Regulatory Affairs, and the Administration on Aging/Long-Term Care Ombudsmen Program, which have made huge impacts on the way long-term care is delivered in the United States. Centers for Medicare and Medicaid Services The Centers for Medicare and Medicaid Services (CMS) has become a staple among regulating long-term care facility practices. The CMS produces and maintains federal regulations for long-term care facilities that choose to accept residents that rely on Medicare and Medicaid benefits as a form of payment (Long-Term Care Facilities, 1989). Local licensing agencies are responsible for surveying, licensing, and inspecting the long-term care facilities to ensure that they are compliant with...
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...National Patient Safety Goals On Reduce Your Risk of Falling Joanna Dela Pena NR224 Chamberlain College of Nursing Introduction Falls are a public health problem worldwide. Hospitalization increases fall risk because of the unfamiliar environment, illnesses, and treatments. Patient falls and fall-related injuries are devastating to patients, clinicians, and the health care system. A single fall may result in a fear of falling and different complications that will reduced mobility, leading to loss of function and greater risk of falls. Older adults are more likely to be injured from a fall. Injurious falls also increase hospital costs and lengths of stay (Bates DW, Aug 1995). Factors affecting fall especially in older adults like environment or health care setting, are rising their numbers simply because of inconvenient structures of facility. Older patient that needs to wake up at night struggling to find their call light for help would literally just go to the bathroom by themselves. Without their full cognitive thinking ability to turn on any light and not able to hold their urine because of many reasons like incontinence, would result to fall accidents. People of any age can also be risk from fall injuries due to many psychological and physiological changes they are into. Changing medications for example could make a person dizzy because the body has not adjusted yet to the change. That person could not be aware of the adverse effect and still would do his/her normal...
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...Where Are Nurses In the Nursing Homes and Assisted Living Facilities? Assisted living facilities, one of the fastest growing housing options for older adults, represents a potentially new employment option for RN’s. When most people think of nursing homes, they think about nurses being responsible for the patients. However, most nursing homes and assisted living facilities in the United States do not have any RN’s employed. Most assisted living facilities have LPN’s, medical technicians, and certified nursing assistants. Why are there no nurses in nursing homes/ assisted living facilities? “Slightly fewer than 1 million people age 65 or older live in an estimated 33,000 assisted living facilities, private or shared units.”(Kovner) All assisted living facilities provide congregated meals, laundry and housekeeping services, and some social activities; all assisted living facilities provide health monitoring and assistance with activities of daily living (ADL’s). “Approximately 60% of residents need assistance with one to three ADLs; 75% need assistance with medications.”(Kovner) “Current estimates suggest that 50% of residents in assisted living have Alzheimer’s or Dementia, and the number is expected to grow.”(Kovner) Many assisted living facilities have a special locked down unit for residents with Alzheimer’s or Dementia. On average a nursing assistant will have 14-30 residents to tend to. This means making sure everyone is checked on every hour, changed, and making sure...
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...Professional Development of Nursing Professionals The nursing profession will face significant changes in the near future. There is an urge to reconsider changes in the healthcare system to better outcome for patients and nursing professionals. Over the years patients needs become more complex with a great desire for more skilled, trained, and highly educated nurses to provide higher quality of care. The report of Institute of Medicine (IOM) together with Robert Wood Johnson Foundation (RWJF) that started in 2008 and finish in 2010 elaborates on the impact and benefits patients and particularly patient care would have if these changes would occur. To achieve the suggested recommendations by IOM and RWJF, and to meet the future changes in healthcare, nurses must transform their education, nursing practice, and leadership roles. The Impact of IOM report on nursing education As a result of our aging population and more critical patient conditions, care shifted from acute to more chronic condition. Nurses are required to be reeducated to an expanding role, understanding care management system and quality improvement methods to deliver a high standard of care for the patients. “There is a strong trend for higher educational attainment with the coming generation of older adults…a factor associated with improved health and lower disability” (ANA, 2013). In the past an Associate’s of nursing Practice meet the requirements, currently and in the near future a Baccalaureate Degree of...
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...The purpose of this paper is to perform a holistic assessment of the older adult using the SPICES tool. What is SPICES? The acronym SPICES stands for Sleeping disorder, Problems with eating and feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown (Fulmer & Wallace, n.d.). Each area of the tool is important to assess in order to address problems and develop interventions or solutions to the problems to ultimately provide quality patient care. Sleep is important not only for promoting healing, but also for the overall well-being of the individual. When there are problems with the sleeping pattern, it impacts the overall health and safety of the older adult. The person will not have enough rest and too tired to perform...
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...results in the geriatric population. Fear of falling is a defined geriatric syndrome that may contribute to further functional decline in an already frail patient. When people experience something unpleasant, their natural response is an aversion to that experience. People may begin to limit their activities after a fall or as they become weaker and less agile with increasing age. This leads to a more sedentary lifestyle and physical atrophy, which further predisposes them to falls (Lee, 2013, p.37). According to Al-Aama (2011): A fall is a complex multifactorial phenomenon. In order to understand the mechanism of falls, it is essential to understand the prerequisites of normal gait. Essential substrates for a normal gait include fine neural networks such as the cortical–basal ganglia loop and the basal ganglia–brainstem system, exquisite musculoskeletal structures with appropriately regulated muscle tone, and proper processing of sensory information (p. 772). A fall in the geriatric population could be the result of various long-term or short-term factors. A short-term factor could include an acute illness or an adverse drug reaction. Normal gait and balance requires freely moving joints; muscles contracting at the right time with the appropriate strength; and accurate visual, vibratory, and proprioceptive input. As patients age, they may experience stiffened joints, decreased muscle strength, and impaired neurologic feedback (Lee, 2013, p.37). These factors, along with other...
