Marie Boltz - Academia.edu (original) (raw)

Papers by Marie Boltz

... Marquis D. Foreman, PhD, RN, FAAN Professor and Chairperson, Rush University, Chicago, IL Jan... more ... Marquis D. Foreman, PhD, RN, FAAN Professor and Chairperson, Rush University, Chicago, IL Janice Foust, PhD, RN Assistant ... Northeastern University, Boston, MA Elizabeth Galik, PhD, CRNP Assistant Professor, University of Maryland, Baltimore, MD Mindy Grall, PhD, APRN ...

Journal of advanced nursing, Jan 9, 2015

The aim of this study was to examine the association of specific personal and environmental facto... more The aim of this study was to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment. Eating is the one of the most basic and easiest activities of daily living to perform. While multilevel factors can be associated with eating performance, the evidence among those with dementia was insufficient. A secondary analysis of baseline data collected between March and September in 2012 from 199 residents in eight long-term care facilities. Eating performance was conceptualized using the single self-care 'feeding' item in the Barthel Index and was scored based on four levels of dependence and assistance required. Binary logistic regression was used to examine the adjusted association of specific factors with eating performance. Almost one-third of the residents needed help with eating. After adjusting the type of facility, number of comorbidities, chair-sitting balance,...

5 is a practical, easy to use instrument that can identity patients at risk for functional declin... more 5 is a practical, easy to use instrument that can identity patients at risk for functional decline during and after an acute hospital admission. The HARP instrument stratifies patients' risk for new ADL disability into low, medium, or high-risk categories based on scores obtained including age, preadmission Instrumental Activities of Daily Living (IADL) score, and an abbreviated Folstein Mini-Mental Status

WHY: Urinary incontinence (UI) is the involuntary loss of urine sufficient to be a bother. Depend... more WHY: Urinary incontinence (UI) is the involuntary loss of urine sufficient to be a bother. Depending on the setting, up to two-thirds of older adults experience UI. Yet, UI should not be considered a normal consequence of aging. Despite available treatment options, UI is not adequately assessed and managed in the older adult population. UI is associated with falls, obesity, skin impairments, urinary tract infections, limited functional status, depression, impaired cognition, poor self-rated health, social isolation, and increased caregiver burden. Proper assessment identifies the type of UI: transient or established (chronic). Try This: ® UI Part I focuses on assessing for contributing causes of transient UI, which is significantly under addressed both in clinical practice and in the health care literature. Try This: ® UI Part II focuses on established UI. Transient UI is generally defined as a sudden-onset UI that, if left untreated, may lead to established UI.

WHY: Informal supporters provide the majority of long-term care to chronically disabled older adu... more WHY: Informal supporters provide the majority of long-term care to chronically disabled older adults. Caregiving has been recognized as an activity with perceived benefits and burdens. Caregivers may be prone to depression, grief, fatigue, financial hardship, and changes in social relationships. They may also experience physical health problems (Thornton & Travis, 2003). Perceived caregiver strain has been associated with premature institutionalization for care recipients along with reports of unmet needs. Screening tools are useful to identify families who would benefit from a more comprehensive assessment of the caregiving experience.

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Livi... more We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Living Legends program, which includes life review writing and an intergenerational exchange, compared with life review writing alone, for community-dwelling older adults. This study was a randomized controlled trial with a connected qualitative component. We analyzed quantitative data using independent-samples t tests and written descriptions of program experiences using Collaizi's qualitative methodology; we then used a triangulation protocol to integrate the qualitative and quantitative data. For participants in the writing workshop plus intergenerational exchange, sense of purpose and meaning in life increased significantly (p < .0001) compared with those in the writing workshop alone. Qualitative themes revealed additional program benefits. Living Legends enhanced participants' sense of purpose and meaning in life, a factor known to prevent cognitive loss and disability, comp...

