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SIGN Vol 21, Issue 1 First Quarter 2014

President's Message: "I Am A Nurse"
By Mary Rita Hurley, MPA, RN, FNGNA

I am hopeful this month that our East coast members and colleagues have survived the Polar Vortex. I was receiving text messages at the height of the blizzards letting me know that once again the bag was packed and they were sleeping in their respective institutions. My initial reaction was, “I remember those times I spent all night, as well.” But, those experiences brought back that sense of pride and camaraderie for our profession. We consistently stay calm, assess the immediate situation, assist in the creation of the plan, implement it, and then evaluate the outcomes with our peers. Sounds like the nursing process! This skill set should not be taken lightly. Our education and clinical practice has honed these skills. We need to own who we are and what we bring to every environment we inhabit. Our skills can be transferred to any setting, especially in everyday life.
 
We need to identify ourselves as nurses within our communities, churches, professional organizations, and yes, even on a plane! We consistently have unique opportunities to communicate to the public that we serve, what it is we actually do.
 
There is no better time for us to identify ourselves than right now.   The Affordable Care Act (ACA) deadline for choosing a plan is March 2014.  The U.S. Department of Health and Human Services Secretary, Kathleen Sebelius, and HRSA Administrator, Dr. Mary Wakefield, participated in a call in January. One topic of discussion was the important work that nurses are doing in order to help their communities better understand the ACA Health Insurance Marketplace outreach and enrollment. Secretary Sebelius and Dr. Wakefield both began their presentations by thanking nurses all across the country for the work they extend to their patients and families. They recognize the high value ofnurses and have experienced the important work that nurses do in their communities through education about healthcare. Nurses are demonstrating their impact by developing Outreach programs in Philadelphia and having members of their communities show their ‘new’ insurance cards. Psych/Mental Health nurses are assisting uninsured individuals to obtain the insurance they need. This promotes a decrease in long deferred medical attention. Another nurse works with the Health Department in her state as a Certified Marketplace Navigator. She works closely with her state’s nursing association presenting webinars to nurses – giving them the information they need to educate their communities. A nurse in the southwest is helping people in her state with the bilingual education information.
 
My dear colleagues, we are helping to shape the IOM’s new model of care. We know our patients, residents, clients, and families better than anyone. We are the 24/7 healthcare professionals.  The time is now - to inform the country that we are researchers, educators and highly trained clinicians. Yes, we are compassionate and caring but it is the science of what we do that makes us who we are. No matter where you are, please be proud when you say, “ I am a Nurse.”
 
All the best,
 
Mary Rita Hurley, RN, MPA, FNGNA
President


 NGNA 2014 Convention: It’s Closer Than You Think!

Submitted by Adrianne Linton, PhD, RN, FAAN and Mary Mather, MSN, RN-BC, CNL
 
Mark your calendars for October 2-4, 2014. The theme for the 2014 convention to be held in San Antonio TX is “NGNA on the Riverwalk: Spur Your Passion for Older Adults.” This year’s meeting promises to inform, update, and invigorate participants who care for and care about older adults. Convention provides the ideal opportunity to invite and engage colleagues and students in NGNA.

Early Fall is the perfect time to visit San Antonio, a lively multicultural city known for its food, music, and friendliness. The convention hotel is situated on the famed Riverwalk, which offers a safe and beautiful place to stroll and unwind with numerous dining and shopping options. Downtown is easily navigated for those who wish to visit the Alamo, historic missions, museums, and the Mexican Market.

We look forward to seeing you and sharing the latest news in Geriatric Nursing.
 


NGNA 2014 Call for Abstracts is OPEN! Submit Your Abstract Today!

NGNA invites you to submit an abstract for presentation at the 2014 Annual Convention in San Antonio, TX, October 2-4, 2014.

Submissions are due by Monday, March 3, 2014.

Abstracts will be accepted in the following categories:
  • Concurrent Session Oral presentations: General topics 60 minutes in length;
  • Concurrent Session Research Oral presentations: Research reports 15-20 minutes in length;
  • Research poster presentations (featuring completed research), Optional: May be submitted for consideration for the Judith Braun Excellence in Research Award (see the web page for additional information);
  • Evidence-Based Practice poster presentations (featuring novel clinical practices), Optional: May be submitted for consideration for the Innovations in Practice award (see the web page for additional information);
  • NEW! Quality Improvement (QIP)/Performance Improvement Projects (PIP), Optional: May be submitted for consideration for the Innovations in Practice award (see the web page for additional information)
  • Student Poster presentations (Call for Student Abstracts Coming Soon!)
Click here to view the Call for Abstracts and submit your abstract online. We look forward to receiving your submissions!
 


