AACN News—February 2000—Practice

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Vol. 17, No. 2, FEBRUARY 2000

Geriatric Corner

Did you complete the Aging IQ Quiz, which appeared in the January issue of AACN News? Find out how you scored by checking the answers presented here. The rationale for each answer is included.

Developed by the National Institute on Aging, the Aging IQ Quiz was presented at AACN’s National Teaching Institute™ in May 1999 in New Orleans, La., by the Specialty Nursing Activities Partnership Program (SNAPP) of the Hartford Institute for Geriatric Nursing. SNAPP provides associations like AACN assistance in educating their members in the essentials of geriatric nursing. Given a burgeoning older population, it is fair to say that every nurse will provide nursing care to older adults in the course of his or her career.

A total of 725 nurses who visited the SNAPP booth completed the 20-question Aging IQ Quiz, which addresses common themes and issues associated with aging. Seventy-one percent (71%) of the nurses who took the quiz missed more than two questions; 32% missed more than four questions; and 2% answered all the questions correctly.

Following are the questions and correct “true” or “false” answers:

Aging IQ Quiz
1. Baby boomers are the fastest growing segment of the population. FALSE
More than 3 million Americans are 85 and older, which is the fastest
growing age group. This number is expected to quadruple by the year 2040.
11. People begin to lose interest in sex at about age 55. FALSE
Most older people can lead an active, satisfying sex life.

Most older people can lead an active, satisfying sex life.
2. Families don’t bother with their older relatives. FALSE
Most older people live close to their children and see them often. Many live with their spouses. An estimated 80 % of men and 60% of women live in family settings. Only 5% of the older population live in nursing homes.
12. If your parents had Alzheimer’s disease, you will inevitably get it. FALSE
The overwhelming number of people with Alzheimer’s disease have not inherited the disorder.
3. Everyone becomes confused or forgetful if they live long enough. FALSE
Confusion and serious forgetfulness in old age can be caused by Alzheimer’s disease or another condition that can bring on irreversible damage to the brain. However, at least 100 other problems, such as a head injury, high fever, poor nutrition, adverse drug reactions and depression, can bring on the same symptoms. Many of these problems are treatable and the confusion may be eliminated.
13. Diet and exercise reduce the risk for osteoporosis. TRUE
Women are at particular risk for osteoporosis. Eating a diet rich in calcium and exercising regularly throughout life can help to prevent bone loss.
4. You can be too old to exercise. FALSE
Exercise at any age can help strengthen the heart and lungs and may lower blood pressure.
14. As your body changes with age, so does your personality. FALSE
Research has found that, except for the changes that can result from Alzheimer’s disease and other forms of dementia, personality is one of the few constants of life.
5. Heart disease is a much bigger problem for older men than for older women. FALSE
The risk of heart disease increases dramatically for women after menopause. By age 65, both men and women have a one in three chance of showing symptoms. However, following a healthy diet and exercising can significantly reduce risks.
15. Older people might as well accept urinary accidents as a fact of life. FALSE
Urinary incontinence is a symptom, not a disease.
6. The older you get, the less you sleep. FALSE
In later life, it’s the quality of sleep that declines, not total sleep time. Researchers have found that, sleep becomes more fragmented as people age. This may explain why older people are less likely than younger people to stay awake throughout the day and why older people tend to take more naps than younger people.
16. Suicide is mainly a problem for teenagers. FALSE
Suicide is most prevalent among people age 65 and older. An older person’s concern with suicide should be taken very seriously and professional help should be sought quickly.
7. People should watch their weight as they age. TRUE
Most people gain weight as they age. Because of changes in the body and decreasing physical activity, older people usually need fewer calories.
17. Falls and injuries “just happen” to older people. FALSE
Falls are the most common cause of injuries among people older than 65. However, many of these injuries can be avoided. Regular vision and hearing tests and good safety habits can help prevent accidents.
8. Most older people are depressed. Why shouldn’t they be? FALSE
Most older people are not depressed. A physician can determine whether a depression is caused by medication they might be taking, by physical illness, stress or other factors.
18. Everyone gets cataracts. FALSE
Not everyone gets cataracts, though a great many older people do. Eighteen percent of people between the ages of 65 and 74 have cataracts. However, more than 40% of those between 75 and 85 have the problem.
9. There is no point in screening older people for cancer, because
they can’t be treated.
Many older people can beat cancer, especially if it is found early. More than half of all cancers occur in people 65 and older, which means that screening for cancer in this age group is especially important.
19. Extremes of heat and cold can be especially dangerous for older people. TRUE
The body’s thermostat tends to function less efficiently with age, making the older person’s body less able to adapt to heat or cold.
10. Older people take more medications than younger people. TRUE
Older people often have a combination of conditions that require drugs. They consume 25% of all medications and can have many more problems with adverse reactions.
20. You can’t teach an old dog new tricks. FALSE
People at any age can learn new information and skills. Research indicates that older people can obtain new skills and improve old ones.