Journal of the American Medical Directors Association, Jan 5, 2015

The objective of this study was to evaluate the impact of a well-developed theory-based function-... more The objective of this study was to evaluate the impact of a well-developed theory-based function-focused care for cognitively impaired (FFC-CI) intervention on eating performance among long-term care (LTC) residents with moderate-to-severe cognitive impairment. A secondary analysis of longitudinal data from 2 cluster-randomized controlled trials that originally tested the impact of FFC-CI on all function and physical activities. Participants were 199 residents with moderate-to-severe cognitive impairment from 4 nursing homes and 4 assisted living facilities. Data at baseline, and 3 and 6 months were used. Resident outcome data used in this analysis included eating performance conceptualized using the single self-care "feeding" item in the Barthel Index, cognitive function by Mini-Mental State Examination, sitting balance conceptualized using the single "chair sit-sitting balance" item in the Tinetti Gait and Balance scale, physical capability by Physical Capabili...

Worldviews on Evidence-Based Nursing, 2015

Review of research to date has been focusing on maintaining weight and nutrition with little atte... more Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance. To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long-term care (LTC). A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, intervention. Intervention studies that optimize eating performance and evaluate change of self-feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full-texts were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Eleven intervention studies (five randomized controlled trials; RCTs) were identified, and classified into four types: Training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate, with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance. This review provided preliminary support for using training and mealtime assistance to optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may focus on training nursing caregivers as interventionists, lengthening intervention duration, and including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness of training combined with mealtime assistance may also be tested to achieve better resident outcomes in eating performance.

Neurodegenerative disease management, 2015

SUMMARY Aim: Hospital-acquired disability causes decreased quality of life for patients with dem... more SUMMARY Aim: Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.

International Journal of Orthopaedic and Trauma Nursing, 2015

By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of... more By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery for these individuals is more complicated than among younger individuals. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. Overall recruitment rates were consistent with other studies and the intervention was implemented as intended. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.

Journal of the American Geriatrics Society, 2014

A comparative trial using a repeated-measures design was designed to evaluate the feasibility and... more A comparative trial using a repeated-measures design was designed to evaluate the feasibility and outcomes of the Family-Centered Function-Focused-Care (Fam-FFC) intervention, which is intended to promote functional recovery in hospitalized older adults. A family-centered resource nurse and a facility champion implemented a three-component intervention (environmental assessment and modification, staff education, individual and family education and partnership in care planning with follow-up after hospitalization for an acute illness). Control units were exposed to function-focused-care education only. Ninety-seven dyads of medical patients aged 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. Fifty-three percent of patients were female, 89% were white, 51% were married, and 40% were widowed, and they had a mean age of 80.8 ± 7.5. Seventy-eight percent of FCGs were married, 34% were daughters, 31% were female spouses ...

The Gerontologist, Jan 16, 2014

To explore the experience of older adults in their neighborhood in relation to perceived fall ris... more To explore the experience of older adults in their neighborhood in relation to perceived fall risk, fear of falling (FOF), and resources/strategies for fall prevention. Fourteen older adults, 65 years of age and older from 3 urban senior centers, participated in this qualitative study. The semistructured interview guidelines and background questionnaire were developed by the researchers based on the literature and an existing measure of walkability. Both tools were refined based on pilot interviews with seniors. Collaizzi's phenomenological method was used for data analysis. Five themes emerged from the data: (a) The built environment contributes to perceived fall risk and FOF, (b) personal strategies used to adapt to perceived neighborhood fall risks-behavioral approaches, (c) resources for physical activity and safety, (d) barriers to physical activity and exercise, and (e) neighborhood features as a motivator. Urban-dwelling seniors perceive that neighborhood features contrib...

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses

WHY: Chronic diseases, such as cancer, diabetes, and cardiovascular disease (coronary heart disea... more WHY: Chronic diseases, such as cancer, diabetes, and cardiovascular disease (coronary heart disease, hypertension and dyslipidemia), disproportionately affect older adults and are associated with disability and diminished quality of life. These conditions share many of the same common, modifiable risk factors, including obesity and physical inactivity. Today, about 80% of older adults have at least one chronic condition, and 50% have at least two. Identification of chronic disease risk factors and early disease detection, through screening, may decrease the burden of chronic disease and protect and promote the health of older adults.

