Determination of care needs according to functional health patterns model of elderly individuals who live in a nursing home

The COVID-19 pandemic, which was first seen in Wuhan, China, caused by the virus named SARS-CoV-2, causes serious, economic and social problems with the deaths of nearly 1.5 million people all over the world. Although initially diagnosed with COVID-19, only mild/moderate cold/flu-like symptoms were seen in the vast majority of cases, COVID-19 results in severe respiratory failure in individuals with advanced age and chronic disease. Because the infection is very contagious, it makes the prognosis of the patients worse by switching to other patients. It plays an important key role in the healthcare team in breaking the nurses’ chain of infection and minimizing disease and treatment-related complications. Therefore, nurses are expected to take precautions to minimize the transmission of COVID-19 and at the same time meet their care needs with a holistic perspective. This situation is only possible with a qualified and holistic nursing care. It is a necessity for patients who have undergone amputation to receive qualified care both physically and mentally in terms of developing a favorable prognosis. Systematized data collection models, internationally accepted nursing diagnoses and interventions should be used in order to provide optimal and standardized nursing care in patient groups where comorbid conditions such as COVID-19 develop with amputation. In this case report, the nursing care of a transtibially amputated COVID-19 patient is presented using the Functional Health Patterns Model (FSO) and the North American Association of Nursing Diagnostics (NANDA) nursing diagnoses. The case in the study included nursing diagnoses that require the care of physiological problems such as hyperthermia, less than necessary nutrition, risk of fluid electrolyte imbalance, disruption in gas exchange, as well as nursing diagnoses aiming to care for emotional problems such as anxiety and body image deterioration. Thus, it was aimed to meet physiological, emotional and social care needs as a requirement of holistic care in nursing philosophy. Positive care outcomes were determined as a result of the holistic nursing care for the patient. Keywords: diabetic foot, amputation, COVID-19, nursing care, functional health patterns

Download Full-text

Impact of Roommates on MDRO Spread in Nursing Homes

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.553 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s66-s67

Author(s):

Gabrielle M. Gussin ◽

Ken Kleinman ◽

Raveena D. Singh ◽

Raheeb Saavedra ◽

Lauren Heim ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Secondary Analysis ◽

Nursing Home Residents ◽

Multidrug Resistant ◽

Healthcare Intervention ◽

Odds Ratios ◽

Care Needs ◽

Environmental Cleaning ◽

The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

Download Full-text

Determınatıon Of The Causes That Force The Elders To Choose Nursıng Home Lıves

Journal of Academic Research in Nursing ◽

10.5222/jaren.2017.073 ◽

2017 ◽

Cited By ~ 1

Author(s):

Ümmühan Kılıç ◽

Deniz Şelimen

Keyword(s):

Nursing Home

Download Full-text

Teleconferencing: An Avenue for College Coursework in Nursing Home Settings

The International Journal of Aging and Human Development ◽

10.2190/xr0n-rhy9-n0dd-xyj4 ◽

1988 ◽

Vol 26 (3) ◽

pp. 201-210

Author(s):

Jan L. Stanley-Muchow ◽

Betty Y. Poe

Keyword(s):

Nursing Home ◽

Sense Of Self ◽

Nursing Home Residents ◽

Research Information ◽

Elderly Individuals ◽

Home Life ◽

College Course ◽

Home Living ◽

Future Work

With increasing numbers of elderly individuals facing nursing home living, interest in programs addressing the experienced quality of life in these residences has increased. Educational programs have been identified as one way to improve the experience of nursing home life. Concurrently, technology has developed rapidly and provides new avenues for service delivery. This article describes the use of a growing technology, teleconferencing, to provide a college course to elderly nursing home residents. Students' responses to the course are presented using five individual illustrations, and implications for programs and research are discussed. Preliminary findings are reported and related to three areas: the potential effectiveness of courses offered via teleconferencing to nursing home residents, the importance of nursing home programs which foster residents' sense of self, and a type of research information which appears fruitful for future work in this area.

Download Full-text

Falls Self-Efficacy in German Nursing Home Residents: Assessment of Validity and Determination of a Cutoff Point

Research in Gerontological Nursing ◽

10.3928/19404921-20150827-33 ◽

2015 ◽

Vol 9 (3) ◽

pp. 134-144 ◽

Cited By ~ 2

Author(s):

Franziska Könner ◽

Ronny Kuhnert ◽

Sonja Kalinowski ◽

Dagmar Dräger ◽

Reinhold Kreutz ◽

...

