Nursing

Clostridium difficile is currently recognized as the most common cause of nosocomial infectious diarrhea in the nursing home setting. Data from the Centers for Disease Control and Prevention confirm that the incidence of C. difficile has doubled in recent years and accounts for approximately 3 million cases of diarrhea and colitis each year. Overall mortality associated with C. difficile infectious diarrhea is estimated to be 17% but is even higher in the older adult population. Older adults are at higher risk for this infection because of age-related changes in fecal flora and host defenses, as well as the presence of multiple comorbidities. Nursing staff, nurse practitioners, and physicians must become knowledgeable in the treatment and management of C. difficile before it reaches epidemic proportions. Diligent infection control practices, health care worker education, family education, and identification of new prevention and control strategies are vital to limiting its spread.

This article describes the prevalence of protein/calorie malnutrition among newly admitted elderly nursing home residents and identifies the most significant predictors using Minimum Data Set (MDS) variables. This random selection, cross-sectional study included 266 residents, 65 and older, from three nursing homes. Malnutrition risk factors, indicators, and prevalence variables in the MDS were measured for each resident on admission to the nursing home. MDS data provide an opportunity for early identification of residents at risk for malnutrition and accompanying morbidity. Treating residents who are malnourished or at high risk for weight loss on admission could dramatically improve their quality of life.

Falls are the most common cause of injury deaths and nonfatal injuries in older adults. In an effort to detect a resident's movement, many nursing homes use bed or chair alarms to alert staff that the resident may get up and possibly fall. However, there is little evidence that bed or chair alarms prevent falls, and mounting evidence that alarms can impede the functional status and negatively impact feelings of dignity among older adults in nursing homes. The purpose of this article was to describe the development and pilot testing of an alarm elimination program for nursing homes. A program aimed at decreasing or eliminating the use of alarms may enhance quality of life of older adults in nursing homes.

The purpose of this article is to describe the Individual Nutrition Rx (INRx) assessment process and report findings on elder nutritional status, common nutrition problems identified by the INRx process, resolution outcomes from each problem, and the most efficacious approaches used to address the identified nutrition problems. The study used a two-group prospective quasi-experimental design with measures taken at baseline and at 6 months. Participants in the treatment group (n = 41) received the 6-month INRx assessment process, while residents in the comparison group (n = 40) received routine care specific to their nursing home. The most frequent nutritional problems identified were appetite change, poor positioning while eating, and problems with oral status. A total of 39 approaches were recommended by the interdisciplinary research team. Serum albumin and prealbumin, and depression scores were all significantly improved post intervention. The problems, approaches, and outcomes identified during the INRx process support the premise that interdisciplinary teams following the INRx process can assess complex nutritional problems and influence outcomes for older adults living in nursing homes.

This article is a part of a larger study that identified nutrition education needs for nurses and nursing assistants that resulted in an educational intervention. The purpose of this article is to introduce newly developed evidence-based dining room guidelines. These guidelines can be used as a part of nursing homes' quality improvement programs to evaluate dining services and assist facility staff to identify problem areas.

Food that reflects our family backgrounds is a source of comfort that can play an important part in recovery from illness or adaptation to the nursing home, especially for older individuals. However, no studies could be found that explored residents' perspectives on how their food and food service preferences are, or are not, met in nursing homes. This exploratory qualitative study examined dietary preferences acquired during the course of a lifetime, and the meaning of mealtimes to 20 nursing home residents, and attempted to connect that meaning with their social world. Exploring the meaning of food and food service to nursing home residents could furnish insights for improving nutritional status, adaptation to the nursing home, and quality of life through promotion of individualized nutritional care.

The purpose of this article is to describe the Individual Nutrition Rx (INRx) assessment process and to report preliminary findings on baseline nutritional status, common nutrition problems, and specific individualized interventions. The INRx utilizes a predictive model for participant identification, a systematic assessment process, and evidence-based interventions to improve the nutritional status of at-risk residents. Nineteen percent of participants had abnormal serum albumin levels, and 32.8% had abnormal serum prealbumin levels, indicating diminished protein stores and protein-calorie malnutrition. Frequent nutritional problems identified through the INRx assessment process are appetite change, poor positioning while eating, and oral status concerns. D

The purpose of this article is to introduce a theory-based intervention program, the Self-Care Self-Efficacy Enhancement Program (SCSEEP), which was derived from Bandura's Social Cognitive Theory (SCT). The SCSEEP, based on the concept of "perceived self-efficacy" within the SCT, was designed to improve self-care ability in Chinese nursing home elders. The theory-based SCSEEP was tested during a pilot study involving 42 elders from 2 nursing homes in Taiwan. Following the study, basic activities of daily living performance improved significantly in treatment group residents. Many Chinese elders are placed in nursing homes in the United States; thus, the SCSEEP may also be used as a theory-based caring model to improve self-care performance in Chinese Americans.

Inadequate food intake leading to malnutrition impacts up to 85% of nursing home residents. Malnutrition can result in compromised quality of life and lead to chronic disability, functional decline, increased health care utilization and costs, and death. This article examines organizational structure (Perrow, 1979) and person-environment fit (Lawton, 1982) as factors in nutritional care of nursing home residents. The strategies used by residents to cope with organizational food and food service issues, competence, and environmental press in the nursing home can alert nurses to the need for changes in dietary services to increase food intake and quality of life.

Background. Up to 85% of the older adults living in our nation's nursing homes suffer from protein-calorie malnutrition (PCM). Early identification and treatment of PCM can reduce or prevent hospital stays, reduce complications, and decrease mortality. We describe the influence of PCM on quality of life in nursing homes, using archived data from the Minimum Data Set.

Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.