Evidence-Based
Geriatric Nursing
Protocols for
Best Practice
Editors
Elizabeth Capezuti, PhD, RN, FAAN
DeAnne Zwicker, MS, APRN, BC
Mathy Mezey, EdD, RN, FAAN
Terry Fulmer, PhD, RN, FAAN
3
EDITION
Associate Editor
Deanna Gray-Miceli, DNSc, APRN, FAANP
Managing Editor
Malvina Kluger
Health care is an ever-changing field. The authors and editors of this book have made
extensive efforts to ensure that recommendations and medication regimens are accurate
and conform to the standards accepted at the time of publication. However, constant
changes in information resulting from continuing research and clinical experience, reasonable
differences in opinions among authorities, unique aspects of individual clinical
situations, and the possibility of human error in preparing such an extensive text require
that the reader exercise individual judgment when making a clinical decision and,
if necessary, consult and compare information from other sources, some of which are
provided.
Copyright © 2008 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without the prior permission of Springer Publishing Company,
LLC.
Copyrights to Chapter 9, “Preventing Falls in Acute Care,” is retained by the author,
Deana Gray-Miceli. Permission for any materials from Chapter 9 must be granted by the
author.
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Library of Congress Cataloging-in-Publication Data
Evidence-based geriatric nursing protocols for best practice / Elizabeth
Capezuti...[et al.], editors.—3rd ed.
p. ; cm.
Rev. ed. of: Geriatric nursing protocols for best practice / Mathy Mezey... [et al.],
editors. 2nd ed. © 2003.
Includes bibliographical references and index.
ISBN 978-0-8261-1103-6 (hardback)
1. Geriatric nursing. 2. Nursing care plans. 3. Evidence-based nursing. I. Capezuti,
Liz. II. Geriatric nursing protocols for best practice.
[DNLM: 1. Geriatric Nursing—methods. 2. Nursing Care. 3. Aged.
4. Evidence-Based Medicine. 5. Nursing Assessment. WY 152 E93 2007]
RC954.G465 2007
618.97
0231—dc22 2007029671
Printed in the United States of America by Bang Printing.
About the Editors
Elizabeth Capezuti, PhD, RN, ARNP-BC, FAAN, is an Associate Professor at New
York University College of Nursing. She also serves as Co-director for The Hartford
Institute for Geriatric Nursing at New York University, where she directs
the Nurses Improving Care for Health System Elders (NICHE) and the Geriatric
Nursing Research Scholars programs. Dr. Capezuti received her doctoral degree
in nursing from the University of Pennsylvania in 1995 and is a nationally certified
Geriatric Nurse Practitioner. She was also on the faculty of the University of
Pennsylvania School of Nursing from 1984 through 2000, where she received the
1995 Provost’s Award for Distinguished Teaching. From 2000 to 2003, she held
the Independence Foundation Wesley Woods Chair in Gerontologic Nursing at
Emory University. Dr. Capezuti’s program of research focuses on the development
and testing of interventions aimed at improving care of frail older adults.
Findings from her research have been used to draft both state legislation and
federal regulations related to nursing home care. She serves on several national
boards and has been a consultant to the Hospital Bed Safety Workgroup of the
U.S. Food and Drug Administration and the Center for Medicare and Medicaid
Services. Dr. Capezuti has published extensively in the areas of fall prevention,
restraint and side-rail elimination, elder mistreatment, and legal liability issues.
She is a Fellow of the American Academy of Nursing, the Gerontological Society
of America, the American Association of Nurse Practitioners, and the New York
Academy of Medicine.
DeAnne Zwicker, MS, APRN, BC, is an ANCC certified adult primary care and
geriatric nurse practitioner. She is currently a Senior Advisor for The Hartford
Institute for Geriatric Nursing at New York University’s College of Nursing and
a doctoral student at Drexel University in Philadelphia. She was managing editor
and coauthor of two chapters in Geriatric Nursing Protocols for Best Practice,
2nd Edition (awarded Geriatric Book of the Year, 2003, by American Journal of
Nursing) and editor of The Hartford Institute’s on-line Gerontologic Nursing
Certification Review Course. Her clinical practice includes being a Clinical Services
Manager for a managed-care company that provides nurse practitioners in
long-term care and clinical faculty at NYU Division of Nursing in the advancedpractice
adult and geriatric nurse practitioner programs. Ms. Zwicker has been
a registered nurse for more than 30 years in acute care, including medical ICU,
oncology, and general medicine. She has been a nurse practitioner for 15 years
with extensive clinical experience working in adult primary care and with geriatric
populations in multiple settings, including long-term care, primary care,
subacute care, and rehabilitation.
