- Email: [email protected]
Adolescents' Approaches to Genetic Testing
2009 AAN Poster Abstracts continued From the AAN Annual Meeting and Conference
Methodology: We conducted focus groups (n¼59) and surveyed 304 older adults (OA) (M age 75, SD 8) and community stakeholders (CS) (M age 48, SD 15), stratified by ethnicity and NORC population using a 9item demographic form, 24-item Social Provisions Scale (SPS) (a 093) and 24-item Perceptions of Community (POC) scale (a 088). Findings: Phase I results provide the context for reporting Phase II results. Transportation, walkability (safety, lack of sidewalks, vehicular speed) and lack of health care services (providers, pharmacy, clinics) were major concerns. OA and CS differed significantly (p<05) on SPS total and five SPS subscales; NORCs differed significantly on two SPS subscales, POC total and four POC subscales. Summary Concluding Statement: These results highlight the economic, health care, housing, community and family resource challenges in increasing livable communities that enable older adults to remain in their homes as they age. Creating an agenda for a healthy aging society in livable communities supports the highest quality of life for residents of all ages.
a new model of care using registered nurse (RN) care coordination coupled with in-home services was developed based on prior research helping older adults age in place. Built and operated by Americare, a leading long-term care provider, TigerPlace, an independent senior living facility, was designed as a demonstration site for the aging in place model. The Sinclair School of Nursing developed a home health agency to provide RN care coordination and home care services to TigerPlace and the surrounding community. Personal care, skilled nursing and hospice services are arranged to assist residents and health promotion activities are provided to maintain independence enabling aging in place. Purpose: Assess the impact of the aging in place model of care on costs and outcomes. Methodology: A semi-annual comprehensive health assessment including the mini-mental state exam, geriatric depression scale, minimum data set, fall risk assessment and SF-12 health survey was completed on all of the residents of TigerPlace (n¼66) from 2005 to 2008. Adverse events and costs of services provided were also tracked. Statistical summaries were prepared about the clinical and cost data. Findings: RN care coordination reduces adverse health events, improves outcomes, reduces nursing home utilization and is cost effective. The cost for any resident (both care and housing) has never approached or exceeded the cost of nursing home care (average annual cost for care in 2008 was $3,594 plus housing costs). Summary Concluding Statement: RN care coordination coupled with in-home services can be a viable option for long term care while saving money and allowing older adults to remain independent in a pleasing, private apartment, congregate housing setting.
Adolescents’ Approaches to Genetic Testing Lynn Rew EdD, RN, FAAN, Michael Mackert, and Daniel Bonevac
Background: Direct-to-consumer advertising of genetic testing via the Internet poses potential risks to individuals with limited knowledge about the human genome and without benefit of genetic counseling to make decisions about testing. Adolescents can be both targeted and tempted by such advertising, but we know little about their approach to such opportunities. Purpose: To determine what adolescents know, what information and resources they would use to make decisions about genetic testing, and how these factors differ by age group (middle¼14-17 v late¼18-21 year-old adolescents). Methodology: A qualitative descriptive design was used. A multi-ethnic sample of 22 middle (n¼11) and late (n¼11) adolescents were interviewed and responded to hypothetical scenarios involving genetic testing. Audio-tapes were transcribed and coded for manifest and latent content. Findings: Both groups of adolescents had limited knowledge of the human genome and the risks involved in genetic testing. Younger adolescents were more likely than older adolescents to seek additional information from their parents, but both groups identified physicians and the Internet as resources for additional information Both groups would seek more information about how and why genetic testing is done, including its history and benefits. Older adolescents would also consider
Healthy Aging in Livable Communities Veronica F. Rempusheski, PhD, RN, FAAN, Becky Laster, MSW, Susan R. Getman, and James Thornton
Background: Aging in place and the in-migration of retirees can form a Naturally Occurring Retirement Community (NORC) – a geographic area within which a significant number of older adults reside, although not planned as such. The percentage of persons age 65+ is projected to increase by 104% in the US by 2030, and to almost 2 billion worldwide by 2050, when for the first time in history the population of older adults will outnumber the population of children. Purpose: The goal of this project is to enhance the livability in three NORCs in NE USA The study objective for phase II of the project was to assess the perceptions of availability of and access to resources and services for older adults within three NORCs defined by postal code. e26
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2009 AAN Poster Abstracts continued From the AAN Annual Meeting and Conference
cost, meaning of tests results, and credibility of testing site in deciding to have genetic testing. Summary Concluding Statement: Adolescents are maturing in the Genomic Era and need more factual information to make decisions about genetic testing. Findings have implications for developing nursing interventions and public policy.
