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Acute Pain Management in the Older Adult[HERE]
Pain is a complex, subjective, and multidimensional experience without objective biological markers and is a prevalent problem in a growing segment of the population. In developed countries, older adults comprise 20% of the population and by 2050 is estimated to be a third of the population. Research demonstrates older adults receive significantly less analgesic medication than younger adults experiencing similar painful conditions or procedures, leading to inadequate pain relief in these older adults.
This evidence-based practice guideline provides recommendations for the management of acute pain in older adults. Studies have shown that when evidence-based practice guidelines are effectively implemented, patient outcomes improve and resource use declines. Written 1997; Revised 2000; 2003; 2006; 2016.
Assessing Heart Failure in Long-Term Care Facilities [HERE]
Heart failure (HF) is the only cardiovascular disease with escalating mortality despite advances in treatment. The Centers for Medicare and Medicaid Services (2008) report HF as the most common inpatient discharge diagnosis in older adults and one of the most expensive diseases to treat in the long-term care setting.
The purpose of the heart failure assessment guideline is to outline a systematic approach for the assessment of heart failure and the early recognition of symptoms of worsening heart failure in the long-term care setting, post-acute care units, and short-term rehabilitation units using taught observation skills of direct caregivers. This evidence-based practice guideline is intended for use by healthcare workers in long-term care facilities. Written 2006; Revised 2012.
Bathing Persons with Dementia [HERE]
When people require assistance with bathing the process is complicated by the culture, values, and expectations of people who assist with the bath. Seemingly simple concepts such as what is clean versus what is dirty and how one responds to what they perceive can trigger conflicts.
There is a large body of research and literature regarding all aspects of bathing practices including assessment, risk, practices for staff, training, antecedents to negative behaviors, environment, and administrative policies. The purpose of this evidence-based practice guideline is to provide strategies for minimizing fear, agitation, combative behavior, and development of secondary behavioral symptoms during and/or after personal hygiene. The goal is to reduce frequency and severity of negative bathing episodes in patients with chronic dementing illness. Includes guides for personal hygiene standards for people with dementia and helpful communication techniques along with instructions for thermal bathing and towel or bed baths. Written 1995; Revised 2004; 2013.
Changing the Practice of Physical Restraint Use in Acute Care [HERE]
The use of physical restraint in health care institutions has been challenged for over two decades by nurses and health professionals who considered the practice overused, unethical and inappropriate in many cases. Physical restraints have not been shown to prevent the key problems for which they are used most often (falls or pulling out devices), and in fact, continue to be associated with negative outcomes for patients, including death.
The purpose of this evidence-based practice guideline is to assist nurses and other health care professionals in reducing the use of physical restraints for patients in acute care settings. This guideline identifies individual patient characteristics as well as characteristics of staff and facilities associated with restraint use. Additionally, it provides alternative strategies and approaches to restrain-free care. Written 1996 (originally titled Restraints); Revised 2005; 2014.
The purpose of this evidence-based practice guideline is to provide direction for identifying risk factors, conducting appropriate assessments, and implementing effective strategies for the prevention and treatment of delirium. Delirium is a common cause of morbidity and mortality and may lead to permanent cognitive impairment and dementia. It is estimated that delirium affects approximately 14% to 56% of older (i.e., > 65 years of age) hospitalized patients with 20% of the 12.5 million patients experiencing a complication during hospitalization because of delirium.
This guideline is intended for use by nurses and other healthcare disciplines that provide care for elderly hospitalized patients on general medical/surgical units. Some of the recommended interventions require physician management and interdisciplinary collaboration, while other interventions are independent nursing actions. Written 1999; Revised 2009; 2015.
*NEW* Detection and Assessment of Late-Life Anxiety [HERE]
Anxiety symptoms and disorders are both common and disabling among older adults. A number of negative outcomes are regularly associated with anxiety symptoms in older adults and underscore the importance of accurate assessment, referral, and treatment. Detection and assessment are essential to accurately identifying and treating clinically significant anxiety and to simultaneously address factors that cause or contribute to anxiety-related symptoms, distress, and discomfort, and functional limitations.
The purpose of this evidence-based guideline is to improve the detection and assessment of anxiety symptoms among older adults. The simplicity of the guideline and associated assessment methods make the guideline appropriate for use by all levels of healthcare practitioners. Written 2008; Revised 2018.
Detection of Depression in Older Adults with Dementia [HERE]
It is anticipated that the incidence and prevalence of Alzheimer disease and other forms of dementia will increase as our nation ages. It is therefore essential that depression and dementia, the two most frequent psychiatric syndromes in the older adult population, are assessed for routinely. However, depression in older adults with and without dementia often goes unrecognized and untreated. Despite expert recommendations and increased availability of a range of depression treatment options (e.g., medication, psychotherapy, combination therapy, and ECT), depression remains a significant public health problem for older adults. Detection is the first essential step to improving depression care for patients with dementia. The purpose of this evidence-based guideline is to improve detection of depression in older adults with dementia. Written 2007; Revised 2014.