We Want to Hear From You
AACN will continue to provide age-related practice information in this “Geriatric Corner.” Do you have suggestions regarding content? Has the practical information presented been useful to you? Have you made changes to your practice because of this information? We want to hear from you. Contact AACN Clinical Practice Specialist, Justine Medina, RN, MS, at (800) 394-5995 ext. 401; fax, (949) 448-5520; e-mail,

Apply Ethics to the Allocation of Healthcare Resources

By Jacqueline Fowler Byers, RN, PhD

George is the charge nurse in the ICU at a community hospital critical care unit in a Midwestern town of 35,000 residents. No other hospital is within a 60-mile radius.

One night, a six-car collision on the interstate results in eight people being transferred to the hospital’s emergency department (ED). A 74-year-old man is already in the ED being evaluated for a probable severe myocardial infarction. In addition, there is a 7-year-old with a head injury in the pediatrics unit, whose condition has deteriorated over the past two hours.

The ED charge nurse notifies George that two patients, after surgery, will need ICU beds; three patients will go directly to the critical care unit; two patients will be taken to the medical-surgical unit; and one patient will be discharged following treatment. Currently, there is only one bed available in the critical care unit, and only one nurse who can accept an additional patient.

Many of us can identify with this scenario. Although many decisions regarding allocation of precious healthcare resources are made at a macro or societal level, individual critical care nurses are faced with these decisions on a case-by-case basis daily. Critical care nurses are frequently placed in the role of patient advocate as they negotiate through complex bureaucracies to ensure that their patients get the care they need, or to ensure that the patient’s wishes are followed when they choose not to accept all available medical interventions. Many critical care charge nurses triage allocation of critical care beds hourly.

There is no “right” answer, assuming that George uses an ethical approach to his decision making. So, how does George approach his challenge? Like all critical care nurses, George’s goal is to “help the starfish to safety” through his power of one.

George does not have to act alone. He has the opportunity to discuss and seek input from his more experienced colleagues and other healthcare providers in order to do the “right thing.” Depending on George’s experience in the charge nurse role, his actions may be intuitive.

The first step is to determine whether there is a current ICU patient who is sufficiently stable to be moved to a lower level of care. There are no absolutes; instead there are principles to guide George’s actions. Factors that will determine who will get the available beds at that point in time will be based on the patient’s wishes, if known (autonomy), the potential burden vs. benefit of treatment (beneficence), futility and fair allocation of available resources (justice).

Creative solutions can be exercised to ensure care for these patients. These may include calling in additional staff, and, perhaps, opening the postanesthesia unit for overflow. Temporary conversion of other areas such as the ED may also be an option. George may find that requesting limited activation of a mass intake procedure for his hospital or the airlifting of patients to other healthcare facilities are also viable options.

Balancing the availability of healthcare resources against patient needs is an ongoing challenge. Skills in negotiating the gray swamp of ethical dilemmas are not as easy to learn as calculating a drug dosage. Using a systematic approach to decision making based on ethical principles assists nurses in ensuring that they are “doing the right thing.” As you apply these principles in your practice, you are serving as a patient advocate and making a difference every day. Use your power of one.

Jacqueline Fowler Byers is a member of the AACN Ethics Integration Work Group. She is associate professor at the University of Central Florida School of Nursing, Orlando, Fla.

Advanced Practice Content Invited for NTI in 2001

AACN is seeking advanced practice content for the National Teaching Institute™ in 2001. The deadline to submit speaker proposal abstracts is March 15, 2000. The NTI 2001, which features the Advanced Practice Institute,™ is scheduled for May 19 through 24 in Anaheim, Calif.

