Purpose: While competent faculty are critical to prepare the future geriatric workforce, we found no instrument measuring nursing faculty gerontological competency. This project is to develop a gerontological nursing competency questionnaire (GNCQ).

Methods: To obtain expert opinion, we distributed the GNCQ to 25 distinguished educators in gerontological nursing (DEGN) at the 2019 National Hartford Center for Gerontological Nursing Excellence (NHCGNE) Leadership conference. Participants rated 22 items, using a 4-point Likert scale on confidence in knowledge and teaching and interest in acquiring further training, commenting on GNCQ construction and comprehensiveness. We distributed the revised GNCQ to 53 DEGN 2020 awardees from the NHCGNE Leadership Conference using an online REDCapTM survey.

Results: The first round of expert participants were 96% female, 92% with doctoral education, and 32.64 mean years of experience. Using a cut-point of 2.90, results showed low confidence in knowledge of spiritual assessment (2.71) and sexual health assessment (2.63); low confidence in teaching spiritual assessment (2.63), sexual health (2.54), and management of chronic pain (2.88). DEGNs recommended adding diversity and cultural competency, health disparity, and caregiver role strain items. Following recommendations, we added 2 survey questions and a 5-point Likert scale. Of the 53 GNCQ surveys sent to the 2020 DEGNs, 18 were returned. Participants were 100% female, 88.9% doctorly educated, with 28.44 years of experience. Similar to the 2019 DEGNs, using a cut-point of 3.65, we found low confidence in knowledge about spiritual assessment (3.50), sexual health (3.56), and substance abuse (3.61) and low confidence in teaching about spiritual assessment (3.56), sexual health (3.61), and substance abuse (3.61). Interestingly, the 2 lowest scores for interest in acquiring new knowledge were for in the same areas of sexual health (3.94), and spiritual health (4.00). No recommendations for changes were made by the 2020 DEGN group.

Applicability: The 2020 DEGNs supported finding from the 2019 DEGN expert panel for content validity. We are distributing the revised online GNCQ2 to the 2018 DEGNs for further feedback. These data suggest that the GNCQ has promising potential for identifying the most important competency areas to be addressed for gerontological nursing faculty development.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Chronic pain is a major medical issue among elderly nursing home residents and is often underdiagnosed and inadequately treated (Williamson & Hoggart, 2005). Nurses’ knowledge and efficiency to accurately assess pain and provide appropriate interventions on time is critical to achieve effective pain management. Undertreated pain in the elderly will affect the quality of life and can increase the mortality and morbidity (McCleane, 2010), whereas effective pain management will increase patient satisfaction and enhance quality of life (The Joint Commission, 2001). The aim of this quality improvement project implementing a pre-/post-design was to evaluate the effectiveness of a well-structured in-service education program on comprehensive pain management to improve nurses’ knowledge, attitude, and documentation skills in a long-term care facility. This project focused on pre and post educational program testing utilizing the knowledge and attitude survey regarding pain (KASRP) and a short demographic survey and chart audits to assess knowledge retention and practice change in the participants. Knowledge scores of nurses were measured at pre-intervention and then twice (post-1- and post-2-time points). Results of the non-parametric Friedman test revealed that there was a statistically significant increase in median knowledge scores from pre- to post-1 and post-2. Results of the non-parametric Friedman test revealed that there was a statistically significant increase in median knowledge scores from pre to post-1 and post-2. The findings of this quality improvement project suggest that the intervention of a knowledge-based instructional tool can help nurses increase their knowledge of pain management in patients.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: The National Pressure Ulcer Advisory Panel (NPIAP) defines a pressure injury as a localized injury to the skin and/or underlying tissue as a result of pressure or when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time (NPIAP 2018). In 2017, at LIJ Forest Hills, there were 41 hospital-acquired pressure injuries (HAPI) and 18 lower extremity hospital-acquired pressure injuries. The aim of the study is to find a way to reduce the number of hospital-acquired pressure injuries to the lower extremities/heels.

