ABSTRACT
A nurse practitioner (NP) psychiatric consultation service was established to provide the residents of five nursing homes with on-site assessment and follow-up treatment for behavioral and psychiatric problems under OBRA and Medicare guidelines. During the 1-year project, 175 residents were referred by the nursing home (NH) staff for agitation, disruptive behavior, depressive symptoms, or decline in activities of daily living. An outcome evaluation documented that the NP recommendations resulted in positive behavioral changes in 62% of residents. Primary physicians, NH staff, and administrators validated that close monitoring of psychotropic medications and staff education in behavioral management strategies provided an effective, collaborative service. The practical aspects of establishing this consult service are addressed.
Subject(s)
Geriatric Nursing , Homes for the Aged/organization & administration , Mental Disorders/diagnosis , Nurse Practitioners , Nursing Homes/organization & administration , Psychiatric Nursing , Referral and Consultation/organization & administration , Aged , Aged, 80 and over , Female , Humans , Male , New York , Treatment OutcomeABSTRACT
Researchers at four nursing home sites experienced similar problems in the informed consent process when they attempted to access a frail, cognitively impaired population to conduct a collaborative, quasi-experimental two year clinical trials study on urinary incontinence. In addition, similar institutional barriers were experienced in these geographically distant and dissimilar nursing homes. The study involved working closely with indigenous licensed nursing and nurse aide staff to implement the independent variable, an individualized toileting prescription. Successful strategies used to overcome barriers in conducting the research will be described.