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...of Interest The selected problem of interest is hospital readmissions after being discharged from hospitals/medical facilities. Several patients enter the hospital and soon after discharge are catapulted back into the seemingly revolving doors of the hospital. Readmission rates affect all areas of healthcare. Center for Medicare and Medicaid (CMS) has targeted readmissions as a guideline of poor quality of care. Engaging patients during their inpatient admission as they transition to alternate levels of care may reduce readmission by 50% (Service, 2008). The intent of this proposed paper is to take a look at hospital readmissions rates in correlation with the patient being elderly and having a diagnosis of heart failure and assess what can be done to positively change these statistics, which increase the quality of care we as healthcare professionals provide to our patients. A Rationale for Selecting the Issue or Problem of Interest Hospital readmissions can occur throughout the patient’s transition through the healthcare system. Many times readmissions occur among those who are frail and have chronic conditions. Readmissions account for approximate 18% of Medicare patients, of this 13%, are suspected to be avoidable and are directly linked to poor quality. Quality is affecting outcomes, which impacts reimbursements and patient safety. Core Measures initiatives are part of every hospital’s make up. Core Measures are hospital initiatives taken to ensure that evidence...
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...uk/articles/article036.htm Burton, L. A., McMurdo, M. T., & Struthers, A. D. (2011). Mineralocorticoid antagonism: a novel way to treat sarcopenia and physical impairment in older people?. Clinical Endocrinology, 75(6), 725-729. Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th Ed.). St. Louis, Mo.: Saunders/Elsevier. Meng-Yueh, C., Hsu-Ko, K., & Ying-Tai, W. (2010). Sarcopenia, Cardiopulmonary Fitness, and Physical Disability in Community- Dwelling Elderly People. Physical Therapy, 90(9), 1277-1287. Scott, D., Blizzard, L., Fell, J., Giles, G., & Jones, G. (2010). Associations Between Dietary Nutrient Intake and Muscle Mass and Strength in Community-Dwelling Older Adults: The Tasmanian Older Adult Cohort Study SCOTT ET AL. DIETARY NUTRIENT INTAKE AND SARCOPENIA. Journal Of The American Geriatrics Society, 58(11), 2129-2134. Silvestri, L. (2011). Saunders comprehensive review for the nclex-rn examination. (5th Ed.). St. Louis: Saunders/Elsevier. Tabloski, P. (2010). Gerontological nursing (2nd Ed.). Upper Saddle River. NJ: Pearson Education, Incorporated. ----------------------- Physiology Aging individuals with Sarcopenia would exhibit a gradual loss of muscle mass and function, will have frail physical structure, will be more prone to fall, fractures and immobility due to decrease in muscle mass. May have an unsteady gait, and problems getting out of sitting position ...
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...Continuum of Care- Long-term Care Long-term care has and is continuing to become an important part of the continuum of care. Years ago Long-term care (LTC) was considered only to be for the elderly, but as time passes it is for anybody and everybody who needs it. Barton (2006) stated, “Regardless of the length of time (i.e., from weeks to years), long-term care is an array of services provided in a range of settings to individuals who have lost some capacity for independence due to injury, chronic illness, or condition” (p. 367). According to Barton (2006), it states that the services long-term care provides help the consumer with basic needs and shows the individuals how to do daily living activities, along with therapy and being able to manage their conditions. Today long-term care is serving consumers of all ages in home, community, and institutional settings (Barton, 2006). Long-term care has contributed to the continuum of care tremendously because it is offering an array of services for consumers in different places and not just focusing on one specific population. In the last few years long-term care has become more of a need for more than 12million people in the United States, and out of these 12 million people, five million of them are nearly disabled (Barton, 2006). Barton (2006) stated, “a significant proportion of people needing long-term care-nearly half –is younger than 65: 40 percent are working age adults and about 3 percent are children younger than age 18”...
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...Alise E. Jenkins May 24th, 2015 HCA-515 Health Care Models Analysis Hypothetical Case (basic details only): The patient is 72 year old female who smokes. She complains of extreme fluid retention in lower two limbs and lower abdomen. Breathing is difficult and she is only able to sleep while sitting erect in a reclining chair. Patient has underlying conditions: Obesity, Coronary Artery disease, Edema, Hypertensions, Dyslipidemia, Ischemia, and hx of quadruple Coronary Artery Bypass Graft. Current dx: Heart Failure Medical Model: A number of tests would be performed to analyze the extent of damage of the heart. An electrocardiogram would be one of the first tests performed to check the electrical activity of the heart and detect any type of ischemia (AHA, 2015). The tests would include X-Rays CT, and MRI scans. Also “Angiography that would allow imaging of the blood vessels” (AHA, 2015). Essentially it is creating a map of the heart. Ultrasound evaluations, echocardiograms, would also help define the amount of damage to the heart. Treatments for heart failure can vary due to underlying causes. However in most cases drugs are used to aid the symptoms. These drugs can include “beta-blockers, ACE inhibitors, and also a diuretic to help rid the body of excess fluid buildup” (CDC, 2015). Mechanical devices can be implemented into the heart too. These devices include pacemakers and defibrillators. These two mechanisms help improve...
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