Methods: The age demographics were from 27-101, both genders included, and from all units (excluding emergency room and labor and delivery). Patients who are immobile, on bedrest, contracted, with a Braden scale below 19, and with impaired skin integrity were targeted. Heel protectors were put on PAR and stocked twice a day and in-services were given for appropriate use, with 2-RN validation and assessment on admission.

Results: 100% compliance for nursing in-service, decrease in total HAPI from 41 (2017) to 5 (2020), and no heel/lower extremity hospital-acquired pressure injury in the past 3 years

Education: Education for this initiative started June 2017 and continues to this day. This was spearheaded by the CWOCN and supported by nursing education and nurse managers for each individual unit. The “no heel HAPI” in-servicing consisted of using the Posey heel boots or standard pillows for offloading, identifying patients that are in need for heel offloading (Braden scale score less than 17, bedrest, poor nutrition, altered mental status), educating the patient/family in regards to the need for heel offloading, and documenting these interventions and education provided.

Each unit received morning (night-and day-shift) and afternoon (mid-shift) in-servicing. Evaluation of the effectiveness of the in-servicing was done on daily rounds for each unit by the unit nurse manager and/or the CWOCN. Evaluation of the effectiveness of the initiative is done daily when the CWOCN receives the daily reports on HAPIs and pressure injuries present on admission. Evaluation is also done weekly due to weekly prevalence studies done by the CWOCN and the nurses on the units.

Conclusion: At the beginning of each year, the goal is to see a 25% reduction in the amount of heel/lower extremity hospital-acquired pressure injuries. Upon implementation of all of these interventions, we were able to see a complete decrease of hospital-acquired heel/lower extremity pressure injuries to ZERO for the past 3 years. The major indicator of compliance with the initiative and effectiveness of the education is application of the pressure injury prevention resources (heel boots or pillows) for all applicable patients and reduction of heel/lower extremity hospital-acquired pressure injuries.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

The Center for Healthy Aging applied to age-friendly health system (AFHS) in 2019, with the intention of advancing the level of geriatric care in our clinic through the adoption of 4Ms of AFHS. Prior to applying to participate in AFHS, we assumed that our geriatric care was complete. The clinic was providing three of the 4Ms: mentation with the PHQ9 and dementia assessments, mobility assessments with the get-up-and-go test, and medication review with every appointment. The last M was the what matters most (WMM) question. The 4Ms framework was developed using evidence-based intervention with 2 important drivers, assessment and action.

In order to become recognized by AFHS , the clinic began a quality improvement process over several months. Initially, we surveyed our team to determine which what matters most question (WMM) we would ask our patients. The Allscripts team provides a monthly report of the number of patients asked what matters most including the actual answers and patient demographics. Regular communications and progress reports were submitted to AFHS for review. Most patients were pleased and surprised when asked what matter most to them. The answers became a permanent part of their chart. The clinic achieved recognition after 3 months of PDSA.

As providers, we can make assumptions about what matters most to our patients. Our assumptions can influence care. We were assessing and acting on the individual WMM responses but still had preconceived assumptions about what mattered most. Four months of patient WMM responses were compiled and ranked in order of frequency. Providers then ranked the list of top patient responses according to their assumptions about our patients.

The top themes for patients were safety, independence, and family, while the providers and staff top themes were weight, safety, and pain. Though dementia or memory loss was never mentioned by patients, it was a major assumption of importance by the providers and staff. This project provided more insight into what matters most to our patients and helped to guide the care provided by advance practice nurses and physicians to our patients. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

After Alzheimer’s disease, Parkinson's disease (PD) is the second most common age-related neurodegenerative disorder globally. Approximately 1 million individuals in the United States (US) have PD; every year 60,000 more Americans are diagnosed. PD is a movement disorder caused by dopamine insufficiency in the substantia nigra. The disease process is complicated by falls, constipation, dysphagia, insomnia, anxiety, depression, and behavioral and cognitive disorders. Upon diagnosis, evidence-based symptom management should include individualized non-pharmacologic and pharmacological interventions and lifestyle changes that will promote positive outcomes.