Call for Leadership Nominations

Leadership. It’s the backbone of every professional association. The role of the Board of Directors is to define, protect and advance the mission of the organization. If you or someone you know may be interested in a leadership position, read on!

Elections for officers and directors-at-large of the NGNA Board of Directors are held in the spring with the terms commencing in the fall at the Annual Convention. The positions are for two-year terms. Nominations are being sought for the following NGNA offices:

President-Elect
  • Previous experience in an organizational leadership position
  • Expresses a vision for NGNA in this leadership position
  • Engaged in NGNA activities (committee, chair, Fellow) for at least 3 years
  • Able to participate in monthly conference calls and in person meetings as scheduled.
  • Committed to this 4 year Board position
Treasurer
  • Documented previous budget experience competency in reviewing spreadsheets and/or numbers
  • Leadership experience in a professional organization
  • Able to work with staff and board regarding fiduciary oversight
  • Detail-oriented
  • Able to participate in monthly conference calls and in person meetings as scheduled
  • Active NGNA member for at least 2 years through committee or task force participation, annual convention attendance or local chapter involvement
Director at Large (2 positions)
  • Active member of NGNA for at least 2 years through committee or task force participation, annual convention attendance or local chapter involvement
  • Leadership experience in a professional organization
  • Expresses understanding of the purpose of NGNA and intent to support that purpose
Nominating Committee (1 position)
  • Active member of NGNA for at least 2 years through committee or task force participation, annual convention attendance or local chapter involvement
  • Established network of NGNA members (through attending convention, committee work, etc.)
The National Office must receive nominations no later than April 1, 2014, in order to be considered by the Nominating Committee. All current members of NGNA are eligible to be nominated. Self-nominations are encouraged. Nomination does not guarantee that a person's name will appear on the final slate.

PLEASE NOTE THE FOLLOWING: The Nominating Committee will consider only nominations submitted using the online form (please login to the Members’ Only section of the website to access).

Members may serve only in one elected or appointed position at any given time. If you are currently a committee member and wish to run for office, it would be necessary to give up the appointed committee position upon taking office.

If elected, the term of office begins at the end of the 2014 Annual Convention and ends at the 2016 Annual Convention. Self-nominations will be accepted, or members may nominate other members (with the acceptance of the nominee).

NOMINATE A LEADER TODAY!


Donations

Thanks to those who have donated to NGNA in 2014! Your commitment and support are much appreciated.

Mission Advancement Fund
Jean Gaines, Ph.D., RN, FNGNA
Peg Gray-Vickrey, DNS, RN, FNGNA
Nancy Chu, PhD, RN, GCNS-BC, FNGNA
Tamika Sanchez-Jones, PhD, RN, FNGNA

Scholarship Fund
Cindy Shemansky, MEd, RN-BC, LNHA, FNGNA
Jean Gaines, Ph.D., RN, FNGNA

Chapter News

It’s that time of year again! Please take a minute to complete your local chapter’s Annual Report online by April 1st, in order for the chapter to remain current for another year! Click here to access the online form.

Additionally, the chapter member roster and $50 fee must be submitted to NGNA Headquarters. You may send the roster and payment by check to:
  • NGNA Headquarters
  • ATTN: Courtney Devine
  • 3493 Lansdowne Drive, Suite 2
  • Lexington, KY 40503
You may also pay by credit card by calling headquarters at 800-723-0560. Please email cdevine@ngna.org with any questions.

Geriatric Nursing: NGNA's Official Journal

Geriatric Nursing is a peer-reviewed journal with a five year Impact Factor of 1.238. As the official publication of the National Gerontological Nursing Association, it is written for nurses who care for elders in the community, acute care, or long-term care. A subscription to Geriatric Nursing is one of the benefits of NGNA membership. Click here for more information about the journal.

NGNA Section of Geriatric Nursing Looking for Authors and Articles!

