Evidence-Based Geriatric Nursing Protocols for Best Practice, Fifth Edition

by Marie Boltz PhD, RN, GNP-BC, FGSA, FAAN (Editor), Elizabeth Capezuti PhD, RN, FAAN (Editor), Terry T. Fulmer PhD, RN, FAAN (Editor), DeAnne Zwicker DrNP, APRN, BC (Editor)

Overview

This new edition of one of the premier references for geriatric nurses in hospital, long-term, and community settings delivers current guidelines, real-life case studies, and evidence-based prools developed by master educators and practitioners. With a focus on improving quality of care, cost-effectiveness, and outcome, the fifth edition is updated to provide the most current information about care of common clinical conditions and issues in older patients. Several new expert contributors present current guidelines about hip fractures, frailty, perioperative and postoperative care, palliative care, and senior-friendly emergency departments. Additionally, chapters have been reorganized to enhance logical flow of content and easy information retrieval.

Prools, systematically tested by more than 300 participating NICHE (Nurses Improving Care for Health system Elders) hospitals‚ are organized in a consistent format and include an overview, evidence-based assessment and intervention strategies, and an illustrative case study with discussion. Additionally, prools are embedded within chapter text, providing the context and detailed evidence for each. Chapter objectives, annotated references,and evidence ratings for each prool are provided along with resources for additional study.

New to the Fifth Edition:

• Reorganized to enhance logical flow of information and ease of use
• Updated and revised
• Includes new contributions from expert educators and practitioners
• Provides new chapters on perioperative and postoperative care, general surgical care, care of hip fracture, palliative care, and the senior-friendly emergency department

Key Features:

• Includes PowerPoints and a test bank for instructors
• Delivers evidence-based, current guidelines and prools for care of common clinical conditions in the older person
• Illustrates the application of clinical prools to real-life practice through case studies and discussion
• Edited by nationally known geriatric leaders who are endorsed by the Hartford Institute for Geriatric Nursing and NICHE
• Written for nursing students, nurse leaders, and practitioners at all levels, including those in specialty roles

Product Details

ISBN-13:	9780826171665
Publisher:	Springer Publishing Company
Publication date:	03/28/2016
Edition description:	Reprint
Pages:	752
Product dimensions:	8.10(w) x 10.00(h) x 1.70(d)

About the Author

Marie Boltz, PhD, RN, GNP-BC, FGSA, FAAN, is the Elouise Ross Eberly and Robert Eberly Endowed Professor, Penn State College of Nursing, where she teaches both gerontological nursing and PhD research courses. In addition to teaching students, she has had a significant influence on the education of nurses, physicians, and clinicians in other disciplines through the generation, synthesis, and dissemination of gerontological knowledge. She has provided leadership training and ongoing consultation to hundreds of nurse clinicians and administrators who are leading systemwide geriatric programs. Dr. Boltz has developed more than 40 evidence-based, field-tested teaching tools and resources for clinicians, administrators, patients, and families. She has authored and coauthored more than 200 journal publications and 40 book chapters and has co-edited six books. Dr. Boltz's areas of research are geriatric models of care, including dementia-capable and family-centered interventions that support function, and nonpharmacological approaches to support well-being of older adults with dementia. Her multiple research studies have been funded by the National Institute on Aging, the National Institute on Nursing Research, and multiple foundations. Her scholarship has been recognized with writing, teaching, and research awards, including the ENRS Geriatric Practice Research Award and the Gerontological Society of America Doris Schwartz Gerontological Nursing Research Award. She is a fellow in the American Academy of Nursing and the Gerontological Society of America. Dr. Boltz received her bachelor's degree in nursing from LaSalle University, her master's degree as a geriatric advanced practice nurse from the University of Pennsylvania, and her doctoral degree from New York University. She participated in postdoctoral study at the University of Maryland.

