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Polypharmacy is commonly encountered by providers caring for patients with medically complex and palliative care needs in many settings. The purpose of this quality improvement project was to measure the impact of an evidence-based educational deprescribing intervention on polypharmacy rate and provider confidence and knowledge in the nursing home. We invited providers working in 52 nursing homes to attend a 1-hour-long educational deprescribing session. Twenty-one nurse practitioners and 1 physician assistant across 11 states participated in the intervention. Provider confidence level related to deprescribing improved in all categories, with statistical significance demonstrated with both paired t test and Wilcoxon signed rank test (P <.001). The polypharmacy rate 3 months after the intervention decreased more in centers where a provider had attended the training. Additional open-ended data about experiences with and barriers to deprescribing were collected and analyzed. The findings from this quality improvement project demonstrate that an educational intervention focused on providers practicing in the nursing home setting can improve deprescribing confidence and reduce polypharmacy rates. These findings may be used to implement similar deprescribing education programs for palliative care nurses and providers that prioritize goals of care for patients living with serious illness. [ABSTRACT FROM AUTHOR]

MASSACHUSETTS, ALONG WITH MANY STATES, HAS RECOGNIZED THE IMPERATIVE TO ADDRESS CURRENT AND IMPENDING SHORTAGES IN THE LONG-TERM CARE (LTC) NURSING WORKFORCE. Approximately 8 percent of licensed nursing positions are [...]

Within long-term care, the transitional care setting provides post-acute and short-stay rehabilitation to older adults, easing the transition between the acute care hospital and home or long-term care. The current nursing shortage makes it difficult for these facilities to attract and retain qualified nursing staff. In order to meet the rehabilitation needs for this patient population while at the same time addressing the challenge in nursing education of limited clinical placements and severe nurse faculty shortages, an academic-practice partnership was developed to establish a Dedicated Education Unit (DEU). The DEU is an innovative clinical education model in which experienced staff nurses serve as clinical teachers to nursing students. This paper describes the process of developing a DEU using the Partners in Caring Model as the framework. Formative and summative evaluation results and recommendations for program improvement of this pilot project are discussed. [ABSTRACT FROM AUTHOR]

Identifying or constructing instruments that are logically consistent with a particular conceptual model of nursing and collecting data are two of the most time consuming aspects of research. Consequently, the use of secondary data can be an attractive alternative. The Outcome and Assessment and Information Set (OASIS) and the Minimum Data Set (MDS) are two instruments routinely used to collect data in healthcare organizations. Examination of the OASIS items and the MDS elements revealed linkages with certain concepts of Orem's Self-Care Framework. Examples of how data from those instruments can be used in nursing studies are provided. [ABSTRACT FROM AUTHOR]

1. To gain knowledge about delivering provider education for internal palliative care programs focused on primary palliative care, polypharmacy and deprescribing. 2. To review the outcomes of this quality improvement project, including polypharmacy rate, provider confidence and knowledge, and experiences with deprescribing. Palliative care needs in the nursing home are significant and there is limited study about the education of providers focused on polypharmacy and deprescribing. This quality improvement project evaluates the impact of an educational deprescribing intervention on the polypharmacy rate, provider confidence and knowledge in this setting. There are significant palliative care needs in the nursing home population, and expert recommendations include training for internal palliative care programs (Ersek et al., 2022). Polypharmacy is commonly encountered, however provider barriers include deficits in deprescribing confidence and knowledge (Randles et al., 2022). To measure the impact of an evidence based educational deprescribing intervention on polypharmacy rate, provider confidence and knowledge in the nursing home. Using a quasi-experimental design, we invited providers working in 52 nursing homes with high polypharmacy rates to attend a live web-based educational intervention with focus on polypharmacy and deprescribing. The following measures were collected before and after the intervention: polypharmacy rate (average number of routine medications per patient), provider confidence level, and deprescribing knowledge. Twenty-one Nurse Practitioners and one Physician Assistant across 11 states participated in the intervention; 14% reported geriatric certification. Over 40% of the providers had been practicing for at least 5 years; 45% had been practicing for 1-5 years; and 14% had been practicing for less than one year. Provider confidence level related to deprescribing increased from 68.4% to 81.2% following a one-hour educational intervention. The polypharmacy rate three months after the intervention was 16% lower in centers where a provider had attended the training, compared to a 13% reduction in centers where a provider had not attended the training. There was no significant change in the deprescribing knowledge score. Additional qualitative data about experiences with and barriers to deprescribing were also collected. The findings from this quality improvement demonstrate that an educational intervention focused on providers practicing in the nursing home setting can improve deprescribing confidence and reduce polypharmacy rates. These findings may be used to implement internal palliative care programs with training about primary palliative care and deprescribing strategies for patients living with serious illness. Workforce / Career Development; Quality Improvement [ABSTRACT FROM AUTHOR]

Despite modest gains in ethnic and racial minority representation in the nursing profession, the current nursing workforce does not mirror the U.S. population. Efforts to increase and maintain baccalaureate-prepared minority nurses to begin to reflect the diverse population needing culturally responsive, high quality care is a continuing goal of nursing education and practice. Because of this, initiatives focusing on increasing ethnic and cultural diversity of healthcare workers are of high priority. The Bring Diversity to Nursing (BDN) project describes the University of Massachusetts Lowell's success at pre-entry, retention, and graduation of minority and educationally and economically disadvantaged students. The resultant graduation and practice of BDN students as professional nurses can contribute to addressing health care needs and reducing health disparities in the Lowell and Lawrence communities and beyond. [ABSTRACT FROM AUTHOR]

Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health problems faced by patients in rehabilitation settings. A case study is used to highlight the importance of laboratory testing.

The older adult with dementia who exhibits problem behaviors is likely to be experiencing physical or psychological distress. Both can negatively affect the health, rehabilitation, and quality of life for the older adult. Managing problem behaviors can challenge the skills of the most experienced nurse. Being able to identify the origins of these behaviors can help caregivers respond in a way that will achieve behavioral management and preserve the dignity of the older adult. This article presents some practical measures to assist nurses with minimizing the negative effects of dementia-associated problem behaviors in older adults.