Mathy Mezey, EdD, RN, FAAN, received her undergraduate and graduate education
at Columbia University. She worked as a public health nurse and at
Jacobi Hospital in New York City. Dr. Mezey taught at Lehman College of the
City University of New York. For 10 years, she was a professor at the University
of Pennsylvania School of Nursing, where she directed the geriatric nurse practitioner
program and the Robert Wood Johnson Foundation Teaching Nursing
Home Program. Since 1991, she has been a professor at New York University
College of Nursing. In 1996, Dr. Mezey assumed the position of Director of The
Hartford Institute for Geriatric Nursing at NYU.
Dr. Mezey has authored 10 books and has more than 60 publications that
focus on the preparation of baccalaureate and advanced practice nurses to care
for older adults, nursing practice with older adults, and bioethical issues that affect
decisions at the end of life. A Member of the American Academy of Nursing,
Dr. Mezey is Editor for the Springer Series in Geriatric Nursing and Co-Editor of
the Springer publication, The Encyclopedia of Elder Care. Her current research
and writing focus on quality of care for older people in hospitals and long-term
care.
Dr. Mezey is a Fellow in the American Academy of Nursing and the Gerontological
Society of America, sits on the Board of the Visiting Nurse Service of
New York, and is Trustee Emeritus, Columbia University.
Terry Fulmer, PhD, RN, FAAN, is The Erline Perkins McGriff Professor and
Dean of the College of Nursing at New York University. She received her bachelor’s
degree from Skidmore College, her master’s and doctoral degrees from
Boston College, and her Geriatric Nurse Practitioner Post-Master’s Certificate
from New York University. Dr. Fulmer’s program of research focuses on acute
care of the elderly and, specifically, elder abuse and neglect. She served on
the National Research Council’s panel to review risk and prevalence of elder
abuse and neglect and has published widely on this topic. She has received the
status of Fellow in the American Academy of Nursing, the Gerontological Society
of America, and the New York Academy of Medicine. She is a member of the
National Committee for Quality Assurance geriatric measurement assessment
panel and the Veteran’s Administration Geriatrics and Gerontology Advisory
Committee. She completed a Brookdale National Fellowship and is a Distinguished
Practitioner of the National Academies of Practice. Dr. Fulmer was the
first nurse to be elected to the board of the American Geriatrics Society and the
first nurse to serve as the president of the Gerontological Society of America.
Deanna Gray-Miceli, DNSc, APRN, FAANP, is consultant to New York
University-Hartford Institute for Geriatric Nursing (HIGN) and Project Director
for the HIGN/American Association of Colleges of Nursing–sponsored grant,
Preparing Nursing Students to Care for Older Adults: Enhancing Gerontology in
Senior-Level Undergraduate Courses, The G-NEC Experience, and an Adjunct Assistant
Professor of Nursing at the University of Pennsylvania School of Nurs-
ing. As a nationally certified gerontological nurse practitioner for more than
2 decades, Dr. Gray-Miceli has devoted her clinical and research interests to
evaluation and care of older adults who fall. In the mid-1990s, she founded
and directed the first academic nurse-managed Fall Assessment and Prevention
Program in the country, housed at a school of medicine. In 2001, she completed
a doctoral degree, focusing her dissertation research on the “Lived experience
and meaning of a serious fall to older adults.” In 2002, Dr. Gray-Miceli was
awarded a Post-Doctoral Scholarship by The John A. Hartford Building Academic
Geriatric Nursing Capacity Program, working with faculty mentors from
the School of Nursing and School of Medicine at the University of Pennsylvania.
Dr. Gray-Miceli’s program of research includes the development, validation,
and feasibility for Registered Nurses to use a post-fall assessment tool for older
adults in nursing homes. The tool is capable of detecting reasons for fall events
by clinical staff.
For the past 4 years, Dr. Gray-Miceli has been an invited consultant to a
state department of health for statewide fall prevention initiatives including
development of programs and services for older adults. Several health care
provider and professional initiatives directed at fall prevention in clinical practice
settings have also been launched. In 2006, she was an invited reviewer to the
State and Territorial Injury Prevention Directors Association (STIPDA), Injury
Surveillance Workgroup on Falls [ISWF] Report: Consensus Recommendations
for Surveillance of Falls and Fall-Related Injuries, and contributed to ECRI’s
book “Fall Prevention Strategies in Health Care Settings” and national webinar
educational series on fall prevention. Dr. Gray-Miceli has published more than
25 refereed journal articles and 10 book chapters, authored a book titled “Falls
Toolkit,” and presented more than 25 papers or posters at national and local
scientific meetings mostly related to falls in older adults. She is a Fellow of the
American Academy of Nurse Practitioners and the Gerontological Society of
America.