Elizabeth A. Capezuti, PhD, RN, FAAN, is the William Randolph Hearst Foundation Chair in Gerontology at the Hunter-Bellevue School of Nursing of the City University of New York (CUNY), where she directs the PhD in Nursing program. She is known for her work in improving the care of older adults by interventions and models that positively influence healthcare providers' knowledge and work environment. Dr. Capezuti's research interests include fall prevention, nonpharmacological approaches to improve sleep, palliative care, the geriatric nursing work environment, and the design of the "built environment" to facilitate older persons' health outcomes. Dr. Capezuti has disseminated the findings of 40 funded projects in five co-edited books and more than 150 peer-reviewed articles and book chapters. She is the recipient of the Otsuka/American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award and the American Academy of Nursing Nurse Leader in Aging Award. She is an international speaker and consultant, including a Fulbright Specialist to Lithuanian University of Health Sciences. Dr. Capezuti received her bachelor's degree in nursing from Lehman College (CUNY), her master's degree as a geriatric advanced practice nurse from Hunter College, and her doctoral degree in nursing from the University of Pennsylvania.

Terry Fulmer, PhD, RN, FAAN, is the President of the John A. Hartford Foundation in New York City, a foundation dedicated to improving the care of older adults. Established in 1929, the Foundation has a current endowment of more than half a billion dollars. She serves as the chief strategist for the Foundation, and her vision for better care of older adults is catalyzing the Age-Friendly Health Systems social movement. She is an elected member of the National Academy of Medicine and served on the independent Coronavirus Commission for Safety and Quality in Nursing Homes established to advise the Centers for Medicare and Medicaid Services. She previously served as Distinguished Professor and Dean of Health Sciences at Northeastern University. Prior, she served as the Erline Perkins McGriff Professor and Founding Dean of the New York University College of Nursing. She received her bachelor's degree from Skidmore College, her master's and doctoral degrees from Boston College, and her Geriatric Nurse Practitioner Post-Master's Certificate from New York University. She completed a Brookdale National Fellowship and is the first nurse to have served on the board of the American Geriatrics Society. She is also the first nurse to have served as President of the Gerontological Society of America, which awarded her the 2019 Donald P. Kent Award for exemplifying the highest standards for professional leadership in the field of aging. Dr. Fulmer is nationally and internationally recognized as a leading expert in geriatrics. She is known for conceptualization and development of the Age-Friendly Health Systems movement and the national Nurses Improving Care for Healthsystem Elders (NICHE) program, as well as for her research on the topic of elder abuse and neglect, which has been funded by the National Institute on Aging and the National Institute of Nursing Research. She is a Trustee for the Josiah Macy Jr. Foundation, Springer Publishing Company, and the Bassett Healthcare System and is a Member of the Reimagining Long-Term Care Task Force in New York State and a member of the National Academy of Medicine's Forum on Aging, Disability, and Independence. Dr. Fulmer also serves as Vice Chair of the Department of Veterans Affairs Special Medical Advisory Group. She was the Chair of the National Advisory Committee for the Robert Wood Johnson Foundation Executive Nurse Fellows Program and held board positions at Skidmore College, the Institute for Healthcare Improvement, the Geriatrics and Gerontology Advisory Committee for the U.S. Department of Veterans Affairs, and the Advisory Board for Hong Kong Polytechnic University School of Nursing. She is one of the top 50 Influencers in Aging by PBS's Next Avenue, the premier digital publication dedicated to covering issues for older Americans. Dr. Fulmer is the recipient of prestigious awards, including the American Society on Aging's 2017 Rosalie S. Wolf Award for her body of work on elder abuse. In 2016, she received the 2016 Award for Exceptional Service to The New York Academy of Medicine for her distinguished service on the Academy's Board of Trustees, including as vice-chair, and for her active engagement in the policy work of the Academy, especially its Age-Friendly NYC initiative. She has been honored with invitations for named lectureships from noted universities. She has held faculty appointments at Columbia University, where she was the Anna C. Maxwell Chair in Nursing, and she has also held appointments at Boston College, Yale University, and the Harvard Division on Aging at Harvard Medical School. She has served as a visiting professor of nursing at the University of Pennsylvania and Case Western Reserve University. She is a Distinguished Practitioner of the National Academies of Practice and is currently an attending nurse at Mount Sinai Medical Center in New York City. Her clinical appointments have included the Beth Israel Hospital in Boston, the Massachusetts General Hospital, and the NYU Langone Medical Center. She is a Fellow of the American Academy of Nursing, the Gerontological Society of America, and the New York Academy of Medicine, where she served as vice-chair. She has authored more than 150 peer-reviewed papers and edited 23 books.