Nursing research

Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Im... more Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery. To explore the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP, test its validity with a sample of staff registered nurses (RNs), and evaluate its invariance across 4 groups of RNs who worked at 4 different types of hospitals. Staff RNs (N = 9,400) at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, were split randomly into 2 groups for cross-validation. A 3-step data analysis was completed. The a priori factor structure was developed using exploratory factor analysis. The obtain...

The American journal of nursing, 2005

Aims and objectives. To explain the relationship between a positive nurse practice environment (N... more Aims and objectives. To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background. The NPE is a system-level intervention for promoting quality and patient safety; however, there are populationspecific factors that influence the nurses' perception of their practice and its' relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs. Discursive paper. Method. In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals' systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results. Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions. Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff's perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice. The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.

Journal of the American Geriatrics Society, 2014

Rehabilitation Nursing, 2011

International Journal of Nursing Practice, 2010

Functional decline is a common complication for hospitalized older adults. Illuminating the facto... more Functional decline is a common complication for hospitalized older adults. Illuminating the factors that influence the physical function of hospitalized older adults is critical in order to develop effective interventions to prevent avoidable loss of function. Twenty-four older adults in three senior centres located in metropolitan New York City, who had recent experience with hospitalization, participated in focus groups to discover these factors. An exploratory qualitative design was used. Participants defined physical function as the ability to be mobile and resume the enactment of their roles, routines and relationships. Participants also believed that hospitalization should improve physical function. They described staff and system supports of, as well as the challenges to physical function in the hospital setting. The findings provide evidence for developing education programmes as well as new models of nursing care aimed at preventing functional decline.

Purpose -The purpose of this mixed methods study is to define the core components of a system-wid... more Purpose -The purpose of this mixed methods study is to define the core components of a system-wide, acute care program designed to meet the needs of older adults. Design/methodology/approach -Concept mapping methodology (multidimensional scaling and cluster analysis) was used to obtain data describing the core components of a geriatric acute care model. The input of 306 "stakeholders" (clinicians, administrators, consumers, educators, and researchers) was obtained through a world wide web interface, supplemented with consumer interviews. Findings -The findings yielded eight clusters describing components of a geriatric acute care program: guiding principles, leadership, organizational structures, physical environment, patient-and family-centered approaches, aging-sensitive practices, geriatric staff competence, and interdisciplinary resources and processes. A total of 113 items that describe dimensions of quality were identified with these clusters. Practical implications -The clusters and dimensions provide a framework for a hospital to use to plan, implement, and evaluate an acute care model for older adults. Originality/value -There is not a common understanding of what constitutes a comprehensive set of resources, programs, and activities to address the needs of hospitalized older adults and their families and the staff who serve them. Concept mapping was an effective method of engaging the perspectives of various stakeholders in creating a framework to address these needs, as well as useful in illuminating areas for future research.

Functional decline is a common complication in hospitalised older adults, associated with low mob... more Functional decline is a common complication in hospitalised older adults, associated with low mobility and physical activity. Fear of falling may contribute to limited mobility and physical activity, and loss of physical function. An understanding of this relationship, as well as contributing factors, may inform the development of safe, function-promoting interventions. To describe fear of falling in hospitalised older adults and its relationship with patient characteristics and physical function and explore patient views of associated factors. combined quantitative and qualitative approach using chart extraction, observation and interviews of older adults. (i) correlations and analysis of variance methods; (ii) content and thematic analysis; and (iii) evaluation of convergence, complementarity and dissonance of quantitative and qualitative data. Depressed older persons were more likely to describe fear of falling (r = 0.47, P = 0.002). Fear of falling was associated with the loss of physical function from admission to discharge (F = 7.6, P = 0.009). The participant response to fear of falling was activity restriction vs. self-direction. Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy. Fear of falling plays a significant role in restricting physical activity and function. A multifactorial approach may provide a viable alternative to activity restriction, by facilitating self-direction and functional recovery. Interventions to prevent falls and activities to promote functional mobility are ideally developed in tandem, with attention paid to the physical and social environment. Preventing hospital-acquired disability may require a shift in organisational values around safety, from a soley protective approach to one that reflects an enabling philosophy emphasising independence and self-direction. Such a paradigm shift would demonstrate a valuing not only of the absence of falls but also the preservation and restoration of function.