More than 50% of persons diagnosed with PD develop psychotic symptoms. Parkinson’s disease psychosis (PDP) is a non-motor symptom and consists primarily of hallucinations and delusions. PDP is caused by neurotransmitter changes in the brain; some related to long-term use of parkinsonian medications. In many cases, PDP symptoms are mis-diagnosed as a chronic co-morbid condition, such as mild cognitive impairment or dementia.

Symptoms run from benign to aggressive. Undiagnosed and untreated symptoms can accelerate. Delirium caused by medications or infections may contribute to psychosis. Rapid eye movement sleep (REMS) disorder associated with PD results in daytime sleepiness and acting out dreams. All symptoms profoundly affect formal and informal caregivers. When underlying causes are identified by expert advanced practice registered nurses (APRN), symptoms may be reversible. There are many evidence-based paths to follow such as managing polypharmacy, appropriate prescribing patterns, and the effective use of nonpharmacologic interventions.

During this presentation the complexities of the disease are addressed including the toll PDP can have on the person living with PD, their caregiver(s) and the interdisciplinary healthcare team. It is imperative the APRN can simultaneously manage the overlapping motor symptoms and PDP to prevent physical and mental disabilities and improve quality of life. After attending this session, the APRN will be able to provide quality care to individuals living with PDP and their caregivers.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Purpose: The purpose of this quality improvement (QI) project was to create, implement, and evaluate an evidence-based delirium prevention protocol in a post-acute care facility in Sonoma County, California.

Background: Delirium is a neurocognitive syndrome common in the older adult (65 years or older) population characterized by rapid onset, fluctuating attention, and disorganized thinking. Delirium is costly and under-recognized and can be fatal. Delirium can lead to numerous short- and long-term complications, including long-term cognitive decline, functional decline, increased risk for 30-day readmission, and institutionalization. Despite these factors, delirium is preventable in up to 40% of older adult post-acute care patients.

Method: This QI project followed the plan-do-study-act model. Skilled nursing facility staff were given in-service training specific to delirium risk factors and prevention. A delirium prevention protocol was then implemented for all new admissions. Pre- and post-implementation chart audits were conducted to assess new-onset delirium incidence in the older adult post-acute care population. Additionally, the staff was surveyed after implementation to evaluate their perception of the protocol.

Results: In the pre-implementation chart audit sample, 8% of patients were diagnosed with new-onset delirium during their post-acute care stay. The post-implementation sample group had 0 cases of new-onset delirium. The licensed nurses found the protocol simple to use. This group also reported the protocol to moderately change their daily practice. The CNAs reported the education and protocol significantly changed their daily practice.

Conclusion: This QI project’s results suggest that the implementation of a delirium prevention protocol can change nurse and CNA daily practice and has the potential to decrease the incidence of new-onset delirium.

Learning objectives: At the conclusion of this presentation participants will 1) be able to identify risk factors for post-acute delirium and 2) be introduced to a delirium prevention protocol applied in post-acute care.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.  

Heart failure is a chronically progressing illness associated with emotional and physical burden. A large portion of residents in skilled nursing facilities have a diagnosis of heart failure. Morbidity and mortality rates are significantly higher for older adults hospitalized with heart failure discharging to skilled nursing facilities rather than returning to home. Effective management of heart failure while residing at a skilled nursing facility with medications and treatments can help alleviate suffering from the disease and reduce hospital admissions. A lack of standardized care processes at skilled nursing facilities is a barrier to providing quality heart failure care. Having heart failure management protocols used in skilled nursing facilities is helpful in managing heart failure symptoms and alerting providers to deterioration in clinical status. Palliative care is targeted to relieving suffering and improving quality of life for persons with serious illness such as heart failure. Palliative care helps facilitate advanced care planning conversations to help patients determine their goals of care. Having goals of care conversations may help promote better quality of life and also reduce hospitalizations. The learning objectives of this presentation are:
1) Identify appropriate medical management of heart failure specific to the skilled nursing facility population.
2) Apply and implement an order set for management of heart failure in the skilled nursing facility.
3) Implement palliative care and advanced care planning with those in the skilled nursing facility with heart failure.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

