Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project was based on the stage theory of organizational change and focused on the goal of improving diabetes management in the long-term care geriatric population by using clinical practice guidelines. The American Medical Directors Association's and Diabetes Association's updated clinical practice guidelines and systematic review literature on diabetes provided the evidence to support the educational project. A pretest, posttest, and summative evaluation were used to evaluate the project. A paired t test was used to compare the pretest and posttest scores for all participants. Posttest results showed a significant improvement in provider knowledge compared to pretest scores (t = -4.416, df = 12, p < .01). Participant evaluation of the program showed that the goals and objectives were met, content was understandable, and presentation was professional. The findings of the project may be beneficial at the organizational level to promote positive social change by improved management of diabetes in the geriatric long-term care population, thus potentially decreasing unwanted side effects and improving geriatric veteran health.

Patient Safety: Improving Medication Reconciliation Accuracy for Long-Term Care Residents by Annisa L. Stover MSN, Southern University, 2008 BSN, Our Lady of the Lake College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 During transition of care, inaccurate medication reconciliation is associated with increased risk of adverse events for patients. Older adults are the population most often affected by medication errors, and long-term care facilities struggle to accurately document medication reconciliation. Errors are more common at hospital discharge, but the critical moment for detecting and resolving them is during hospital or long-term care admission. Guided by Rosswurm and Larrabee's model for change, Rogers' diffusion of innovation, and the Multi-Center Medication Reconciliation Quality Improvement toolkit, a 6-member interdisciplinary team composed of nurses, pharmacists, and institutional stakeholders was mobilized to develop policy and practice guidelines as well as secondary documentation necessary to implement and evaluate a quality improvement initiative to address medication reconciliation. Current evidence was explored and used to develop policy and practice guidelines for medication reconciliation, then submitted to 4 scholars, including 2 practice experts, a nurse administrator, and a specialist in pharmacy, to validate content. Scholarly validation supported the premise that the developed products would be beneficial in the accurate documentation of medication reconciliation. Scholarly feedback was evaluated by comparing to current best practices for medication reconciliation. Implementation, education, and evaluation plans were developed to guide operationalization of policy and practice guidelines. This project may positively affect social change by fostering a new practice policy, practice guidelines, and supporting documents to manage medication reconciliation of long-term care residents transitioning to acute care settings, thereby improving medication safety at transitions of care for vulnerable populations.

Indiana University-Purdue University Indianapolis (IUPUI) / A move toward care of residents in nursing homes where they are respected and heard is finally emerging. Common strategies used in nursing homes to improve quality of care for residents are integration of person-centered care and assessing care using satisfaction surveys. Although approaches of integrating person-centered care and satisfaction surveys have been valuable in improving nursing home quality, strategies of care that include things that matter from residents’ perspectives while living in nursing homes need investigation. The purpose of this qualitative descriptive study was to describe things that residents age 65 and older state matter to them while living in the long-term care sections of nursing homes. A qualitative mode of inquiry using purposeful sampling led to a natural unfolding of data that revealed things that mattered to residents. Content analysis was used to reduce the data in a manner that kept the data close to the context yet moved the data toward new ideas about including things that mattered to residents in nursing care. The findings revealed residents’ positive and negative experiences and addressed the question: How can nurses manage residents’ positive and negative aspects of care in nursing homes? This study substantiated the importance of developing nursing care strategies derived from residents’ descriptions of care. Finding ways to promote nurses’ investment in attitudes about a person-centered care philosophy is essential for successful person-centered care implementation. Enhancing nurses’ knowledge, skills, and attitudes with an investment in person centeredness will be more likely to put nurses in a position to role-model care that is person-centered from residents’ perspectives.

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Ältere und auch pflegebedürftige Menschen werden den Alltag in den Zahnarztpraxen in den kommenden Jahren immer stärker prägen. Mit zunehmender Gebrechlichkeit der Betagten und Hochbetagten sollte sich die zahnmedizinische Behandlung in eine zahnmedizinische Betreuung wandeln. Auch bei einer, im Vergleich zu früher, später eintretenden Pflegebedürftigkeit sind in der Zukunft bei vielen Pflegebedürftigen die zweiten und dritten Zähne zu versorgen. Leider ist festzustellen, dass die zahnmedizinische Versorgung in Pflegeeinrichtungen noch nicht ausreichend standardisiert ist. Von den Pflegebedürftigen in Sachsen, Berlin und Nordrhein Westfalen besaßen nur 18,6 % stationär Pflegebedürftige und 41,2 % ambulant Pflegebedürftige ein zahnmedizinisches Bonusheft. Die Verteilung war regional sehr unterschiedlich. Anteilig besaßen die Pflegebedürftigen in Sachsen am häufigsten ein Bonusheft. Das Vorhandensein des Bonusheftes war weder von Alter oder Geschlecht abhängig. Der Verlust einer besseren Bonusregelung bei Zahnersatzleistungen wird dabei von den Pflegedienstleitungen und dem medizinischen Dienst völlig außer Acht gelassen, teilweise sind die Bonusregelungen auch nicht ausreichend bekannt. Die Organisation eines kontinuierlichen Konsildienstes könnte mit der Anforderung an das Führen eines zahnmedizinischen Bonusheftes verbessert werden. Hierzu müssen aber die Informationen zum Bonusheft gezielt an die Heimleitungen, die Heimaufsichten, die Heimräte, die Angehörigen und an den medizinischen Dienst herangetragen werden.

AN ABSTRACT OF THE DISSERTATION OF Stephanie Jerstad, for the Doctor of Philosophy degree in Criminology and Criminal Justice, presented on January 11, 2022, at Southern Illinois University Carbondale.TITLE: CARE FOR THE AGING: LONG-TERM CARE FACILITIES WILLINGNESS TO ACCEPT PERSONS CONVICTED OF SEXUAL OFFENDING MAJOR PROFESSOR: Dr. Breanne Pleggenkuhle The present study is a multi-pronged approach to examine the willingness of long-term care facilities (LTCF) to accept persons on the sex offender registry or with a sexual offense conviction. First, this dissertation utilizes a statutory analysis to examine all 50 states policies for admitting and managing such individuals in long-term care. Second, the study aims to explain why some states may enact a LTC/SO policy by examining state characteristics, policy and political affiliation. Third, the study sets out to better understand if facility-level characteristics matter to the acceptance of persons on the sex offender registry. And will discuss findings from semi-structured interviews of LTCF administrators of their decision-making processes, and their attitudes towards company policy. The findings of all three levels of analyses are presented and future research is discussed. Keywords: Sex offender, long-term care facility, SORN and residency restriction laws, statutory review, collateral consequences of sex offender policy

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