Deanna Gray-Micelli, PhD, GNP-BC, FAANP, Patricia A. Quigley, PhD, MPH, APRN, CRRN, FAAN, FAANP Reprinted with permission from Springer Publishing Company. Evidence-Based Geriatric Nursing Protocols for Best Practice, 4th Edition, © Springer Publishing Company, LLC. The text is available here. Goals A. Prevent falls and serious injury outcomes in hospitalized older adults. B. Recognize multifactorial risks and causes of falls in older adults. C. Institute recommendations for falls prevention and management consistent with clinical practice guidelines and standards of care. Overview Falls among older adults are not a normal consequence of aging; rather, they are considered a geriatric syndrome most often due to discrete multifactorial and interacting, predisposing (intrinsic and extrinsic risks), and precipitating (dizziness, syncope) causes., Fall epidemiology varies according to clinical setting. In acute care, fall incidence ranges from 2.3 to 7 falls per 1, 000 patient days depending on the unit. Nearly one-third of older adults living in the community fall each year in their home. The highest fall incidence occurs in the institutional long-term-care setting (i.e., nursing home), where 50% to 75% of the 1.63 million nursing-home residents experience a fall yearly. Falls rank as the eighth leading cause of unintentional injury for older Americans and were responsible for more than 16, 000 deaths in 2006. (Ref 3) Background and Statement of the Problem A. Definition 1. Fall: A fall is an unexpected event in which the participant comes to rest on the ground, floor, or lower level. (Ref 4) B. Fall Etiology 1. Fall risk factors include intrinsic risks of cognitive, vision, gait or balance impairment, high-risk/contraindicated medications, and/or the extrinsic risks of assistive devices, inappropriate footwear, restraint, use of nonsturdy furniture or equipment, poor lighting, uneven or slippery surfaces. (Ref 5) 2. Fall causes include, among others, orthostatic hypotension, arrhythmia, infection, generalized or focal muscular weakness, syncope, seizure, hypoglycemia, neuropathy, and medication. Parameters of Assessment A. Assess and document all older adult patients for intrinsic risk factors to fall: 1. Advancing age, especially if older than 75 2. History of a recent fall 3. Specific co-morbidities: dementia, hip fracture, Type II diabetes, Parkinson's disease, arthritis, and depression

Take the undershirt and cut it in half. Cut off the straps and cut the back in half so it opens up. Hem the bottom. To hem all you need to do fold the bottom up a half inch and then fold it again. Press with an iron to help keep folds straight and pin it. Use a simple strait stitch to sew the hem. Because of the material of my undershirt I did a second layer of stitching to ensure a good hold. Tada! The under layer is done! Now to attach it to the top shirt. First, turn the top shirt inside out with the front of the shirt facing towards you. Lay your undershirt right side down on top of your top shirt. Pin the shirts together along the armpit seam. Since my undershirt was smaller than my top shirt the seams do not line up perfect, but that is okay. Place a pin facing along the top shirt's side seam so you know where to stop sewing. Pin the left and the right sides this way. With thread that is an "exact, to close" match to your top shirt, sew the two shirts together along the armpit seam. Try to sew along or as close the top shirt's hem line as you can. When your two shirts are attached along the armpit seams, place a pin sideways at your side seams to mark the bottom of your undershirt. Your side pins will hold the undershirt in place. Flip the shirt outside right, and sew along the side seam, directly on top of the seam. It is SUPER important that your thread matches your shirt! Stop at your sideways pin. If you stayed along the seam you won't be able to see the stitches! :D Repeat on the other side, then flip the shirt inside out again. You will see your seam on the inside. Trim along the seam on both sides. You now have an under layer! Flip your shirt outside right again and enjoy! In roughly 25 minutes you made yourself and up-cycled, discreet, nursing top! If you want to add an extra touch (and your shirts are the same size) You can take the bottom of the undershirt and add it to the bottom of your top shirt for extra length and a layered look.

