Using EHR Data to Identify Patient Frailty and Risk for ICU Transfer.

The predictive properties of four definitions of a frailty risk score (FRS) constructed using combinations of nursing flowsheet data, laboratory tests, and ICD-10 codes were examined for time to first intensive care unit (ICU) transfer in medical-surgical inpatients ≥50 years of age. Cox regression modeled time to first ICU transfer and Schemper-Henderson explained variance summarized predictive accuracy of FRS combinations. Modeling by age group and controlling for sex, all FRS measures significantly predicted time to first ICU transfer.

Using the ModSPICES Geriatric Assessment Tool in Undergraduate Nursing Education.

Background: Trends in aging demographics for a growing older adult population highlights the need for Gerontologic nursing competencies to prepare future nurses to provide safe and effective person-centered care.

Method: A geriatric assessment learning module incorporated the ModSPICES assessment tool based on geriatric syndromes in a didactic and clinical course in a prelicensure baccalaureate nursing program to facilitate nursing students' critical thinking and clinical judgment in the care of hospitalized older adults.

Results: The ModSPICES tool fostered nursing students' critical thinking for data collection with attention to geriatric syndromes, which are highly prevalent and associated with numerous adverse outcomes but are also preventable and treatable.

Machine learning for predicting readmission risk among the frail: Explainable AI for healthcare.

Healthcare costs due to unplanned readmissions are high and negatively affect health and wellness of patients. Hospital readmission is an undesirable outcome for elderly patients. Here, we present readmission risk prediction using five machine learning approaches for predicting 30-day unplanned readmission for elderly patients (age ≥ 50 years).

Frailty and In-Hospital Mortality Risk Using EHR Nursing Data.

PurposeThe purpose of this study was to evaluate four definitions of a Frailty Risk Score (FRS) derived from EHR data that includes combinations of biopsychosocial risk factors using nursing flowsheet data or International Classification of Disease, 10th revision (ICD-10) codes and blood biomarkers and its predictive properties for in-hospital mortality in adults ≥50 years admitted to medical-surgical units. In this retrospective observational study and secondary analysis of an EHR dataset, survival analysis and Cox regression models were performed with sociodemographic and clinical covariates. Integrated area under the ROC curve (iAUC) across follow-up time based on Cox modeling was estimated.

Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes: The 2019 Literature Year in Review.

Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses.

Advancing Nurse Scope of Practice in the Republic of Moldova Using Simulation.

Background: Nurse identity in the Republic of Moldova is undergoing change to achieve recognition as a profession. This article describes a faculty development program designed to help articulate the professional nurse role and scope of practice through enhanced teaching pedagogies used in basic nursing education.

Method: Experiential learning strategies such as high-fidelity simulation, unfolding geriatric case study, role-play, task trainers, moulage, and teach-back were used to demonstrate the nursing process and scope of practice.

Hospital Readmission Outcomes by Frailty Risk in Adults in Behavioral Health Acute Care.

The purpose of the current retrospective study was to determine whether frailty is predictive of 30-day readmission in adults aged ≥50 years who were admitted with a psychiatric diagnosis to a behavioral health hospital from 2013 to 2017. A total of 1,063 patients were included. A 26-item frailty risk score (FRS-26-ICD) was constructed from electronic health record (EHR) data.

Definitions of Frailty in Qualitative Research: A Qualitative Systematic Review.

The purpose of this qualitative systematic review was to examine how frailty was conceptually and operationally defined for participant inclusion in qualitative research focused on the lived experience of frailty in community-living frail older adults. Search of six electronic databases, 1994-2019, yielded 25 studies. Data collection involved extracting the definition of frailty from the study aim, background, literature review, methods, and sampling strategy in each research study.

Comparison of a Frailty Risk Score and Comorbidity Indices for Hospital Readmission Using Electronic Health Record Data.

The purpose of the current study was to investigate the predictive properties of five definitions of a frailty risk score (FRS) and three comorbidity indices using data from electronic health records (EHRs) of hospitalized adults aged ≥50 years for 3-day, 7-day, and 30-day readmission, and to identify an optimal model for a FRS and comorbidity combination. Retrospective analysis of the EHR dataset was performed, and multivariable logistic regression and area under the curve (AUC) were used to examine readmission for frailty and comorbidity. The sample ( = 55,778) was mostly female (53%), non-Hispanic White (73%), married (53%), and on Medicare (55%).

Risk prediction and segmentation models used in the United States for assessing risk in whole populations: a critical literature review with implications for nurses' role in population health management.

Objective: We sought to assess the current state of risk prediction and segmentation models (RPSM) that focus on whole populations.

Materials: Academic literature databases (ie MEDLINE, Embase, Cochrane Library, PROSPERO, and CINAHL), environmental scan, and Google search engine.

Methods: We conducted a critical review of the literature focused on RPSMs predicting hospitalizations, emergency department visits, or health care costs.

Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients ≥ 50 Years of Age.