The co-editors of the NGNA section, Elizabeth (Ibby) Tanner (etanner3@jhu.edu) and Alyce Ashcraft (alyce.ashcraft@ttuhsc.edu), invite authors to submit scholarly manuscripts including research, systematic reviews, evidence based practice, quality improvement, policy implementation and evaluation, and program implementation and evaluation. The editors will also consider reflection pieces on the art and science of gerontological nursing that compel us to stop and think about the meaning of growing old. In addition, this section will showcase NGNA activities.

Writing Mentors Available
The editors are willing to provide assistance with writing or may engage the assistance of an NGNA Fellow if extensive help is needed. To request assistance, please contact one of the editors.

Submitting an Article to Geriatric Nursing
It is helpful to complete and submit the Submission Checklist with the manuscript to insure incorporation of important elements into the paper.


 
Gerontological Advanced Practice Nurse SIG

Intimate Conversations: How to Talk About Urinary Incontinence
Submitted by Susan DeRosa MS RN GCNS BC

The purpose of this article is to provide a broad overview of the types of urinary incontinence, the impact on the individual, and the assessment and management of UI.  The important role of the nurse is highlighted.

Definition
 
Urinary Incontinence (UI) is the uncontrolled loss of urine that causes stress to the individual. In a social context UI is passing urine at the wrong time and in the wrong place.

Urinary incontinence (UI) is one of the most underreported yet treatable medical conditions. The condition affects 10-40 percent of women over age 18, and as many as 53 percent over the age of 50. In addition, 11-31 percent of men over the age of 60 have UI.

Whether out of embarrassment or thinking it is part of normal aging, adults often tend to turn to incontinence products rather than discussing the matter with their health care providers. Nurses have an opportunity to open the lines of communication between those with UI and their health care providers (HCP).
 
The consequences of UI can be three fold. Social consequences include shame, isolation, and, for some, a fear of nursing home placement. Physical consequences include urinary tract infection, falls, skin irritation to pressure ulcers, and a possible sign of diabetes. Economic consequences include the costs of incontinence products, furniture replacement, and treatment for urinary tract infection, skin irritations, or pressure ulcers.
 
There are six types of UI.  Not all types have the same intervention.
  1. Stress UI: this is an involuntary loss of a small amount of urine while sneezing, lifting, or coughing and is related to an increase in the intraabdominal pressure.
  2. Urge UI: involuntary urine loss associated with a strong desire to void (urgency-“got to go”) that may have a neurological etiology.
  3. Mixed UI: the combination of Stress UI and Urge UI . A common UI in women
  4. Overflow UI: involuntary loss of urine associated with an over-distended  bladder. Overflow UI may be due to an under-active detrusor muscle or outlet obstruction.
  5. Functional UI: there are no problems of the urinary tract. Individuals are unable to get to the toilet in time because of  cognitive or physical limitations.
  6. Transient UI: temporary and reversible and can be caused by an infection, side effect of medications, or fecal impaction.
 
Underreported
UI is one of the medical conditions that if not asked about, the individual might not mention.  The majority of individuals with UI can be treated by the HCP and do not require a specialist visit.  Self-diagnosis and self-treatment are not uncommon for many individuals.  The recent over-the-counter treatment for urge incontinence can delay correct diagnosis.
 
Nurse role
Nurses can help by being direct and including in the assessment the question: In the last 3 months have you experienced an accidental loss of urine?  This question will help to ask the clarifying questions that start the voiding record.  In addition, nurses should listen for cues such as the individual asking about incontinence products, reluctance to take diuretics or changing the prescribed timing of the diuretic, or mentioning frequent trips to the bathroom.
 
Assessment
Appropriate intervention begins with the assessment.  The individual with UI can help determine the type by describing the UI pattern to the HCP. A voiding record will help to identify the cause and this usually includes: time and amount of each urination, activities at the time of incontinence (e.g. sneezing, etc., the amount and types of liquids, including frozen liquids consumed, and whether they contained caffeine). The impact of UI on activities and daily routine should also be included.
 
Treatment
Treatment of UI is dependent on the etiology.  Management can include invasive or non-invasive methods such as: medications (anticholinergic, estrogen, tricyclic antidepressant), pelvic floor physiotherapy, bladder training, Kegel exercises (in men, this may be used post- prostate surgery, after the catheter is removed), electrical stimulation, urethral bulking agents, sacral nerve stimulation, pessaries, and surgery.  There is a place for absorbent products; however, they are not a treatment.  If absorbent products are used, skin protection and a moisture barrier is necessary.

