Moral distress and patients who forego care due to cost.

BACKGROUND: In the US, many patients forgo recommended care due to cost. The ANA Code of Ethics requires nurses to give care based on need. Therefore, US nurses are compelled to practice in a context which breaches their professional ethical code. RESEARCH OBJECTIVES: This study sought to determine if nurses do care for patients who forgo treatment due to cost (PFTDC) and if so, does this result in an experience of moral distress (MD). RESEARCH DESIGN: Semi-structured interviews were transcribed and analyzed using a qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A convenience sample of 20 nurses in practice for at least one year from a variety of health care setting participated. ETHICAL CONSIDERATIONS: This project was approved by the Michigan State University Biomedical Institutional Review Board. RESULTS: There were 19 female and one male nurse-participants, averaging 47 years old with an average of 10 years in practice. 18 reported caring for PFTDC. These 17 nurse-participants experienced a moderate degree of MD as a result, averaging 5.4 of 10 on the Moral Distress Thermometer. In the interviews, the following themes were identified, strategies to help PFTDC, and the broken US health care system which had the subthemes of preference for business over patient-oriented benefit, PFTDC using the emergency department, and limited support for treatment/management of PFTDC. CONCLUSIONS: The existence of this phenomenon places the profession of nursing in the US in a position of moral compromise and threatens to corrupt the institution of nursing in the US.

Evolution of the adult/gerontological APRN and GAPNA: The fourth decade, 2011-2021.

The 40th anniversary gemstone is traditionally a ruby - the stone of kings and queens. The Latin derivative is "ruber" which means red (the deep color of the stone). Rubies are thought to have an eternal inner flame or fire that in many global cultures symbolizes nobility, purity, and passion. The ruby is believed to promote health and knowledge as well as love and compassion. It has also been connected to improved energy, creativity, motivation, and goal setting. Does this sound like the GAPNA mission, vision, goals, and experience you know? A gathering of inspired and dedicated gerontological nurses founded this organization in 1981 and it has been growing stronger and burning brighter with recognized influence every year. This article highlights the last decade of work and accomplishments that have occurred from the passion of individuals working with older adults. GAPNA has forged ahead as visionary leaders in the care of older adults; creative in approaches to meeting the needs through certification and leadership opportunities. Health policy is a dedicated advocacy focus for advanced practice nursing and older adults, making the world a better place for aging and quality health care access and equity. This article will remind you or acquaint you with some of the accomplishments in the last decade. The authors hope the outcome of reading the article will delight you, but also motivate you to become actively engaged with the organization in the next years as GAPNA heads toward becoming golden.

Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing.

Advanced practice nurses (APRNs) make significant contributions to the mental health of older adults. Despite the surge in the number of older adults, the number of APRNs choosing educational preparation for geropsychiatric nursing (GPN) is limited. The purpose of the GAPNA GPN Position Statement is to sustain a new vision for the nursing profession that will improve the care of older adults with psychiatric and mental health disorders. This position paper was written by a diverse group of APRNs with the collective intent to reflect respect, decrease stigma, remove controversy, and uphold a positive, person-centered approach to mental disorders among older adults and their families. The GAPNA GPN Position Statement was written to advance excellence in the GPN subspecialty, provide holistic care for older adults and make recommendations for practice. Blending gerontological and psychiatric nursing results in a subspecialty at the top of the APRN Consensus Model pyramid.

The Moral Distress of Nurses When Patients Forgo Treatment Because of Cost.

Nursing must recognize an ethical obligation to respond on behalf of these patients.

Seasonal Influenza (Flu).

Seasonal influenza, or flu, is an airborne respiratory virus that occurs every year in the fall to early spring in the United States. The virus is highly contagious and symptoms can run from mild to severe. In some populations (very young, individuals with chronic comorbid conditions, immunocompromised individuals of all ages, pregnant women, and frail older adults), the virus can lead to increased morbidity and mortality. In a majority of cases, seasonal influenza is preventable through safe and readily available vaccinations.

Knowledge, attitudes, and perceptions of advanced practice nurses regarding urinary incontinence in older adult women.