Detection of Depression in the Cognitively Intact Older Adult [HERE]
The downward spiral of disability that is associated with depression is costly to individuals and society, both financially and emotionally. Depression increases the risk of needing a higher level of care, including hospitalization among elderly home health patients and nursing home placement for community-dwelling older adults. Depression also reduces the likelihood that community-dwelling older adults who are admitted to acute care settings will recover their prehospitalization level of mobility following discharge.
The purpose of this evidence-based guideline is to improve detection of depression in medically compromised, cognitively intact, older adults. This guideline provides easy to use tools that can be used with limited training, making it ideal for a variety of healthcare workers and informal caregivers across settings. Written 1998; Revised 2005; 2014.
*NEW* Elder Abuse Prevention [HERE]
Violence and abusive behavior continue to ravage homes, institutions, and communities across the country--elder abuse is a part of this atrocity. The projected numbers of persons 65 years and older will be 20% of the United States population in 2030, compared to 13% in 2010. Currently, there are approximately 48 million persons age 65 years and older in this country projected to be more than 70 million by 2030. As the population ages, more individuals will be at risk for elder mistreatment. Further evaluation of elder abuse issues is required to achieve a reversal of unfavorable trends in abusive behaviors.
The purpose of this evidence-based practice guideline is to facilitate healthcare professionals’ assessment of older persons in domestic and institutional settings who are at risk for elder abuse and to recommend interventions to reduce the incidence of mistreatment. Written 2004; Revised 2010; 2017.
Fall Prevention for Older Adults [HERE]
The purpose of this evidence-based guideline is to describe strategies for identifying persons at risk for falling and for preventing falls in older adults while maintaining autonomy and independence. The goals of this guideline are to: 1) identify factors that place an individual at risk for falling; 2) detect persons who have experienced a fall; 3) prevent the occurrence of falls; and 4) prevent injury from falls among older adults. This guideline includes information regarding risk factors for falling, fall evaluation tools, fall prevention interventions, and outcome evaluations that pertain to the care of older adults in primary care, acute care, long-term care, and community settings. Written 1996; Revised 2004; 2016.
Family Involvement in Care for Persons with Dementia [HERE]
When persons with dementia are moved to a new care environment, including home care, nursing home, assisted living, daycare, and hospital settings, families may need to take on new or different care roles. The ultimate goals of the family involvement in care intervention are to provide quality care for persons with dementia and assist family members to enact meaningful and satisfactory caregiving roles regardless of setting.
This evidence-based guideline focuses on a program to involve family members in the care of their relative with dementia through partnerships with other, both formal and informal, care providers. Successful care partnerships result in the establishment of meaningful and satisfactory caregiving roles regardless of the care setting. Written 1999; Reviewed 2001; 2015.
Family Preparedness and End of Life Support before the Death of a Nursing Home Resident [HERE]
Along with the ‘invention’ of chronic illness came the need for nursing homes, to care for people during a prolonged period of chronic illness and increasing disability.
The vast majority of people admitted to a nursing home reside there until death; each year, 25% of all deaths in the United States and 35% of all deaths in Canada occur in nursing homes about one-third of nursing home residents die each year in North America. End-of-life care of nursing home residents, now and in the future, must encompass specific strategies for residents dying of dementia, and the impact on their family caregivers. This evidence-based guideline provides end-of-life support for family members before the death of a nursing home resident. Written 2002; Revised 2009; 2015.
Hydration Management [HERE]
Water is an essential component of body composition. However, hydration problems rarely involve body water alone, but rather are a water and electrolyte problem. Older individuals are at increased risk for hydration problems for a variety of reasons.
The purpose of this evidence-based guideline is to help health care providers in all settings determine adequate oral fluid intake for elders and to use strategies that will improve and maintain hydration. Ultimately, this guideline focuses on the prevention of dehydration through careful assessment, identification of elders at risk for hydration problems, and implementation of individualized nursing interventions based on a risk profile. Written 1998; Revised 2011.
Improving Medication Management for Older Adult Clients [HERE]
The management of medications for older adults in long-term care facilities presents unique challenges and calls for a dynamic process of ongoing assessment, transitions, and shifting care. Polypharmacy is common for nursing home residents and frequently related to both increased adverse drug reactions and a risk of inappropriate prescribing. Additionally, the management of these medication regimens is complicated by the frail population’s vulnerability to both errors and adverse drug reactions related to functional health and individual responses.