International Evidence Based Practices for Stroke Leslie Ritter, PhD, RN, Bruno Barbiroli, MD, PhD, and Gabriella Formiggini, PhD
Background: The Universities of Bologna Ravenna and Arizona Education for Nurses (UNI-BRAZEN) program provides opportunities to undergraduate and graduate nurses for knowledge exchange (Phase I) and translation (Phase II) of research and evidence based nursing practices to improve outcomes of major public health conditions. Purpose: The purpose of this Phase I program was to provide undergraduate nurses from the University of Bologna an opportunity to study and exchange evidence based nursing practices for care of stroke with nurses at the University of Arizona. Methodology: Two undergraduate University of Bologna nursing students were paired with a nursing faculty mentor at the University of Arizona for one month. Mentored activities included shadow clinical experiences across the continuum of stroke care, inter-professional conferences, critical review of stroke policies and procedures, and a focused literature review of evidence based guidelines. A tertiary care hospital with Primary Stroke Center designation and a rehabilitation hospital were utilized. Faculty-mentored experiences in Italy mirrored those in Arizona. The final project was a thesis comparing evidence-based nursing practices for stroke in the US and Italy. Findings: Integral to the success of this Phase I program was the students’ proficiency in English, interest in stroke, and scholarship support. Careful matching of faculty-student interests and the provision of evidencebased practices and research experiences at the University of Arizona were key elements to success. After students returned to Italy, continued discussions among Bologna and Arizona faculty and the student were necessary to facilitate completion of the thesis. Thesis findings were shared with Arizona and Italian program participants. Summary Concluding Statement: Stroke is a major cause of death and disability and represents a major public health burden worldwide The UNI-BRAZEN Phase I knowledge exchange program represents the first step in translating evidence-based practices to improve outcomes after stroke in the US and Italy.
Disparities in Diabetes Education Kathy F. Shaw, DNP, RN, CDE, Maureen R. Killeen, PhD, RN, FAAN, Erin Sullivan, MSN, FNP-BC, and Patricia Bowman, DNP, APRN-BC
Background: Diabetes is among the ten most expensive health conditions in the US, accounting for one of every five dollars spent on health care. From 20012007, the number of newly diagnosed cases of diabetes among adults 18 and older tripled from 511,000 to 16 million. Despite recognition that Diabetes Self Management Education (DSME) is an essential component of diabetes management, availability of DSME is often limited for the 20% of Americans who are uninsured. In some states, DSME is not a covered Medicaid benefit. Purpose: (Objectives #2 and 3) To examine the accessibility, availability and quality of DSME for un- and underinsured adults in a community with the fifth highest poverty rate among mid-sized cities in the US. Methodology: A descriptive needs assessment was conducted utilizing an interview guide to assess accessibility, availability, and quality of programs serving uninsured adults with diabetes. Interviews were conducted with 22 health care providers, educators, and administrators at eight clinical sites. Findings: Access to DSME is inadequate for those who are uninsured or have Medicaid. DSME programs which adhere to recommended guidelines exist, but have limited availability for uninsured adults. Diabetes education is primarily provided by hospital emergency departments and free or low-cost clinics serving the uninsured. Clinicians provide 86% of diabetes education during patient encounters which are infrequent and of limited duration. Summary Concluding Statement: Although DSME can improve self management and glycemic control for adults with diabetes, system wide disparities exist in access to DSME for un- and underinsured adults. Severely limited availability of quality diabetes education places vulnerable adults at increased risk for devastating and costly complications. The knowledge generated by this project will be shared with the community’s antipoverty and health consortium to increase awareness, foster university/community partnerships and collaborations, and develop new strategies for delivering care to this vulnerable population.