This study examined the level of knowledge and the attitudes and perceptions of advanced practice nurses (APNs) regarding urinary incontinence (UI) in older adult women. UI is a common health issue for older adult women, and APNs are in a unique position as health care providers to prevent, diagnose, treat, and manage the condition successfully. Little is known about how well APNs were educated regarding UI, especially in older adult women. Purposive sampling was utilized to conduct a cross-sectional, descriptive, and correlational design study. Fifty-four APNs completed a questionnaire developed by the author based on the aging literature, advanced practice nursing competencies, and UI guidelines. Findings suggest that APNs generally have positive attitudes, perceptions, and knowledge of UI in women. However, participants had difficulty in applying this knowledge to the clinical setting: assessing, diagnosing, treating, and managing UI. More emphasis is needed in graduate nursing curriculums and in precepted clinical experiences regarding UI in women.

Nursing staff beliefs and expectations about continence care in nursing homes.

OBJECTIVE: The purpose of this qualitative study was to consider the current beliefs of nursing assistants and directors of nursing about management of urinary incontinence (UI) among the residents in nursing homes. DESIGN: This was a qualitative study using purposive sampling and a focus group methodology. SETTING AND SUBJECTS: Three focus groups including 38 participants were held in 2 different regions. Two of the focus groups comprised nursing assistants and 1 comprised directors of nursing. METHOD: The focus groups were facilitated by 2 different advanced practice nurses (BR and LJK), and 2 similar interview guides were used: 1 for the nursing assistants and 1 for the nurses. The interviews were tape recorded and transcribed verbatim; data were analyzed via content analysis. RESULTS: Ten themes were identified from the data; 3 focused on resident factors that influence UI, 4 related to staff and family contributors to UI, and 3 focused on recommendations to improve UI management in the nursing home setting. CONCLUSIONS: The findings from this study can be used to guide interventions to decrease or eliminate barriers to continence care and thereby facilitate the implementation of clinical practice guidelines and evidence-based interventions to improve urinary continence among nursing home residents.

Urinary incontinence: basic evaluation and management in the primary care office.

With the increasing number of older adults in the population, the office-based clinician can expect to see more people with UI. Continued UI research is warranted, especially research that includes older adults who reside in the community and frail elderly women who are still living in the community. Better outcome measures should be developed to assess the effectiveness of interventions for UI. Reliance on information obtained from voiding diaries is used extensively, yet the reliability and validity for any specific instrument have not been tested with older adults. Hopelessness and spiritual distress, as precursors to health decline and how they impact on quality of life, should be studied in older adults with UI. Given the prevalence of UI, should it be considered a public health problem for which population-based interventions are used? What is known is that older adults demonstrate significant improvement in symptoms of UI when education, counseling, support, and encouragement in behavior management and lifestyle interventions are provided. When motivated and positive, even frail older adults experience improvement in the severity of urine leakage. Perhaps the single most important action that the office-based clinician can take is to start asking every older adult about UI and to follow with the basic approaches to evaluation and management described in this article.

A dog and a "happy person" visit nursing home residents.

Recent recognition of the importance of the human-animal bond has led to the proliferation of programs designed to improve the lives of nursing home residents through the use of animals. Because human-human interaction in the nursing home setting is often of an obligatory nature, we wondered if a visit from a nonjudgmental, outgoing, enthusiastic young adult ("a happy person") could elicit the same positive influence as a visit from a nonjudgmental dog. The purpose of this study was to determine if elderly residents of a midwestern nursing home had a preference for the type of visitor (dog vs. person) when both visits were nonobligatory and nonjudgmental. Behaviors were evaluated to determine if one visitor was more likely to influence prosocial behaviors (moving closer, patting, smiling). Six residents were visited by both the dog and the happy person: 5 of 6 completed the final interview. Residents were equally likely to smile at and move closer to both visitors. Residents were more likely to pat the dog. Three residents liked both visits equally: 1 preferred the dog, and 1 preferred the happy person. These data suggest that nonobligatory visits to nursing home residents from a happy person may be as beneficial to the resident as visits from a dog.