Keyword(s):

Nursing Home ◽

Self Efficacy ◽

Nursing Home Residents ◽

Cutoff Point

Download Full-text

Older persons’ thoughts about death and dying and their experiences of care in end-of-life: a qualitative study

BMC Nursing ◽

10.1186/s12912-020-00514-x ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Johanna Tjernberg ◽

Christina Bökberg

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

End Of Life ◽

Older Persons ◽

Death And Dying ◽

Living Condition ◽

Care Needs ◽

Healthy Persons

Abstract Background Few studies have focused on how older persons living in nursing homes perceive their last period of life. Furthermore, previous research on older persons’ perceptions of death and dying is limited. Hence, there is an urgent need to explore their experiences during their final period in life. Aim To explore thoughts about death and dying and experiences of care in end-of-life among older persons living in nursing homes. Methods This study employed a qualitative approach including individual interviews with 36 older persons living in Swedish nursing homes. Questions related to quality of life; physical health; thoughts about death, dying, and the future; and experiences related to the living condition and environment were asked. The interview transcripts were analysed through content analysis. The study was approved by the Regional Ethics Review Board (reference number: 2015/4). Results The analysis resulted in the identification of three main thematic categories: The unavoidable and unknown end of life, Thoughts on control and Living your last period of life at a nursing home. The older persons did not fear death itself but had some worries about dying. Spending the last stage of life at a nursing home contributed to different thoughts and feelings among the older persons. With a few exceptions, older persons characterized life at the nursing home as boring and felt they were surrounded by people who did not belong there. Conclusions This study indicates a need for older persons to talk about death, dying and end-life issues. Furthermore, this study highlighted that the co-residence of cognitively healthy persons and persons with dementia in the same ward adversely affected cognitively healthy persons. This situation resulted in there being not enough time to both handle the care needs of persons with dementia and have the conversations that cognitively healthy persons desired, such as conversations about thoughts about existence, that could have improved their quality of life. Trial registration NCT02708498 Date of registration 16 February 2016.

Download Full-text

LOOKING UPSTREAM: THE ASSOCIATION BETWEEN AFFORDABLE HOUSING, NURSING HOME USE, AND UNMET CARE NEEDS IN THE COMMUNITY

Innovation in Aging ◽

10.1093/geroni/igz038.558 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S155-S156

Author(s):

Meghan Jenkins Morales ◽

Stephanie Robert

Keyword(s):

Nursing Home ◽

Affordable Housing ◽

Protective Factor ◽

Population Aging ◽

Community Dwelling ◽

Housing Cost ◽

Housing Crisis ◽

Care Needs ◽

Nationally Representative ◽

Income Model

Abstract In the U.S., population aging is coinciding with a growing affordable housing crisis. Evidence suggests that housing security contributes to health, but less is known about how affordable housing affects aging in place. We use a nationally representative sample (n=5,117) of older community-dwelling Medicare beneficiaries from the 2015 National Health and Aging Trends Study to test the association between housing cost burden (HCB) and moving to a nursing home, death, or remaining in the community by 2017. Among 2017 community-stayers (n=4,836), we also test the association between HCB and unmet care need, defined as experiencing a consequence related to 12 mobility (e.g., stayed in bed), self-care (e.g., skipped meals) and household (e.g., no clean laundry) activities. HCB is the proportion of income spent on rent or mortgage: low (<30%), moderate (30-50%), severe (≥50%), or home paid off (referent). Among nursing home movers, 26% had moderate or severe HCB in 2015 compared to 16% of community-stayers. Informed by the person-environment fit perspective, weighted stepwise regression models (multinomial and logistic) adjust for race, age, sex (Model 1), self-rated health, probable dementia (Model 2), living with others and high income (Model 3). Severe HCB is significantly associated with nursing home entry (RRR=2.66, SE=0.89) and this association is only partially mediated by health factors (RRR=2.16, SE=0.72) and resources (RRR=1.95, SE=0.64). Among community-stayers, severe HCB is significantly associated with unmet care need across all models. This study suggests that affordable housing is an important protective factor for older adults to age well in the community.

