J Gerontol Nurs
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Comparative Study
Nurse staffing in nursing homes in the United States: Part II.
This study compared state minimum staffing standards with actual nurse staffing levels in nursing homes in each state. The actual nurse staffing levels in nursing homes were compared to the nurse staffing levels recommended by experts in 2000 and 2001. ⋯ When actual nurse staffing levels were compared with the minimum standards recommended in a federal report, 97% of all nursing homes had staffing levels below those considered safe. Considerable new federal and state resources are needed to bring the state staffing standards and the actual nursing home staffing levels up to the levels recommended by experts.
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Multicenter Study
Physician orders for life-sustaining treatment form: honoring end-of-life directives for nursing home residents.
Physician Orders for Life-Sustaining Treatment (POLST) form provides choices about end-of-life care and gives these choices the power of physician orders. The POLST form assures end-of-life choices can be implemented in all settings, from the home through the health-care continuum. ⋯ An informed consent process was evidenced in 16 of 21 cases, and the POLST form was congruent with residents' existing advance directives for health care. The findings support the continued use, development, and evaluation of this promising tool for improving end-of-life care.
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This study tested the Elder Care Supportive Interventions Protocol (ECSIP), which are nursing and family support interventions designed to reduce discomfort and the associated consequences of delirium, impaired physical function, and need for post-hospital care in hospitalized older adults experiencing confusion from delirium or dementia. All adults older than age 74 or older than age 64 if from a nursing home who were admitted to the medical and surgical units of a tertiary care hospital were screened for a diagnosis of dementia, dependence on functional activities, or delirium. ⋯ Patients problems with delirium and impaired physical function improved over hospitalization but were still pronounced at discharge. With the exception of reduced discomfort, there were no significant treatment effects for patients, which is attributed, in part, to inadequate implementation of the ECSIP protocol by nursing staff.
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Currently, adults older than 50 account for approximately 15% of the total number of acquired immune deficiency syndrome (AIDS) cases. As baby boomers age, the number of older adults infected with the human immunodeficiency virus (HIV) is expected to rise. This expected increase is due, in part, to an increase in the number of individuals newly diagnosed with HIV, and, in part, to improved efficacy of the highly active antiretroviral therapy (HAART) medications used to treat HIV/AIDS. ⋯ Thus, a considerable risk for drug interactions between the medications used specifically for HIV treatment and those used for other conditions exists. This article is intended as a guide for gerontological nurses facing these complexities. It includes reviews of the goals of HAART therapy and of the mechanisms of drug interactions, as well as detailed discussions related to the effects of HAART and their potential interactions with medications used to treat conditions commonly found in aging populations.