Malvina Kluger, BA, is Senior Administrator of The Hartford Institute at the
New York University College of Nursing. In this role, she plans, implements,
and manages various initiatives, primarily in nursing education and policy. She
has been editor of The Hartford Institute newsletter Nursing Counts, and her
background includes research and family services social work.
Contents
About the Editors ......................................................................v
Contributors ......................................................................... ix
Foreword ...........................................................................xv
Preface ............................................................................xvii
Introduction ........................................................................xix
Dedication and Acknowledgments .....................................................xxiii
Chapter 1 Developing and Evaluating Clinical Practice Guidelines:
A Systematic Approach ........................................1
Rona F. Levin, Joanne K. Singleton, and Susan Kaplan Jacobs
Chapter 2 Measuring Performance, Improving Quality ........................9
Lenard L. Parisi
Chapter 3 Assessment of Function .......................................23
Denise M. Kresevic
Chapter 4 Assessing Cognitive Function ..................................41
Tom Braes, Koen Milisen, and Marquis D. Foreman
Chapter 5 Depression .................................................57
Lenore H. Kurlowicz and Theresa A. Harvath
Chapter 6 Dementia ...................................................83
Kathleen Fletcher
Chapter 7 Delirium: Prevention, Early Recognition, and Treatment ............111
Dorothy F. Tullmann, Lorraine C. Mion, Kathleen Fletcher,
and Marquis D. Foreman
Chapter 8 Family Caregiving ...........................................127
Deborah C. Messecar
Chapter 9 Preventing Falls in Acute Care ................................ 161
Deanna Gray-Miceli
Chapter 10 Pain Management...........................................199
Ann L. Horgas and Saunjoo L. Yoon
Chapter 11 Iatrogenesis: The Nurse’s Role in Preventing Patient Harm .........223
Deborah C. Francis
Chapter 12 Reducing Adverse Drug Events ................................257
DeAnne Zwicker and Terry Fulmer
Chapter 13 Urinary Incontinence ........................................ 309
Annemarie Dowling-Castronovo and Christine Bradway
Chapter 14 Mealtime Difficulties .........................................337
Elaine J. Amella
Chapter 15 Nutrition .................................................. 353
Rose Ann DiMaria-Ghalili
Chapter 16 Managing Oral Hydration .....................................369
Janet C. Mentes
Chapter 17 Oral Health Care ............................................391
Linda J. O’Connor
Chapter 18 Preventing Pressure Ulcers and Skin Tears ......................403
Elizabeth A. Ayello and R. Gary Sibbald
Chapter 19 Age-Related Changes in Health ................................431
Constance M. Smith and Valerie T. Cotter
Chapter 20 Excessive Sleepiness ........................................459
Eileen R. Chasens, Laura L. Williams, and Mary Grace Umlauf
Chapter 21 Sensory Changes ...........................................477
Pamela Z. Cacchione
Chapter 22 Physical Restraints and Side Rails in Acute and Critical
Care Settings: Legal, Ethical, and Practice Issues .................503
Lorraine C. Mion, Barbara L. Halliday, and Satinderpal K. Sandhu
Chapter 23 Health Care Decision Making ..................................521
Ethel L. Mitty and Linda Farber Post
Chapter 24 Advance Directives ..........................................539
Ethel L. Mitty and Gloria Ramsey
Chapter 25 Comprehensive Assessment and Management
of the Critically Ill ........................................... 565
Michele C. Balas, Colleen M. Casey, and Mary Beth Happ
Chapter 26 Fluid Overload: Identifying and Managing Heart Failure Patients
at Risk for Hospital Readmission .............................. 595
Jessica Coviello and Deborah A. Chyun
Chapter 27 Cancer Assessment and Intervention Strategies ..................615
Janine Overcash
Chapter 28 Issues Regarding Sexuality ...................................629
Jacqueline M. Arena and Meredith Wallace
Chapter 29 Substance Misuse and Alcohol Use Disorders ....................649
Madeline Naegle
Appendix ..........................................................................677
Index ............................................................................. 681
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