Frail patients may have heightened risk of dysphagia, a potentially modifiable health factor. Our aim is to examine whether the relationship between dysphagia and adverse health outcomes differs by frailty conditions among inpatients ≥ 50 years of age. Medical or surgical hospitalizations among patients ≥ 50 years of age in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2014 through the first three quarters of 2015 were included.

Creating a Gerontological Nursing Digital Repository Within a Learning Management System.

Background: Faculty who teach gerontological nursing are challenged to deliver competency-based baccalaureate nursing education. Because our courses are divided into multiple sections and taught by a variety of faculty, the need for a peer-reviewed, curated repository of gerontological learning materials was conceived.

Method: Syllabi for prelicensure and RN-to-baccalaureate nursing (BSN) degree gerontological courses were reviewed.

Resilience in Baccalaureate Nursing Students: An Exploration.

The purpose of the current study was to explore resilience in senior-level baccalaureate nursing students. Twenty-seven participants completed an online questionnaire assessing three stressors that pertained to marriage or divorce, death or loss of family members or close friends, and extreme financial hardship in the past 1 year. Resilience was measured using the 25-item Connor-Davidson Resilience Scale (CD-RISC-25) and one open-ended question about the experience of resilience.

Perspectives of Frailty Among African American Men and Women.

Frailty is a syndrome of impaired homeostasis and poor response to stressors leading to adverse health outcomes. The aim of the current study was to explore lay perspectives about frailty among African American adults. Thirteen men and women participated in two focus groups.

Frailty risk in hospitalised older adults with and without diabetes mellitus.

Background: Research indicates that diabetes mellitus (DM) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM; however, there is limited research in hospitalised older adults.

Objectives: To determine the extent of frailty in hospitalised older adults with and without DM using a 16-item Frailty Risk Score (FRS) and assess the role of frailty in predicting 30-day rehospitalisation, discharge to an institution and in-hospital mortality.

Methods: The study was a retrospective, cohort, correlational design and secondary analysis of a data set consisting of electronic health record data.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record.

Introduction: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes.

Purpose: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization.

Methods: The sample included 278 patients ≥55 years old admitted to medicine units.

Clinical leadership development in accelerated baccalaureate nursing students: an education innovation.

Nursing faculty members are responsible for assuring competence and safety in the preparation of prelicensure students who are preparing to deliver care in diverse settings. The growing complexity of care and the rapid expansion of knowledge have challenged the adequacy of traditional educational approaches. Proposed solutions have encouraged closer integration of classroom and clinical teaching.

Diffusion of innovations in long-term care measurement battery.

Poor understanding of factors influencing integration of new practices into long-term care (LTC) hinders timely implementation of evidence-based practices (EBPs). Using the Diffusion of Innovations (DOI) framework, a new instrument measuring staff perceptions of an EBP was developed as part of a DOI-LTC measurement battery and tested in a cross-sectional survey of North Carolina LTC nursing personnel. Valid questionnaires were received from 95 licensed nurses and 102 certified nursing assistants (CNAs).

Delegation in Long-term Care: Scope of practice or job description?

This study is a qualitative, descriptive study of how registered nurses (RNs) (N=33) in leadership roles in institutionalized long-term care settings delegate care, including their strategies and processes for delegating care, and their perceptions of barriers to effective delegation and potential benefits of delegation. Findings indicate two key approaches to delegation, including the "follow the job description" approach, emphasizing adherence to facility-level roles and job descriptions, and the "consider the scope of practice" approach, emphasizing consideration of multiple aspects of scope of practice and licensure, and the context of care. While the former resulted in more clarity and certainty for the RN, the latter facilitated a focus on quality of resident care outcomes as linked to the delegation process.

The Connected Learning Model for disseminating evidence-based care practices in clinical settings.

Clinical practice guidelines have been developed to improve patient care and outcomes. Guideline implementation is often stymied by the complexity of patients' conditions, complex care environments, and limited advanced clinical training of nursing staff. To translate key elements of heart failure guidelines into practice in a nursing home, the Connected Learning Model was developed based on the diffusion of innovations framework.

Sojourner syndrome and health disparities in African American women.

Despite improvements in many aspects of health, African American women experience early onset of disease and disability and increased mortality because of health disparities. African American women experience stress and health disadvantages because of the interaction and multiplicative effects of race, gender, class, and age. Sojourner Syndrome is an illustrative and symbolic representation that describes the multiple roles and social identities of African American women on the basis of historical referents and adaptive behaviors that fostered survival and resilience under oppressive circumstances.

Teaching evidence-based nursing practice in geriatric care settings: the geriatric nursing innovations through education institute.

Evidence-based practice holds tremendous potential to optimize care outcomes for older adults, yet many nurses are ill prepared to identify, interpret, and apply the best evidence to their practice. The Geriatric Nursing Innovations through Education (GNIE) Institute is a 39-contact-hour, hybrid distance learning continuing education model designed to strengthen RNs'clinical knowledge, leadership skills, and capacity for implementing evidence-based geriatric care. The GNIE Institute combines reflective, learner-centered instructional approaches with a practicum during which evidence-based guidelines are implemented.