The purpose of this evidence-based guideline is to improve medication management practices for older adults who reside in long-term care facilities. The goals of this guideline include reducing inappropriate prescribing, decreasing polypharmacy, avoiding adverse events, and maintaining function. Written 2004; Revised 2012.
*NEW* Late-Life Suicide: Secondary Prevention [HERE]
The vast majority of older adults feel they have productive lives, are depression free, and experience later life as a time of time fulfillment and satisfaction. However, for some older adults, later life can be a time of dissatisfaction with the past and present. Some older adults experience so much physical and emotional pain that they feel hopeless about being able to change and improve their life. Consequently, for some, late life is a period for increased risk for suicide. In fact, older adults have the highest rate of suicide adults in later life in the United States.
This evidence-based guideline provides information that will assist nurses and other healthcare providers in recognizing at-risk suicidal behavior in the elderly by presenting appropriate and effective crisis interventions. The goal of this guideline is to decrease the occurrence of suicide among elderly individuals who have contact with nurses and other healthcare providers. Written 2002; Revised 2017.
Management of Constipation [HERE]
The purpose of this evidence-based guideline is to reduce the frequency and severity of constipation among older adults. The guideline may be used as a reference guide to assist clinicians who care for older adults. The goal is to maintain bowel frequency within normal limits for each individual. This will vary with the individual's perception. Regular bowel movements are commonly defined in the literature as at least two-three times per week with straining at stool less than 25 % of the time. This guideline is applicable to older adults who are hospitalized, residing in long-term care or skilled care facilities, or living in the community. This guideline is not intended for the populations of enterally fed, paraplegic, or quadriplegic individuals. Written 1996; Reviewed 2001; Revised 2009.
Management of Relocation [HERE]
Relocation is a major life transition, is stressful, and can lead to both positive and negative outcomes regardless of the person’s. In later life, adults frequently experience three types or stages of relocation: (a) the first occurs when adults retire and move to a desirable location because of the amenities offered; (b) the second takes place when older adults begin to experience health problems or widowhood and then move closer to family members; and (c) the third happens when family members are not able to meet all the older adult’s needs and a move to a more supportive environment, such as an assisted living facility or nursing home, is necessary. This guideline focuses on the second and third stages of relocation.
This guideline provides strategies to help cognitively intact older adults plan for and adapt to relocation from one residence or home to another. Includes: risk factors indicating the need for relocation, risk factors for maladjustment after relocation, interventions for both pre-relocation and post-relocation management, assessment tools, and outcome evaluations. Written 2005; Revised 2015.
Non-Pharmacologic Management of Agitated Behaviors in Persons with Dementia [HERE]
The prevalence of long-term care residents diagnosed with a chronic dementing condition is between 42 and 84% with a median of 58%. Agitation is one of the behavioral symptoms that have been reported in up to 81% of those with Alzheimer’s disease. Agitated behaviors not only threaten the psychological and physical well-being of the resident with dementia but other residents in the facility, family members, formal caregivers, and visitors are negatively impacted as well.
The purpose of this guideline is to discuss non-pharmacologic interventions to prevent or manage agitated behaviors in long-term care residents with dementia have the potential to improve the quality of life for persons with dementia, their families, other residents and their care providers. Written 1995; Revised 2004; 2015.
Nurse Retention [HERE]
Nurses spend much time taking care of the needs of their patients while their own needs are often neglected. Increases in patient acuity and understaffing have increased the amount of work in nursing units leaving little or no time to attend to nurses’ needs. Staff morale is not usually a high priority until a crisis occurs, such as nurses start to leave their job and/or the nursing profession altogether. Nursing shortages, staff retention, and turnover have become the prime concern of the healthcare industry.
The purpose of this evidence-based practice guideline is to provide strategies for first-line nurse managers in various health care settings, to use in enhancing job satisfaction and decreasing turnover of staff nurses. The goal of this guideline is to summarize literature dealing with issues that first line nurse managers can address, beyond compensation issues that will assist in retaining experienced nurses. Written 2002; Revised 2010.
Oral Hygiene Care for Functionally Dependent and Cognitively Impaired Older Adults [HERE]
Dental caries and periodontal disease account for most tooth loss experienced by Americans. The prevalence of tooth loss has decreased over the past 50 years and can be attributed to improved early detection and treatment of oral disease and more effective preventive measures, such as water fluoridation, increased use of fluoride toothpastes, and improved dental treatments.
This guideline provides practical information to assist healthcare providers with the provision and documentation of oral hygiene care for functionally dependent and cognitively impaired older adults to prevent plaque-related oral diseases. Written 2002; Revised 2011.
