Nursing Homes: A ‘Place No One Wants to Be’

I’m on my way home from Atlanta, site of the 2018 NICHE (Nurses Improving Care for Healthsystem Elders) conference. This organization, housed at New York University-Rory Meyers College of Nursing for the last 26 years, provides education and consultation to organizations to improve the delivery of health care to older adults. It now counts over 700 member organizations in five countries and has been successful in helping facilities implement best practices for providing care to older adults.

Redesigning long-term care.

One of the speakers, Migette Kaup, PhD, from Kansas State University and an expert in designing care facilities, spoke about current efforts to redesign long-term care. She noted that traditional nursing homes, which were designed to mimic hospitals, are “a product no one wants” and a place many people would rather die than go to.

Kaup spoke about the success of the newer “household” model of long-term care, which mimics a home setting rather than a hospital. Key aspects of this model are that it centers around an open kitchen space and is made up of a dedicated staff and small group of residents who live together and implement best practices. Kaup cited successes in decreasing depression and pressure ulcers in low-risk patients, among other parameters. Of course the real goal, as we […]

2018-04-13T11:43:57-04:00April 13th, 2018|family caregiving, Nursing, nursing perspective|3 Comments
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Wound Care: A Common, Often Stressful Family Caregiving Task

“Teaching Wound Care to Family Caregivers” is currently one of AJN‘s most-viewed articles. As the article points out, more than one-third of family caregivers have to perform wound care, and doing so at home “can be a stressful experience.”

In a recent study of the challenges faced by family caregivers, 35% of those sampled reported performing wound care. Importantly, 66% of these caregivers indicated that wound care was difficult for them. For almost half, fear of making mistakes or causing harm was even more of a concern than the time and inconvenience of providing wound care….

The CARE Act mandates family caregiver teaching.

A nurse teaches a family caregiver how to assess a diabetic foot ulcer and safely change the dressing. Photo courtesy of the AARP Public Policy Institute.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Some other topics covered in the series include managing mobility and fall risk in the home, managing complex medication regimens, administering injections, and others.

As AJN editor-in-chief Shawn Kennedy wrote in a

2018-03-16T08:45:20-04:00March 16th, 2018|family caregiving, Nursing, Patients|0 Comments
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AJN in May: Venous Thromboembolism Update, Deep Tissue Pressure Injury Review, Much More

The May issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE Feature: Original Research: Creating an Evidence-Based Progression for Clinical Advancement Programs

The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Building on the competencies identified by the IOM and QSEN, the authors of this study developed eight nursing competency domains and 186 related knowledge, skills, and attitudes for professional nursing practice, then sought to validate them and to determine their developmental progression within a clinical advancement program.

CE Feature: Venous Thromboembolism: Updated Management Guidelines

Each year, as many as 900,000 cases of venous thromboembolism occur in the United States; between 100,000 and 300,000 cases end in death. This article presents an overview of venous thromboembolism—including its pathophysiology, risk factors, symptoms, and key clinical assessments—plus a review of recommendations from an updated American College of Chest Physicians guideline related to treatment options, nursing practice, patient education, diagnostic testing, and […]

2017-04-28T09:09:57-04:00April 28th, 2017|Nursing|0 Comments
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Taking Skin Tear Prevention and Management Seriously

In the Past, Approaches to Skin Tears Were Inadequate

Many years ago, when I worked in a skilled nursing facility, it seemed my patients were always experiencing skin tears. We didn’t have wound care specialists then. My approach to these injuries, which I didn’t see as serious, was to cleanse them with saline and awkwardly attempt to reposition the detached flap. In retrospect, the nursing care I provided didn’t amount to much more than “a lick and a promise.”

Greater Awareness of Risks, Dangers of Skin Tears

screen-shot-2016-11-14-at-6-09-55-pmToday, we know that skin tears can evolve into serious, complex wounds. Available data indicate that in long-term care settings, these injuries affect up to 22% of residents. Wound care specialists have developed a classification system for skin tears—as for pressure injuries, specific recommendations from wound care specialists guide our nursing care.

In this month’s AJN, author Sharon Baranoski and colleagues from the International Skin Tear Advisory Panel detail the assessment and management of skin tears in “Preventing, Assessing, and Managing Skin Tears: A Clinical Review.” While the authors emphasize the need to involve wound care nurses in the management of these injuries, many readers may find the product selection guide in this article to be especially useful.

2016-11-21T13:00:49-05:00November 14th, 2016|Nursing|3 Comments
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AJN in November: Skin Tears, Veteran Women’s Mental Health, Supporting Family Caregivers, More

The November issue of AJN is now live. Here are some articles we’d like to bring to your attention.

ajn1116-cover-onlineCE Feature: “Preventing, Assessing, and Managing Skin Tears: A Clinical Review”

Although skin tears are common, particularly among older adults and neonates, they are often inadequately documented and poorly managed, resulting in complications, extended hospital stays, and negative patient outcomes. In this article, the first in a series on wound care in collaboration with the World Council of Enterostomal Therapists, the authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears.

CE Feature: “Veteran Women: Mental Health–Related Consequences of Military Service”

The last two decades have seen increasing numbers of women entering all branches of the U.S. armed forces. Many are exposed to traumatic events that place them at higher risk for mental health conditions. It’s essential for all nurses to be knowledgeable about the mental health issues commonly seen in this population. The author of this article reviews research confirming that both active-duty and veteran women are at increased risk for postdeployment mental health problems, including posttraumatic stress disorder, military sexual trauma, and suicide—and also addresses the nursing practice […]

2016-11-21T13:00:52-05:00October 28th, 2016|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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