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      A framework for delivering nursing care to older adults with COVID‐19 in nursing homes

      research-article
      Author(s): , PhD, GNP‐BC, FGSA, FNAP, FAANP, FAAN 1 , , , PhD 2 , , PhD, RN‐BC 3 , , PhD, GNP‐BC, FGSA, FAAN 4
      Publication date (Electronic):
      Journal: Public Health Nursing (Boston, Mass.)
      Publisher: John Wiley and Sons Inc.
      Keywords: aged, evidence‐based practice, geriatric nursing, nursing homes, public health nursing practice, safety

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          Abstract

          Public health emergencies threaten the lives of U.S. citizens, often in disproportionate ways. Hardest hit are vulnerable populations of older adults (OAs) residing in nursing homes (NHs), who comprised nearly 43% of all deaths from COVID‐19 in NHs in 2020. New Jersey (NJ) ranks #2 nationally behind New York with the highest numbers of resident deaths; more than 50% of all COVID‐19‐related deaths in NJ have occurred in NHs. This public health emergency has prompted investigators to evaluate existing structural, resident, process of care, regulatory, and policy characteristics that have impacted the delivery of nursing care within NJ NHs. In this manuscript, we discuss data from NJ NHs during COVID‐19, drawing from publicly available data, state reports, and the geriatric literature to offer recommendations. Based on evidence‐based practices (EBPs), we present a series of recommendations to modify existing contextual factors in NHs to best prepare for the next health disaster.

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          Most cited references112

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          Frailty in Older Adults: Evidence for a Phenotype

          L P Fried, C Tangen, J Walston … (2001)
          Article 0 comments Cited 2799 times – based on 0 reviews     Review now
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            Is Open Access

            Accumulation of Deficits as a Proxy Measure of Aging

            Arnold Mitnitski, Alexander J Mogilner, Kenneth Rockwood (2001)
            This paper develops a method for appraising health status in elderly people. A frailty index was defined as the proportion of accumulated deficits (symptoms, signs, functional impairments, and laboratory abnormalities). It serves as an individual state variable, reflecting severity of illness and proximity to death. In a representative database of elderly Canadians we found that deficits accumulated at 3% per year, and show a gamma distribution, typical for systems with redundant components that can be used in case of failure of a given subsystem. Of note, the slope of the index is insensitive to the individual nature of the deficits, and serves as an important prognostic factor for life expectancy. The formula for estimating an individual's life span given the frailty index value is presented. For different patterns of cognitive impairments the average within-group index value increases with the severity of the cognitive impairment, and the relative variability of the index is significantly reduced. Finally, the statistical distribution of the frailty index sharply differs between well groups (gamma distribution) and morbid groups (normal distribution). This pattern reflects an increase in uncompensated deficits in impaired organisms, which would lead to illness of various etiologies, and ultimately to increased mortality. The accumulation of deficits is as an example of a macroscopic variable, i.e., one that reflects general properties of aging at the level of the whole organism rather than any given functional deficiency. In consequence, we propose that it may be used as a proxy measure of aging.
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              Educational levels of hospital nurses and surgical patient mortality.

              Linda Aiken, Sean P. Clarke, Robyn B Cheung … (2003)
              Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes. To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications). Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics. Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level. The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases). In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.
              Article 0 comments Cited 208 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Deanna Gray‐Miceli:
                ORCID: https://orcid.org/0000-0002-1338-9364
                Role: ProfessorDeanna.gray-miceli@jefferson.edu
                Jeannette Rogowski: Role: Professor
                Pamela B. de Cordova: Role: Associate Professor
                Marie Boltz: Role: Elouise Ross Eberly and Robert Eberly Endowed Chair/Professor
                Journal
                Journal ID (nlm-ta): Public Health Nurs
                Journal ID (iso-abbrev): Public Health Nurs
                Journal ID (doi): 10.1111/(ISSN)1525-1446
                Journal ID (publisher-id): PHN
                Title: Public Health Nursing (Boston, Mass.)
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0737-1209
                ISSN (Electronic): 1525-1446
                Publication date (Electronic): 14 March 2021
                Electronic Location Identifier: 10.1111/phn.12885
                Affiliations
                [ 1 ] Jefferson College of Nursing, Thomas Jefferson University Philadelphia PA USA
                [ 2 ] Department of Health Policy and Administration The Pennsylvania State University University Park PA USA
                [ 3 ] Rutgers, the State University of New Jersey School of Nursing Newark NJ USA
                [ 4 ] Penn State College of Nursing University Park PA USA
                Author notes
                [*] [* ] Correspondence

                Deanna Gray‐Miceli, Implementation Science for Falls Prevention, Jefferson College of Nursing, Thomas Jefferson University, 130 South 9 th Street, Philadelphia, PA 19107, USA.

                Email: Deanna.gray-miceli@ 123456jefferson.edu

                Author information
                https://orcid.org/0000-0002-1338-9364
                Article
                Publisher ID: PHN12885
                DOI: 10.1111/phn.12885
                PMC ID: 8251143
                PubMed ID: 33715193
                SO-VID: 880a4976-4a22-426d-b731-3447eec0bc3c
                Copyright © © 2021 Wiley Periodicals LLC.
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date revision received : 31 January 2021
                Date received : 18 August 2020
                Date accepted : 01 February 2021
                Page count
                Figures: 1, Tables: 1, Pages: 17, Words: 35680
                Categories
                Subject: Special Features ‐ Health Policy
                Subject: Special Features ‐ Health Policy
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:02.07.2021

                Keywords: aged,evidence‐based practice,geriatric nursing,nursing homes,public health nursing practice,safety
                Data availability:
                Keywords: aged, evidence‐based practice, geriatric nursing, nursing homes, public health nursing practice, safety

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