Persistent Pain Management in Older Adults [HERE]
People living in the developed world can now expect to live longer than at any time in history. Although evidence-based practices in modern healthcare routinely promote longevity and save people from the brink of death. Approximately half of older adults living in the community have persistently painful conditions with more frequently encountered pain during the final months of life. An even greater proportion of older adults living in institutions face this nemesis on a daily basis.
The purpose of this guideline is to assist nurses and other health care providers in the management of persistent pain in older adults through assessment and treatment strategies. Assessment tools include the Brief Pain Inventory, Verbal Numeric Rating Scale, and the Faces Pain Scale. This guideline discusses pain management strategies, both non-pharmacological and pharmacologic and includes an algorithm for assessing pain in the cognitively impaired older adult. Written 2005; Revised 2015.
Promoting Spirituality in the Older Adult [HERE]
For the older adult, finding the meaning in critical life events or the meaning in life overall can be a challenging process wherein the nurse can have significant influence. Through the process of finding meaning, the older adult often grows spiritually. In addition, several research studies have shown that a sense of meaning in life was associated with improved psychological well-being, satisfaction with life, and overall quality of life.
The purpose of this evidence-based protocol is to provide guidelines for promoting spirituality and spiritual care for health care providers working with older adults in community and institutional settings. Spiritual care refers to care practices intentionally chosen to promote spirituality, as conceptualized universally (rather than limiting it to only religiosity). This guideline is developed from a holistic perspective that views humans as being an integrated whole with physical, psychological, social, and spiritual dimensions. Written 2006; Revised 2014.
*NEW* Prompted Voiding for Persons with Urinary Incontinence [HERE]
Urinary incontinence (UI) is the involuntary loss of urine. The National Association for Continence estimates on the basis of multiple studies and expert opinion that 25 million adult Americans experience transient or chronic UI. UI is one of the most common conditions among residents of extended care settings; post-acute and long-term care (LTC) facilities. UI is seen in at least 55% of nursing home residents and is the second leading cause of institutionalization of the elderly.
The purpose of this evidence-based guideline is to provide information for implementing a treatment program of prompted voiding (PV) for individuals who have UI. PV is a toileting program that combines scheduled voiding with “prompting” from a caregiver. In this guideline, a caregiver may be formal (extended care professional and allied health) or informal (family member, companion). Written 1999; Revised 2018.
Quality Improvement in Nursing Homes [HERE]
Nursing homes with clinical consultation from advanced practice nurses show significantly higher levels of quality than nursing homes without clinical consultants. This administrative guideline is based on the premise that nursing homes use or will use a clinical consultant to enhance their quality of care and their quality improvement program.
The purpose of this evidence-based administrative guideline is to provide quality improvement knowledge and strategies for nursing homes. Nursing homes, including all departments, i.e. administration, nursing, social services, dietary, activities, housekeeping, laundry, finance, maintenance, and any other departments, can use this administrative guideline as a team to develop, define, implement, and evaluate their own quality improvement program. Interdisciplinary collaboration is part of a good quality improvement program and needs to incorporate not only nursing home providers but also patients and their families. Written 2003; Revised 2012.
Wandering can be problematic for caregivers, as well as for the person with dementia. This occurs when wandering behavior disrupts the individual’s sleep, eating, socialization, safety, or the caregiver’s ability to provide care. Assessment of premorbid factors, the disease process, behavioral symptoms typical of dementia, medications and their side effects is important when individualizing interventions for wandering behavior. Other factors, such as environment and the knowledge and skill of the caregiver, should be considered when planning care for older adults with dementia who are at risk for wandering behavior.
The purpose of this evidence-based guideline is to assist caregivers in identifying and in dealing with wandering behaviors in community-dwelling or institutionalized older adults with dementia. Written 2002; Revised 2008; 2014.
Wheelchair Biking for the Treatment of Depression [HERE]
It is estimated that the incidence of depression in older adults living in long-term care facilities can be as high as 77% and is the most common mood disorder of late life. Unrecognized, untreated or undertreated, depression has a host of consequences for older adults. It is important to recognize and aggressively treat depression as its impact goes far beyond affecting mood. The highest suicide rate of any age group is for those over the age of 65.
The purpose of this evidence-based guideline is to describe a specific recreation therapy program, wheelchair biking, for the treatment of depression in older adults, with and without cognitive impairments. The goal of this guideline is to reduce depressive mood in older adults and to provide a complementary or alternative treatment to medications. Written 2003; Revised 2010.
Writing Evidence-Based Practice Guidelines [HERE]
The purpose of this guideline is to help authors with step-by-step directions about how to write an evidence-based practice (EBP) guideline. The practice guidelines are used by nurses and other care
providers and therefore the development of EBP guidelines based on the most current research evidence is essential to enhance clinical decision making designed to achieve improved patient outcomes, quality of care. Written 2001; Revised 2005; 2012; 2016.