Nurses are key to the education of the individual in the treatment regimen.  The goals of self-management and adherence can be supported by using the Teach Back method. Studies have shown that 40-80 percent of the medical information patients receive is forgotten immediately and almost half of the information retained is incorrect.  Nurses can fill this gap by asking the individual to repeat in her/his own words what she/he needs to know and do.  Try to limit the yes/no questions.   Teach Back is a good way to confirm that the information that has been provided is understood by the individual. 
 
Visits with the Health Care Provider
Items to take to the first visit to the HCP for UI should include the voiding diary, the medication list (prescribed, over the counter vitamins and herbal supplements), and questions to be asked.  The office visit may include a pelvic exam and a cough stress test for women and a prostate exam for men. A urine sample may be done.  The situations usually referred to a urologist may be: hematuria, stress incontinence with a cystocele (pessary may be useful), urinary retention with a high post-void residual.  The urologist will help to determine if it is neurologic, obstructive or pharmacologic related.

Good discussions about the treatment plan can help to avoid frequent office visits because the individual will feel confident in the plan and know when to call about side effects or problems. Subsequent office visits, if needed, would include a review of symptoms and response and adherence to the treatment regimen.  Set goals for the next visit until the problem is controlled with the appropriate treatment plan.  Medications are commonly prescribed for stress, urge, and mixed UI.  Adherence to the medication regimen is sometimes a challenge because of the side effects, so adherence should be addressed with each visit.  
 
Summary
UI of any type is a treatable medical condition.  All nurses can help to facilitate the discussion between the individual and the heath care provider by asking the initial question about accidental loss of urine and listing the questions to ask the HCP.  Remind the individual to take the voiding diary, medication list, and list of questions to the appointment with the HCP.
 
References
  1. Urinary Incontinence: Nursing Standard of Practice Protocol: Urinary Incontinence (UI) in Older Adults Admitted to Acute Care. Annmarie Dowling-Castronovo, RN, MA-GNP, Christine Bradway, PhD, CRNP . 
  2. Related Try This:  specific to persistent urinary incontinence and specific to transient urinary incontinence.
  3. Urinary incontinence Assessment in Older Adults: Urogenital distress inventory short form (UDI-6) and Incontinence Impact Questionnaire-Short form (IIQ-7)
  4. American Urological Association 
  5. National Guideline Clearinghouse (AHRQ-Agency for Healthcare Research and Quality) has guidelines for Urinary Incontinence.
  6. For teaching: Age Page on urinary incontinence
  7. For teaching and access to more references


Clinical Corner

Geriatric Syndromes and LTC Nursing
Submitted by Linda Bub, MSN, RN, GCNS-BC and Beth Culross, PhD(c), RN, GCNS-BC, CRRN

In the long term care (LTC) setting, most RNs and LVNs know the devastating impact that a fall with injury can have on a resident, or the effect urinary incontinence can have on the independence of a SubAcute Rehab (SAR) resident. What is usually not known is that these problems are considered geriatric syndromes and thatnurses have the potential to prevent or minimize the impact of these through sound nursing assessment and interventions. Geriatric syndromes are poorly defined, do not have a specific disease category that they can be attributed to,  and cross multiple body and organ systems. The resident that comesto a LTC setting for a short or long stay, develops urinary incontinence that in turn leads to a urinary infection, and then develops  delirium that leads to  fall with injury is a prime example of how geriatric syndromes are not only seen in the acute care environment, but can be commonplace in the LTC setting if not addressed quickly.

