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The Role of Directors of Nursing in Cultivating Nurse Empowerment

In nursing homes, directors of nursing (DONs) are responsible for cultivating nurse empowerment, yet they are often ill-equipped to do so. In this article, the authors explain the accountability–preparation gap, which affects the ability of DONs to create empowering work environments. The authors expand upon the results of a previous integrative literature review that elucidates how nurse empowerment is crucial to improving resident outcomes, particularly because empowerment can reduce staff turnover. The authors also identify three major barriers to empowerment: self-perception, lack of time, and lack of professional preparation. Practical implications of their review are discussed.

Carbon Monoxide Toxicity in Older Adults

This article presents the case of an octogenarian who was hospitalized for CO toxicity, followed by a brief review of diagnosing CO toxicity in the elderly.

Happy in Her Son’s World

This case illustrates how effective navigation of the healthcare system and utilization of resources enabled an older adult with multiple medical conditions to transfer from a nursing home to a home care setting, resulting in fewer hospitalizations and an enhanced quality of life.

What is Our Ethical Responsibility to Treat Smokers? Drawing a Line Between Physician and Patient

Smokers who undergo certain medical procedures often experience poorer outcomes, resulting in increased healthcare costs. Does that mean that we should refuse them treatment? This article examines the multifaceted ethical dilemma of treating smokers, illustrated by a case scenario of an elderly long-term care resident.

Improving Antipsychotic Use in a Veterans Affairs Community Living Center

Quality improvement efforts resulted in an increase in percentage of as-needed antipsychotics with documented behavioral symptoms.

The Role of Nutrition in Modifiable Geriatric Syndromes

The essence of healthcare reform is to shift the paradigm of Western medicine from a treatment model to a prevention model. The inherent benefits of different healthcare interventions for the prevention of disease are debatable. To prioritize the value of different preventive services, the Agency for Healthcare Research and Quality published a technical report titled Common Syndromes in Older Adults Related to Primary and Secondary Prevention, in which they identify eight modifiable syndromes in older adults that frequently lead to institutionalization. The paper focuses on the role of declining nutritional status as a precursor to these syndromes, and outlines nutritional strategies for promoting quality of life in elderly patients. Although the etiology of many of these common geriatric syndromes may not be tied directly to inadequate diet, suboptimal nutrient intake and involuntary weight loss can exacerbate these conditions. Systems that track the effectiveness of nutritional prevention strategies in older adults will facilitate a closer relationship between best practices and the impact of these common syndromes on patient well-being.

Effective Antibiotic Stewardship Programs at Long-Term Care Facilities: A Silver Lining in the Post-Antibiotic Era

The importance and core elements of an antibiotic stewardship program are reviewed.

Pain Management in Long-Term Care Communities: A Quality Improvement Initiative

This QI project improved staff ability to document pain and use targeted pain assessments.

Relieving Drug-Induced Xerostomia With Sorbet

Offering 2 ounces of sorbet prior to meals can help ameliorate drug-induced xerostomia and improve food intake among elderly LTC residents, without changing their medication profiles.

A Caregiver’s Perspective on ALR Care for People with Dementia

This is the fifth article in a continuing series from Allan Vann, who has been the primary caregiver of his wife, Clare, who has Alzheimer's disease.