Meeting the Challenge of Correctional Health Deborah A. Shelton, PhD, RN, NE-BC, CCHP, FAAN
Background: The United States has the highest incarceration rate in the world, with 1 in 32 of US adults under some form of correctional supervision. Incarcerated M
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Methodology: We conducted focus groups (n¼59) and surveyed 304 older adults (OA) (M age 75, SD 8) and community stakeholders (CS) (M age 48, SD 15), stratified by ethnicity and NORC population using a 9item demographic form, 24-item Social Provisions Scale (SPS) (a 093) and 24-item Perceptions of Community (POC) scale (a 088). Findings: Phase I results provide the context for reporting Phase II results. Transportation, walkability (safety, lack of sidewalks, vehicular speed) and lack of health care services (providers, pharmacy, clinics) were major concerns. OA and CS differed significantly (p<05) on SPS total and five SPS subscales; NORCs differed significantly on two SPS subscales, POC total and four POC subscales. Summary Concluding Statement: These results highlight the economic, health care, housing, community and family resource challenges in increasing livable communities that enable older adults to remain in their homes as they age. Creating an agenda for a healthy aging society in livable communities supports the highest quality of life for residents of all ages.
a new model of care using registered nurse (RN) care coordination coupled with in-home services was developed based on prior research helping older adults age in place. Built and operated by Americare, a leading long-term care provider, TigerPlace, an independent senior living facility, was designed as a demonstration site for the aging in place model. The Sinclair School of Nursing developed a home health agency to provide RN care coordination and home care services to TigerPlace and the surrounding community. Personal care, skilled nursing and hospice services are arranged to assist residents and health promotion activities are provided to maintain independence enabling aging in place. Purpose: Assess the impact of the aging in place model of care on costs and outcomes. Methodology: A semi-annual comprehensive health assessment including the mini-mental state exam, geriatric depression scale, minimum data set, fall risk assessment and SF-12 health survey was completed on all of the residents of TigerPlace (n¼66) from 2005 to 2008. Adverse events and costs of services provided were also tracked. Statistical summaries were prepared about the clinical and cost data. Findings: RN care coordination reduces adverse health events, improves outcomes, reduces nursing home utilization and is cost effective. The cost for any resident (both care and housing) has never approached or exceeded the cost of nursing home care (average annual cost for care in 2008 was $3,594 plus housing costs). Summary Concluding Statement: RN care coordination coupled with in-home services can be a viable option for long term care while saving money and allowing older adults to remain independent in a pleasing, private apartment, congregate housing setting.
Adolescents’ Approaches to Genetic Testing Lynn Rew EdD, RN, FAAN, Michael Mackert, and Daniel Bonevac
Background: Direct-to-consumer advertising of genetic testing via the Internet poses potential risks to individuals with limited knowledge about the human genome and without benefit of genetic counseling to make decisions about testing. Adolescents can be both targeted and tempted by such advertising, but we know little about their approach to such opportunities. Purpose: To determine what adolescents know, what information and resources they would use to make decisions about genetic testing, and how these factors differ by age group (middle¼14-17 v late¼18-21 year-old adolescents). Methodology: A qualitative descriptive design was used. A multi-ethnic sample of 22 middle (n¼11) and late (n¼11) adolescents were interviewed and responded to hypothetical scenarios involving genetic testing. Audio-tapes were transcribed and coded for manifest and latent content. Findings: Both groups of adolescents had limited knowledge of the human genome and the risks involved in genetic testing. Younger adolescents were more likely than older adolescents to seek additional information from their parents, but both groups identified physicians and the Internet as resources for additional information Both groups would seek more information about how and why genetic testing is done, including its history and benefits. Older adolescents would also consider
Healthy Aging in Livable Communities Veronica F. Rempusheski, PhD, RN, FAAN, Becky Laster, MSW, Susan R. Getman, and James Thornton
Background: Aging in place and the in-migration of retirees can form a Naturally Occurring Retirement Community (NORC) – a geographic area within which a significant number of older adults reside, although not planned as such. The percentage of persons age 65+ is projected to increase by 104% in the US by 2030, and to almost 2 billion worldwide by 2050, when for the first time in history the population of older adults will outnumber the population of children. Purpose: The goal of this project is to enhance the livability in three NORCs in NE USA The study objective for phase II of the project was to assess the perceptions of availability of and access to resources and services for older adults within three NORCs defined by postal code. e26
V
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U M B E R
2
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U R S I N G
O
U T L O O K
2009 AAN Poster Abstracts continued From the AAN Annual Meeting and Conference
cost, meaning of tests results, and credibility of testing site in deciding to have genetic testing. Summary Concluding Statement: Adolescents are maturing in the Genomic Era and need more factual information to make decisions about genetic testing. Findings have implications for developing nursing interventions and public policy.