Understanding the devastating impact of geriatric syndromes on the older adult and improving nursing care has been the hallmark of geriatric programs such as NICHE Nurses Improving Care for Healthsystem Elders and The Hartford Institute of Geriatric Nursing (HIGN) for over 30 years. Geriatric syndromes include the following medical problems: pressure ulcers, incontinence, falls, functional decline, malnutrition, depression, pain, and delirium.  While most of the literature and study on these syndromes has been focused on the inpatient setting, there is a growing trend to shift focus to include improving care in the LTC environment. LTC sites are now focusing on improving clinical quality, process, and outcomes through programs such as the Advancing Excellence in America’s Nursing Homes Campaign. Sixty-one percent of LTC sites across the country have signed up for this program. The mission of the Advancing Excellence (AE) in America’s Nursing Homes Campaign is to help nursing homes achieve excellence in the quality of care and quality of life for the more than 1.5 million residents of America’s nursing homes by:
  • Establishing and supporting an infrastructure of Local Area Networks for Excellence (LANEs),
  • Strengthening the workforce, and
  • Improving clinical and organizational outcomes
When looking at the clinical goals of the AE campaign, prevention and treatment of geriatric syndromes is integral to the Clinical Improvement goals of:
  • Infection
  • Medication safety
  • Mobility
  • Pain
  • Pressure Ulcers
The Process goals, meant to improve and strengthen the work force focus on:
  • Consistent caregivers
  • Hospitalizations
  • Patient Centered Care
  • Staff Stability
As long term care sites look to improve the quality of care, they should look no further than the work already implemented in this campaign. AE has educational and program resources for the syndromes associated with their goals. Programs such as NICHE and HIGN have resources that can be adapted and i easily implemented in the LTC setting. Education for nurses on the competent care of older adults is the hallmark of NICHE and the Geriatric Resource Nurse model of care.  NICHE is a membership program for acute care, long term care and home health settings and the tools and resources are suited for any venue of care. HIGN offers tools and resources on the web such as SPICES, a tool created by Terri Fulmer to identify geriatric syndromes that can be used in any setting. SPICES address the following potential risks for patients: Sleep disorders, Problems with eating/feeding, Incontinence, Confusion, Evidence of falls, Skin Breakdown. The How to Try This series can be adapted as well to provide education about screenings for cognition, incontinence, and pain that can improve the nursing care of patients in these settings. Creating the infrastructure and practice environment is essential to success. The AE campaign tools and resources, coupled with a desire for improved clinical outcomes will help drive this change in the LTC setting.
 
Nurses and LTC leaders not able to utilize the NICHE and HIGN programs can hardwire assessments through MDS 3.0 to focus on the needs of the older adult and prevent or minimize geriatric syndromes.  The MDS assessment focuses on clinical needs of residents on admission, including identification of a significant change in condition through nursing assessment of areas including behavior and cognition, swallowing, skin (pressure ulcer) and incontinence. Framing the MDS assessment, as well as integration of SPICES or other tools, as essential nursing assessments to care for this vulnerable population can alleviate the frustration of mandatory MDS assessments.  Nursing leaders are at the forefront to implement these nursing care-focused programs to elevate nursing practice in the LTC setting. Adapting tools and resources that are already created can improve success and sustainability of any quality improvement program focused on the care of older adults.
 
Linda Bub MSN, RN, GCNS-BC
Gerontological Clinical Nurse Specialist and NICHE, Director of Education and Program Development
 
Beth Culross, PhD(c), RN, GCNS-BC, CRRN
Gerontological Clinical Nurse Specialist and Nursing Instructor at the University of Nebraska Medical Center
 
Resources:
http://www.ltlmagazine.com/article/spices-helps-develop-care-plan
http://www.annalsoflongtermcare.com/content/educating-ltc-residents-about-geriatric-syndromes
http://www.ltlmagazine.com/blogs/judah-ronch/geriatric-syndromes-are-not-part-normal-aging
http://www.healthinaging.org/files/documents/tipsheets/geri_syndromes1.pdf
http://journals.lww.com/nursing/Fulltext/2013/01000/Geriatric_syndromes_and_their_implications_for.1.aspx
http://www.nursingcenter.com/lnc/static?pageid=730390
http://www.nicheprogram.org/
http://www.nhqualitycampaign.org/star_index.aspx?controls=PreviewGoals
 
References:
Inyoue, S.K., Studenski, S., Tinetti, M.E., Kuchel, G.A. (2007). Geriatric Syndromes: Clinical, Research and Policy Implications of a core Geriatric Concept. Journal of the American Geriatric Society, May 55(5). 780-791.
Mitty E. (2010) Iatrogenesis, frailty, and geriatric syndromes.  Geriatric Nursing. 2010 Sep-Oct;31(5):368-74. doi: 10.1016/j.gerinurse.2010.08.004. Epub 2010 Sep 15.
 


Thank you for your support of NGNA. You will receive each quarterly issue of SIGN, along with other publications, as a member benefit. Do you have a general question, or know someone who is interested in membership? Contact NGNA Headquarters for more details.