... Marquis D. Foreman, PhD, RN, FAAN Professor and Chairperson, Rush University, Chicago, IL Jan... more ... Marquis D. Foreman, PhD, RN, FAAN Professor and Chairperson, Rush University, Chicago, IL Janice Foust, PhD, RN Assistant ... Northeastern University, Boston, MA Elizabeth Galik, PhD, CRNP Assistant Professor, University of Maryland, Baltimore, MD Mindy Grall, PhD, APRN ...

Journal of advanced nursing, Jan 9, 2015

The aim of this study was to examine the association of specific personal and environmental facto... more The aim of this study was to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment. Eating is the one of the most basic and easiest activities of daily living to perform. While multilevel factors can be associated with eating performance, the evidence among those with dementia was insufficient. A secondary analysis of baseline data collected between March and September in 2012 from 199 residents in eight long-term care facilities. Eating performance was conceptualized using the single self-care 'feeding' item in the Barthel Index and was scored based on four levels of dependence and assistance required. Binary logistic regression was used to examine the adjusted association of specific factors with eating performance. Almost one-third of the residents needed help with eating. After adjusting the type of facility, number of comorbidities, chair-sitting balance,...

5 is a practical, easy to use instrument that can identity patients at risk for functional declin... more 5 is a practical, easy to use instrument that can identity patients at risk for functional decline during and after an acute hospital admission. The HARP instrument stratifies patients' risk for new ADL disability into low, medium, or high-risk categories based on scores obtained including age, preadmission Instrumental Activities of Daily Living (IADL) score, and an abbreviated Folstein Mini-Mental Status

WHY: Urinary incontinence (UI) is the involuntary loss of urine sufficient to be a bother. Depend... more WHY: Urinary incontinence (UI) is the involuntary loss of urine sufficient to be a bother. Depending on the setting, up to two-thirds of older adults experience UI. Yet, UI should not be considered a normal consequence of aging. Despite available treatment options, UI is not adequately assessed and managed in the older adult population. UI is associated with falls, obesity, skin impairments, urinary tract infections, limited functional status, depression, impaired cognition, poor self-rated health, social isolation, and increased caregiver burden. Proper assessment identifies the type of UI: transient or established (chronic). Try This: ® UI Part I focuses on assessing for contributing causes of transient UI, which is significantly under addressed both in clinical practice and in the health care literature. Try This: ® UI Part II focuses on established UI. Transient UI is generally defined as a sudden-onset UI that, if left untreated, may lead to established UI.

WHY: Informal supporters provide the majority of long-term care to chronically disabled older adu... more WHY: Informal supporters provide the majority of long-term care to chronically disabled older adults. Caregiving has been recognized as an activity with perceived benefits and burdens. Caregivers may be prone to depression, grief, fatigue, financial hardship, and changes in social relationships. They may also experience physical health problems (Thornton & Travis, 2003). Perceived caregiver strain has been associated with premature institutionalization for care recipients along with reports of unmet needs. Screening tools are useful to identify families who would benefit from a more comprehensive assessment of the caregiving experience.

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Livi... more We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Living Legends program, which includes life review writing and an intergenerational exchange, compared with life review writing alone, for community-dwelling older adults. This study was a randomized controlled trial with a connected qualitative component. We analyzed quantitative data using independent-samples t tests and written descriptions of program experiences using Collaizi's qualitative methodology; we then used a triangulation protocol to integrate the qualitative and quantitative data. For participants in the writing workshop plus intergenerational exchange, sense of purpose and meaning in life increased significantly (p < .0001) compared with those in the writing workshop alone. Qualitative themes revealed additional program benefits. Living Legends enhanced participants' sense of purpose and meaning in life, a factor known to prevent cognitive loss and disability, comp...