International Evidence Based Practices for Stroke Leslie Ritter, PhD, RN, Bruno Barbiroli, MD, PhD, and Gabriella Formiggini, PhD
Background: The Universities of Bologna Ravenna and Arizona Education for Nurses (UNI-BRAZEN) program provides opportunities to undergraduate and graduate nurses for knowledge exchange (Phase I) and translation (Phase II) of research and evidence based nursing practices to improve outcomes of major public health conditions. Purpose: The purpose of this Phase I program was to provide undergraduate nurses from the University of Bologna an opportunity to study and exchange evidence based nursing practices for care of stroke with nurses at the University of Arizona. Methodology: Two undergraduate University of Bologna nursing students were paired with a nursing faculty mentor at the University of Arizona for one month. Mentored activities included shadow clinical experiences across the continuum of stroke care, inter-professional conferences, critical review of stroke policies and procedures, and a focused literature review of evidence based guidelines. A tertiary care hospital with Primary Stroke Center designation and a rehabilitation hospital were utilized. Faculty-mentored experiences in Italy mirrored those in Arizona. The final project was a thesis comparing evidence-based nursing practices for stroke in the US and Italy. Findings: Integral to the success of this Phase I program was the students’ proficiency in English, interest in stroke, and scholarship support. Careful matching of faculty-student interests and the provision of evidencebased practices and research experiences at the University of Arizona were key elements to success. After students returned to Italy, continued discussions among Bologna and Arizona faculty and the student were necessary to facilitate completion of the thesis. Thesis findings were shared with Arizona and Italian program participants. Summary Concluding Statement: Stroke is a major cause of death and disability and represents a major public health burden worldwide The UNI-BRAZEN Phase I knowledge exchange program represents the first step in translating evidence-based practices to improve outcomes after stroke in the US and Italy.
Disparities in Diabetes Education Kathy F. Shaw, DNP, RN, CDE, Maureen R. Killeen, PhD, RN, FAAN, Erin Sullivan, MSN, FNP-BC, and Patricia Bowman, DNP, APRN-BC
Background: Diabetes is among the ten most expensive health conditions in the US, accounting for one of every five dollars spent on health care. From 20012007, the number of newly diagnosed cases of diabetes among adults 18 and older tripled from 511,000 to 16 million. Despite recognition that Diabetes Self Management Education (DSME) is an essential component of diabetes management, availability of DSME is often limited for the 20% of Americans who are uninsured. In some states, DSME is not a covered Medicaid benefit. Purpose: (Objectives #2 and 3) To examine the accessibility, availability and quality of DSME for un- and underinsured adults in a community with the fifth highest poverty rate among mid-sized cities in the US. Methodology: A descriptive needs assessment was conducted utilizing an interview guide to assess accessibility, availability, and quality of programs serving uninsured adults with diabetes. Interviews were conducted with 22 health care providers, educators, and administrators at eight clinical sites. Findings: Access to DSME is inadequate for those who are uninsured or have Medicaid. DSME programs which adhere to recommended guidelines exist, but have limited availability for uninsured adults. Diabetes education is primarily provided by hospital emergency departments and free or low-cost clinics serving the uninsured. Clinicians provide 86% of diabetes education during patient encounters which are infrequent and of limited duration. Summary Concluding Statement: Although DSME can improve self management and glycemic control for adults with diabetes, system wide disparities exist in access to DSME for un- and underinsured adults. Severely limited availability of quality diabetes education places vulnerable adults at increased risk for devastating and costly complications. The knowledge generated by this project will be shared with the community’s antipoverty and health consortium to increase awareness, foster university/community partnerships and collaborations, and develop new strategies for delivering care to this vulnerable population.
Meeting the Challenge of Correctional Health Deborah A. Shelton, PhD, RN, NE-BC, CCHP, FAAN
Background: The United States has the highest incarceration rate in the world, with 1 in 32 of US adults under some form of correctional supervision. Incarcerated M
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