DeAnne Zwicker, DrNP, AGNP-BC, is a certified adult nurse practitioner and geriatric nurse practitioner. She is currently working as an independent geriatric consultant.

Table of Contents

Contents

Contributors

Foreword J. Taylor Harden, PhD, RN, FGSA, FAAN

Preface

Acknowledgments

PART I. INCORPORATING EVIDENCE INTO PRACTICE

1. Developing and Evaluating Clinical Practice Guidelines: A Systematic Approach

Rona F. Levin and Susan Kaplan Jacobs

Educational Objectives

Overview

Definition of Terms

2. Measuring Performance and Improving Quality

Lenard L. Parisi

Educational Objectives

Overview

Quality Health Care Defined

Clinical Outcomes and Publicly Reported Quality Measures

Measuring Quality of Care

Addressing the Challenges

Measuring Performance-Selecting Quality Indicators

Implementing the Quality-Assessment and Performance-Improvement Program

PART II. ASSESSMENT AND MANAGEMENT PRINCIPLES

3. Age-Related Changes in Health

Constance M. Smith and Valerie T. Cotter

Educational Objectives

Overview

Cardiovascular System

Pulmonary System

Renal and Genitourinary Systems

Oropharyngeal and Gastrointestinal Systems

Musculoskeletal System

Nervous System and Cognition

Immune System and Vaccination

Atypical Presentation of Disease

4. Health Care Decision Making

Linda Farber Post and Marie Boltz

Educational Objectives

Overview

Background and Statement of Problem

Decision Aids

Assessment of the Problem

Interventions and Care Strategies

5. Sensory Changes

Pamela Z. Cacchione

Educational Objectives

Overview

Background and Statement of Problem

Normal Changes of Aging Senses

Assessment of the Problem

Interventions and Care Strategies

6. Assessing Cognitive Function

Pieter Heeren, Johan Flamaing, Jos Tournoy, Marquis D. Foreman, and Koen Milisen

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

7. Assessment of Physical Function

Denise M. Kresevic

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

8. Oral Health Care

Linda J. O’Connor

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Intervention and Care Strategies