Journal of the American Medical Directors Association, Jan 5, 2015

The objective of this study was to evaluate the impact of a well-developed theory-based function-... more The objective of this study was to evaluate the impact of a well-developed theory-based function-focused care for cognitively impaired (FFC-CI) intervention on eating performance among long-term care (LTC) residents with moderate-to-severe cognitive impairment. A secondary analysis of longitudinal data from 2 cluster-randomized controlled trials that originally tested the impact of FFC-CI on all function and physical activities. Participants were 199 residents with moderate-to-severe cognitive impairment from 4 nursing homes and 4 assisted living facilities. Data at baseline, and 3 and 6 months were used. Resident outcome data used in this analysis included eating performance conceptualized using the single self-care "feeding" item in the Barthel Index, cognitive function by Mini-Mental State Examination, sitting balance conceptualized using the single "chair sit-sitting balance" item in the Tinetti Gait and Balance scale, physical capability by Physical Capabili...

Worldviews on Evidence-Based Nursing, 2015

Review of research to date has been focusing on maintaining weight and nutrition with little atte... more Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance. To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long-term care (LTC). A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, intervention. Intervention studies that optimize eating performance and evaluate change of self-feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full-texts were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Eleven intervention studies (five randomized controlled trials; RCTs) were identified, and classified into four types: Training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate, with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance. This review provided preliminary support for using training and mealtime assistance to optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may focus on training nursing caregivers as interventionists, lengthening intervention duration, and including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness of training combined with mealtime assistance may also be tested to achieve better resident outcomes in eating performance.

Neurodegenerative disease management, 2015

SUMMARY Aim: Hospital-acquired disability causes decreased quality of life for patients with dem... more SUMMARY Aim: Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.

International Journal of Orthopaedic and Trauma Nursing, 2015

By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of... more By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery for these individuals is more complicated than among younger individuals. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. Overall recruitment rates were consistent with other studies and the intervention was implemented as intended. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.

Journal of the American Geriatrics Society, 2014

A comparative trial using a repeated-measures design was designed to evaluate the feasibility and... more A comparative trial using a repeated-measures design was designed to evaluate the feasibility and outcomes of the Family-Centered Function-Focused-Care (Fam-FFC) intervention, which is intended to promote functional recovery in hospitalized older adults. A family-centered resource nurse and a facility champion implemented a three-component intervention (environmental assessment and modification, staff education, individual and family education and partnership in care planning with follow-up after hospitalization for an acute illness). Control units were exposed to function-focused-care education only. Ninety-seven dyads of medical patients aged 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. Fifty-three percent of patients were female, 89% were white, 51% were married, and 40% were widowed, and they had a mean age of 80.8 ± 7.5. Seventy-eight percent of FCGs were married, 34% were daughters, 31% were female spouses ...

The Gerontologist, Jan 16, 2014

To explore the experience of older adults in their neighborhood in relation to perceived fall ris... more To explore the experience of older adults in their neighborhood in relation to perceived fall risk, fear of falling (FOF), and resources/strategies for fall prevention. Fourteen older adults, 65 years of age and older from 3 urban senior centers, participated in this qualitative study. The semistructured interview guidelines and background questionnaire were developed by the researchers based on the literature and an existing measure of walkability. Both tools were refined based on pilot interviews with seniors. Collaizzi's phenomenological method was used for data analysis. Five themes emerged from the data: (a) The built environment contributes to perceived fall risk and FOF, (b) personal strategies used to adapt to perceived neighborhood fall risks-behavioral approaches, (c) resources for physical activity and safety, (d) barriers to physical activity and exercise, and (e) neighborhood features as a motivator. Urban-dwelling seniors perceive that neighborhood features contrib...

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses

WHY: Chronic diseases, such as cancer, diabetes, and cardiovascular disease (coronary heart disea... more WHY: Chronic diseases, such as cancer, diabetes, and cardiovascular disease (coronary heart disease, hypertension and dyslipidemia), disproportionately affect older adults and are associated with disability and diminished quality of life. These conditions share many of the same common, modifiable risk factors, including obesity and physical inactivity. Today, about 80% of older adults have at least one chronic condition, and 50% have at least two. Identification of chronic disease risk factors and early disease detection, through screening, may decrease the burden of chronic disease and protect and promote the health of older adults.