Download Full-text

Quality of life in dementia patients: nursing home versus home care

International Psychogeriatrics ◽

10.1017/s1041610211001050 ◽

2011 ◽

Vol 23 (10) ◽

pp. 1692-1700 ◽

Cited By ~ 10

Author(s):

Azlina Wati Nikmat ◽

Graeme Hawthorne ◽

S. Hassan Al-Mashoor

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Informal Care ◽

Population Aging ◽

Depression Scale ◽

Short Version ◽

Care Needs ◽

Dementia Patients ◽

Early Dementia

ABSTRACTBackground: Care management providing a high quality of life (QoL) is a crucial issue in dealing with increasing numbers of dementia patients. Although the transition from informal (home-based) care to formal (institutional) care is often a function of dementia stage, for those with early dementia there is currently no definitive evidence showing that informal or formal care provides a higher QoL, particularly where informal care is favored for local cultural reasons. This paper outlines the research protocol for a study comparing formal and informal care in Malaysia. It seeks to provide evidence regarding which is more appropriate and results in higher QoL in early dementia.Methods: This is a quasi-experimental study design involving 224 early dementia patients from both nursing home and community settings. Participants will be assessed for cognitive severity, QoL, needs, activities of daily living, depression and social isolation/connectedness by using the Mini-Mental State Examination (MMSE), Cognitive Impairment Scale – 4 items (CIS-4), EUROPE Health Interview Survey-Quality of Life (WHO8), Assessment of Quality of Life (AQoL8), Camberwell Assessment of Need for the Elderly – Short Version (CANE-S), Barthel Index (BI), Cornell Scale for Depression (CSDD), Geriatric Depression Scale – 15 items (GDS-15), and Friendship Scale (FS) respectively.Conclusion: This study aims to provide a better understanding of care needs in early dementia. Given population aging, the study findings will provide evidence assisting decision-making for policies aimed at reducing the burden of caregiving and preserving the QoL of dementia patients.

Download Full-text

ISSUES IN HOME CARE AND CAREGIVING ARE MEDICAL FOSTER HOMES SERVING VETERANS WHO HAVE SIMILAR FUNCTIONAL IMPAIRMENT AS TYPICAL NURSING HOME RESIDENTS?

Innovation in Aging ◽

10.1093/geroni/igz038.3032 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S822-S823

Author(s):

Cari Levy ◽

Kate Magid ◽

Chelsea Manheim ◽

Kali S Thomas ◽

Leah M Haverhals ◽

...

Keyword(s):

Nursing Home ◽

Home Care ◽

Functional Impairment ◽

Nursing Home Residents ◽

Similar Proportion ◽

Care Needs ◽

Community Based ◽

Foster Home ◽

Term Care ◽

Data Set

Abstract The Veterans Health Administration’s (VHA’s) Medical Foster Home (MFH) program was developed as a community-based alternative to institutional care. This study compares the clinical and functional characteristics of Veterans in the VHA MFH program to residents in nursing homes to understand whether MFHs substitute for nursing home care or serve a population with different care needs. All data were derived from Minimum Data Set (MDS) 3.0 assessments. Nurses collected MDS assessments from Veterans (n=92) in 4 MFHs between April 2014-December 2015. Data for nursing home residents were from a national nursing home dataset of residents with an annual MDS assessment in 2014 (n=818,287). We found that MFH Veterans were more likely to be male, have higher functional status, and perform more activities of daily living (ADLs) independently relative to nursing home residents (p<0.01 for all comparisons). Yet, a similar proportion of MFH Veterans and nursing home residents required total assistance in 9 of the 11 measured ADLs. Cognitive impairment, neurological comorbidity, and psychiatric comorbidity were similar in both cohorts; however, MFH Veterans were more likely to have traumatic brain injury (p<0.01), higher Patient Health Questionnaire (PHQ)-9 depression scores (p=0.04) and less likely to have anxiety (p=0.05). Our results suggest there are two distinct MFH populations, one with lower-care needs and another with Veterans completely dependent in performing ADLs. Given these findings, MFHs may be an ideal setting for both low-care nursing home residents with less functional impairment as well as residents with higher care needs who desire community-based long-term care.

Download Full-text