Suggested clinical topics include pharmacology, advanced practice procedures and skills, and new diagnostic and therapeutic approaches in acute and critical care.

Other content areas related to the advanced practice role in critical care include outcomes research, cost benefit analysis, production evaluation processes, leadership, team and program management skills, cultural diversity and ethical problem solving. It is requested that all submissions be evidence-based. Abstracts from experienced pediatric and neonatal clinicians in these same categories are encouraged.

Speakers receive complimentary airfare, registration, and two nights hotel accommodation (the night before and the night after their presentation). To obtain a speaker proposal packet, call (800) 899-AACN (2226). Submission materials can also be downloaded from the “Professional Development” area of the AACN Web site at http://www.aacn.org.

Practice Resource Network

Q:I have recently received conflicting information about how frequently hemodynamic flush systems should be changed. What is AACN’s recommendation on this practice?

A:AACN recognizes the Center for Disease Control (CDC) as the foremost source of research data on this issue. The CDC published the “Guidelines for Prevention of Intravascular Device-Related Infections” in 1996. It recommended that all components of hemodynamic pressure monitoring systems, including line flush solutions, tubing, disposable transducers and stopcocks can be safely replaced at 96-hour intervals. This document can be accessed via the CDC Web site at www.cdc.gov.

Prior to the published document in 1996, the CDC had recommended that a 72-hour interval could be standard. AACN had access to this information prior to the release of the published CDC recommendations, and had included them in its “Protocol for Practice Pulmonary Artery Monitoring Module.” The difference is an
example of how rapidly recommendations can change.

In the meantime, theories are emerging to suggest that changing pressure monitoring systems even less frequently may be safe. AACN will continue to look to CDC for any revisions of its recommendation in the future.

The Intravenous Nursing Society is also an excellent source of information on this topic, as well as other vascular-related concerns. Visit the society’s Web site at http://www.ins1.org, and check out the Intravenous Nursing Standards of Practice.

The Practice Resource Network can be accessed at (800) 394-5995, ext. 217, by e-mail at practice@aacn.org, or through an online InfoLink discussion forum on the AACN Web site at http://www.aacn.org

Agilent Grant to Fund Study of AED Program Effect

Nelda K. Martin, RN, MSN, CCRN, CS, ANP, is the recipient of the Critical Care Nursing Research Grant for 2000, sponsored by Agilent Technologies. Thomas S. Ahrens, RN, CSN, CCRN, CS, is the coinvestigator.

The $30,000 grant will go toward a study titled “Influence of Automatic External Defibrillators and ECG Telemetry Monitoring on In-Hospital Cardiopulmonary Arrest Response Time and Patient Outcomes.” In addition to the grant award, the recipient receives $2,000 toward travel expenses and $3,000 toward the purchase of a computer, printer and associated utility software.

Martin is the clinical nurse specialist for heart services at Barnes-Jewish Hospital, St. Louis, Mo.

Other Grants
The deadlines to apply for several other nursing research grants are approaching. Following is information about these grants:

AACN Data-Driven Clinical Practice Grant
This grant provides six awards of up to $1,000 each year for studies that stimulate the use of patient-focused data or previously generated research findings to develop, implement and evaluate changes in acute or critical care nursing practice.

The principal investigator must be both an RN and a current AACN member, and cannot be currently conducting a study funded by another AACN research grant. Proposed studies may be used to meet the requirements of an academic degree.

For application materials, call (800) 899-AACN (2226), or visit the AACN Web site at www.aacn.org. For more information, call the AACN Practice and Research Department at (800) 809-2273.

Applications must be received by March 1, 2000.

This $5,000 award is given annually to support critical care nursing research. Sponsored by the American Nurses Foundation (ANF), this grant must be relevant to critical care nursing practice.

The program is designed for either a beginning nurse researcher or an experienced nurse researcher who is entering a new field of study.

The principal investigator must be an RN who has obtained at least a baccalaureate degree in nursing. The proposed study may be used to meet the requirements of an academic degree.

Application materials and instructions are available from ANF, (202) 651-7298, or by clicking on the ANF link from the AACN Web site at http://www.aacn.org.

Applications must be received at ANF by May 1, 2000.

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