9. Managing Oral Hydration

Janet C. Mentes

Educational Objectives

Overview

Background and Statement of Problem

Definitions

Assessment of the Problem

10. Nutrition

Rose Ann DiMaria-Ghalili

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

11. Family Caregiving

Deborah C. Messecar

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

12. Issues Regarding Sexuality

Elaine E. Steinke

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

13. Mistreatment Detection

Billy A. Caceres and Terry Fulmer

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

PART III. CLINICAL INTERVENTIONS

14. Preventing Functional Decline in the Acute Care Setting

Marie Boltz, Barbara Resnick, and Elizabeth Galik

Educational Objectives

Overview

Physical Function as a Clinical Measure

Patient Risk Factors for Functional Decline

The Care Environment and Function

Interventions to Promote Physical Function

15. Late-Life Depression

Glenise L. McKenzie and Theresa A. Harvath

Educational Objectives

Overview

Background and Statement of Problem

Cause and Risk Factors

Assessment of the Problem

Differentiation of Medical or Iatrogenic Causes of Depression

Interventions and Care Strategies

Psychosocial Approaches

16. Dementia: A Neurocognitive Disorder

Kathleen Fletcher

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

17. Delirium: Prevention, Early Recognition, and Treatment

Dorothy F. Tullmann, Cheri Blevins, and Kathleen Fletcher

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

18. Pain Management

Ann L. Horgas, Mindy S. Grall, and Saunjoo L. Yoon

Educational Objectives

Overview

Assessment of Pain

Interventions and Care Strategies

Improving Pain Management in Care Settings

19. Preventing Falls in Acute Care

Deanna Gray-Miceli and Patricia A. Quigley

Educational Objectives

Overview

Background and Statement of Problem

Falls and Injury Risk Assessment

Interventions for Fall Prevention and Management

20. Reducing Adverse Drug Events

DeAnne Zwicker and Terry Fulmer

Educational Objectives

Overview

Background and Statement of Problem

Evaluation of the Problem

Assessment Strategies

Interventions and Care Strategies

21. Urinary Incontinence

Annemarie Dowling-Castronovo and Christine Bradway

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Assessment Parameters

Interventions and Care Strategies

22. Prevention of Catheter-Associated Urinary Tract Infection

Heidi L. Wald, Regina M. Fink, Mary Beth Flynn Makic, and Kathleen S. Oman

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

23. Physical Restraints and Side Rails in Acute and Critical Care Settings

Cheryl M. Bradas, Satinderpal K. Sandhu, and Lorraine C. Mion

Educational Objectives

Overview

Background and Legal Issues

Prevalence and Rationale of Staff

Ethical Issues in the Use of Physical Restraint

Administrative Responsibilities

Interventions and Care Strategies

Alternatives to Physical Restraints

24. Preventing Pressure Ulcers and Skin Tears

Elizabeth A. Ayello and R. Gary Sibbald

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Does Race Make a Difference?

Interventions and Care Strategies

Skin Tears

25. Mealtime Difficulties in Dementia

Melissa Batchelor-Murphy and Sarah Crowgey

Educational Objectives

Overview

Background and Statement of Problem

C3P Model for Assessment and Care Strategies

26. Excessive Sleepiness

Grace E. Dean, Michelle L. Klimpt, Jonna Lee Morris, and Eileen R. Chasens

Educational Objectives

Overview

Background and Statement of Problem

Consequences of Excessive Sleepiness

Physiological Changes in Sleep That Accompany Aging

Primary Causes of Excessive Daytime Sleepiness

Secondary Causes of Excessive Daytime Sleepiness

Assessment of the Problem

Interventions and Care Strategies

27. The Frail Hospitalized Older Adult

Stewart M. Bond, Rebecca Bolton, and Marie Boltz

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

PART IV. INTERVENTIONS IN SPECIALTY PRACTICE

28. Substance Misuse and Alcohol Use Disorders

Madeline A. Naegle and Donna McCabe

Educational Objectives

Overview

Background and Statement of Problem

Assessment of Substance Use Disorders

Assessment of Substance Use

Interventions and Care Strategies

29. Comprehensive Assessment and Management of the Critically Ill

Michele C. Balas, Colleen M. Casey, Lauren Crozier, and Mary Beth Happ

Educational Objectives

Overview

Background and Statement of Problem

Assessment of Problem and Nursing Care Strategies

30. Fluid Overload: Identifying and Managing Heart Failure Patients at Risk of Hospital Readmission

Judith E. Schipper

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

31. Cancer Assessment and Intervention Strategies

Janine Overcash

Educational Objectives

Overview

Assessment of the Older Hospitalized Patient

Developing a Comprehensive Geriatric Assessment for Hospitalized Patients

Medical Emergencies Associated With Cancer and Cancer Treatment

32. Perioperative Care of the Older Adult

Fidelindo Lim and Larry Z. Slater

Educational Objectives

Overview

Background and Statement of Problem

Assessment of Problem and Nursing Care Strategies

Postanesthesia Care Unit Considerations

General Perioperative Considerations

33. General Surgical Care of the Older Adult

Larry Z. Slater and Fidelindo Lim

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem and Nursing Care Strategies