Nursing research

Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Im... more Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery. To explore the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP, test its validity with a sample of staff registered nurses (RNs), and evaluate its invariance across 4 groups of RNs who worked at 4 different types of hospitals. Staff RNs (N = 9,400) at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, were split randomly into 2 groups for cross-validation. A 3-step data analysis was completed. The a priori factor structure was developed using exploratory factor analysis. The obtain...

The American journal of nursing, 2005

Aims and objectives. To explain the relationship between a positive nurse practice environment (N... more Aims and objectives. To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background. The NPE is a system-level intervention for promoting quality and patient safety; however, there are populationspecific factors that influence the nurses' perception of their practice and its' relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs. Discursive paper. Method. In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals' systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results. Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions. Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff's perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice. The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.

Journal of the American Geriatrics Society, 2014

Rehabilitation Nursing, 2011

International Journal of Nursing Practice, 2010

Functional decline is a common complication for hospitalized older adults. Illuminating the facto... more Functional decline is a common complication for hospitalized older adults. Illuminating the factors that influence the physical function of hospitalized older adults is critical in order to develop effective interventions to prevent avoidable loss of function. Twenty-four older adults in three senior centres located in metropolitan New York City, who had recent experience with hospitalization, participated in focus groups to discover these factors. An exploratory qualitative design was used. Participants defined physical function as the ability to be mobile and resume the enactment of their roles, routines and relationships. Participants also believed that hospitalization should improve physical function. They described staff and system supports of, as well as the challenges to physical function in the hospital setting. The findings provide evidence for developing education programmes as well as new models of nursing care aimed at preventing functional decline.

Purpose -The purpose of this mixed methods study is to define the core components of a system-wid... more Purpose -The purpose of this mixed methods study is to define the core components of a system-wide, acute care program designed to meet the needs of older adults. Design/methodology/approach -Concept mapping methodology (multidimensional scaling and cluster analysis) was used to obtain data describing the core components of a geriatric acute care model. The input of 306 "stakeholders" (clinicians, administrators, consumers, educators, and researchers) was obtained through a world wide web interface, supplemented with consumer interviews. Findings -The findings yielded eight clusters describing components of a geriatric acute care program: guiding principles, leadership, organizational structures, physical environment, patient-and family-centered approaches, aging-sensitive practices, geriatric staff competence, and interdisciplinary resources and processes. A total of 113 items that describe dimensions of quality were identified with these clusters. Practical implications -The clusters and dimensions provide a framework for a hospital to use to plan, implement, and evaluate an acute care model for older adults. Originality/value -There is not a common understanding of what constitutes a comprehensive set of resources, programs, and activities to address the needs of hospitalized older adults and their families and the staff who serve them. Concept mapping was an effective method of engaging the perspectives of various stakeholders in creating a framework to address these needs, as well as useful in illuminating areas for future research.

Functional decline is a common complication in hospitalised older adults, associated with low mob... more Functional decline is a common complication in hospitalised older adults, associated with low mobility and physical activity. Fear of falling may contribute to limited mobility and physical activity, and loss of physical function. An understanding of this relationship, as well as contributing factors, may inform the development of safe, function-promoting interventions. To describe fear of falling in hospitalised older adults and its relationship with patient characteristics and physical function and explore patient views of associated factors. combined quantitative and qualitative approach using chart extraction, observation and interviews of older adults. (i) correlations and analysis of variance methods; (ii) content and thematic analysis; and (iii) evaluation of convergence, complementarity and dissonance of quantitative and qualitative data. Depressed older persons were more likely to describe fear of falling (r = 0.47, P = 0.002). Fear of falling was associated with the loss of physical function from admission to discharge (F = 7.6, P = 0.009). The participant response to fear of falling was activity restriction vs. self-direction. Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy. Fear of falling plays a significant role in restricting physical activity and function. A multifactorial approach may provide a viable alternative to activity restriction, by facilitating self-direction and functional recovery. Interventions to prevent falls and activities to promote functional mobility are ideally developed in tandem, with attention paid to the physical and social environment. Preventing hospital-acquired disability may require a shift in organisational values around safety, from a soley protective approach to one that reflects an enabling philosophy emphasising independence and self-direction. Such a paradigm shift would demonstrate a valuing not only of the absence of falls but also the preservation and restoration of function.