By 2050, one in five people will be 60 years or older, totaling 2 billion people worldwide. Individuals may experience extra years in better health and live in a supportive environment, their ability to participate in activities they value will have few limits. Activities of daily living may decline. Despite, these added years, they are dominated by rapid declines in physical and mental capacity, the implications for older individuals and for society as a whole are much more negative. Providing the best possible health in older adults is, therefore, crucial if we are to achieve sustainable blissful living. By tapping into the autonomic nervous system (parasympathetic), and vagal nerve stimulation with the assistance of yoga can reduce blood pressure, heart rate, and increase gastric secretions.

Traditionally, yoga by itself refers to raja yoga, mental science. Yoga is a science of the body, mind, and soul. It is considered the mind and body practice. Asana (postures) and pranayama (breathing) helps control anxiety by occupying the mind with coordination, aligning physical, and chemical energy in the body and expending “nervous” energy in movement. Mindfulness is purposeful awareness, of the present moment, without judgment. Mindfulness assists with the balancing of the sympathetic nervous system. Therefore, yoga and mediation may have an effect on the physiological parameters of stress. Providing advanced practice registered nurses (APRN) with another tool would benefit older adults in all settings.

Yoga is one of the scientific and popular lifestyle practices considered as the integration of mind, body, and soul. During this presentation, the (APRN) will identify different yoga techniques and provide yoga modalities to the older adults (pranayama, mediation, and poses). Ideally incorporating self-care is essential to healthy living. The ultimate outcome is to improve the quality of life, mobility, mental health, and well-being.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

The Power of Self-Care presentation fosters wellness, professional development, motivation, and mindfulness to healthcare professionals. This program offers simple, healthy, compassionate practices for busy, burnt-out, and stressed employees.

Purpose: Define the importance of self-care.

Self-care is the practice of taking an active role in protecting one’s well-being and happiness.

Demonstrate activities for self-care:
• Mindfulness practice – breathing exercise, chair yoga, affirmations
• Wellness quiz, wellness 360 wheel, healthy add-ins guide

Description: The Power of Self-Care program is a simple, effective, inexpensive tool to provide employees with the knowledge, skills, and attitudes to sustain a healthy, involved, motivated relationship with their workplace. The course focuses on self-care: being individually responsible for and using the tools to develop the right attitudes toward self, work, and coworkers. The philosophy and techniques taught help participants to take charge of their own situation. Any job requires the involvement of the entire person – body, soul, and spirit. To enroll all of these in our work life and sustain a positive, healthy use of each is a goal of this program. The presenters are eminently qualified to bring this course because they are empowered women, successful in their work, not to mention their credentials. Each knows and conveys how to develop and employ skills and attitudes to be happy and fruitful in their work. The principles of this course are fundamental to living a self-directed life in advanced age.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: Strategies to ensure “appropriate” prescribing of antipsychotics in behavioral and psychological symptoms of dementia (BPSD) are limited.

Problem: In a metropolitan primary care setting, antipsychotic medications were being inappropriately prescribed for patients with BPSD at a rate of 45%, a result of lack of knowledge about appropriate prescribing practices for continuation and discontinuation.

Methods: Utilizing the IHI model for improvement, a quality improvement project was implemented to reduce inappropriate prescribing in the primary care practice. The neuropsychiatric inventory questionnaire (NPI-Q) tool was utilized to support appropriate prescribing of antipsychotic medication use in BPSD. Eight providers participated in the QIP and 87 eligible patients were screened using the NPI-Q tool. Outcome measures of this project were to reduce inappropriate prescribing from 45% to 30%, and reduce adverse events from 9% to 4%.

Results: Inappropriate antipsychotic prescribing was reduced to 19%. Adverse events were reduced to 6%.

Discussion and Conclusion: Goal outcome measures were achieved through provider education and utilization of the NPI-Q tool.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.