34. Care of the Older Adult With Fragility Hip Fracture

Anita J. Meehan, Ami Hommel, Karen Hertz, Valerie MacDonald, and Ann Butler Maher

Educational Objectives

Overview

Background and Statement of Problem

Definition of Fragility Hip Fracture

Surgical Repair of Hip Fracture

Pathophysiology

Common Complications and Evidence-Based Nursing Care Strategies

Pain: Significance in Hip-Fracture Patients

Delirium: Significance in Hip-Fracture Patients

Malnutrition: Significance in Hip-Fracture Patients

Fluid and Electrolyte Imbalance: Significance in Hip-Fracture Patients

Pressure Ulcer: Significance in Hip-Fracture Patients

VTE: Significance in Hip-Fracture Patients

Catheter-Associated Urinary Tract Infection: Significance in Hip-Fracture Patients

Functional Decline: Significance in Hip-Fracture Patients

Loss, Grief, and Depression: Significance in Hip-Fracture Patients

Care Transitions: Significance in Hip-Fracture Patients

Secondary Prevention: Significance in Hip-Fracture Patients

PART V. MODELS OF CARE

35. Acute Care Models

Elizabeth Capezuti, Ana Julia Parks, Marie Boltz, Michael L. Malone, and Robert M. Palmer

Educational Objectives

Overview

Objectives of Geriatric Acute Care Models

Types of Acute Care Models

36. Transitional Care

Fidelindo Lim, Janice B. Foust, and Janet H. Van Cleave

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Problem

Interventions and Care Strategies

37. Palliative Care Models

Constance Dahlin

Educational Objectives

Overview

Current State of Palliative Care

Quality and Palliative Care

Outcomes

Models Across Health Care Venues

Appendix

38. Care of the Older Adult in the Emergency Department

Marie Boltz and Amala Sooklal

Educational Objectives

Overview

Background and Statement of Problem

Assessment of the Older Adult in the ED

Nursing Interventions

Transitions From the ED

39. Advance Care Planning

Linda Farber Post and Marie Boltz

Educational Objectives

Overview

Background

Types of Advance Directives

Advance Directives and Decision Making

Other Types of ACP

Decisional Capacity to Engage in ACP

Cultural Perspectives on ACP

Nurses’ Roles in ACP

ACP Interventions and Strategies

Index

Editorial Reviews

Reviewer: Katy T Nguyen, M.S.N, R.N(MU Sinclair School of Nursing)
Description: This geriatric nursing book is organized into five parts that address the incorporation of evidence into practice, nursing assessments, clinical interventions, specialty practice, and the models of care.
Purpose: The purpose is to provide references and evidence-based protocols for geriatric care in any setting. The clinical decision-making based on research evidence that is explained in 39 clinical topics meets the objectives of enhancing the levels of evidence supporting gerontological nursing practice.
Audience: The audience includes gerontological nurses, geriatric practitioners, and/or any healthcare providers who are interested in geriatric care. The authors and contributors are clinical experts in gerontological nursing.
Features: This is an excellent resource for gerontological nurses. It emphasizes evidence-based practice from research, addresses the systematic approaches, and delivers the current clinical practice guidelines to improve quality of care and best outcomes. The best features are the many case studies with each chapter that illustrate common problems in the geriatric population and the discussion that helps guide decision-making.
Assessment: The book is well organized in a logical flow of information. As a clinical educator and a gerontological nurse consultant, I appreciate the evidence-based protocols that help guide the decision-making, intervention strategies, and implementation process. This is a great tool for nursing education and practice. I often use it for teaching and managing nursing care delivery.

Doody's Review Service