OBJECTIVE: To provide data needed to design an intervention trial to prevent or treat skin disorders in a high risk, incontinent nursing home population. DESIGN: The incidence and prevalence of nine common skin disorders were measured prospectively over a 60-day period using trained observers. Urinary and fecal incontinence frequency were measured over 24 hours, and mobility was measured with subjects both in and out of bed. Direct measures of skin moisture were taken with an impedance device in the presence and absence of urinary incontinence. Multiple regression analyses were used to relate the incontinence and mobility variables to the presence and development of skin disorders. SETTING: Four nursing homes. PARTICIPANTS: One hundred incontinent nursing home residents. MAIN OUTCOME MEASURES: Prospective measures of nine common skin disorders and skin moisture in four perineal regions under continent and incontinent conditions. RESULTS: All subjects had at least one skin condition identified during the 60-day data collection period. The most commonly observed skin condition was blanchable erythema, which occurred in 94% of the subjects, predominantly in the front and back regions that were closest to the urethra and rectum. Twenty-one percent of residents developed either a Stage 1 (nonblanchable erythema) or 2 pressure ulcer. All skin conditions were transient when measured every 3 weeks with the exception of blanchable erythema, which showed stability. Stage 3 or greater pressure ulcers and edema were not observed, and interrater reliability for the measure of papules was poor. Measures of urinary and fecal incontinence severity were correlated with blanchable erythema severity, and blanchable erythema and low bed mobility were predictive of pressure ulcer severity. Blanchable erythema severity was also predictive of Stage 1 and 2 pressure ulcers. Skin moisture levels in the back perineal farthest from the rectum (peripheral) were affected most by urinary incontinence. CONCLUSION: A trial to detect a 50% preventive effect on Stage 1 and 2 pressure ulcers would require that 167 subjects be monitored for 60 days. The transient nature of the skin effects require that skin be monitored at least once a week. Because blanchable erythema is so prevalent and appears to be associated with more severe skin conditions, it would make an excellent marker for beginning to assess the potential preventive effects of various interventions on the incidence of pressure ulcers and other related skin disorders in incontinent patients. It is likely that the back area peripheral to the urethra and rectum would experience the greatest benefit from an intervention trial to reduce moisture caused by incontinence.

Jump from the bottom step Jump a distance of about 8 inches Jump on a trampoline with 2 hands held Begin to stand on one foot Begin to ride a tricycle Catch a large ball At 3 years old, most toddlers can complete the following gross motor skills: Run forward well Jump in place with two feet together Stand on one foot (with some support) Walk on tiptoe Kick a ball forward Walk on tiptoes and stand on one foot for up to 5 seconds Avoid obstacles in path Catch an 8 inch ball Climb and walk up stairs alternating feet You can help with early child development. Suggested gross motor activities for toddlers between two and three years old are as follows: Visit playgrounds often. When children see the slides and climbing structures, they naturally want to run, swing, and climb everything in sight. If you can’t make it to the playground, chasing each other in the backyard or taking a walk can help your child’s little muscles grow strong. Imitate each other. Stick your arms out wide and pretend to fly around the room. Tell your child it’s his/her turn to be the bird. Then, let your child be the leader and you copy whatever he/she does. Become a horse. If you cross your legs and place your child on your knee, it’s easy to take it for a horse ride. A variation would be to hold your child’s hands while it straddles your foot. Then bounce, bounce, and bounce some more. Play catch. Show your child how to hold out its hands and throw a ball directly, and gently, into them. Start out standing close together. As your child gets better, move farther away. It’s soccer time! Turn a large box on it’s side to become your goal. Then take turns trying to kick the ball into the goal, cheering when your little athlete makes a goal. Let’s be kangaroos. Make a chalk line on the sidewalk or place a washcloth on the floor. Show your child how to jump with both feet together and see how far each kangaroo can jump. Have fun with balloons. Here’s a fun game for a rainy day. Kick a balloon from one side of the room to another. Put a laundry basket on its side and your child can kick it into the basket. Act like animals. Can your child stand like a flamingo, squat like a duck, run on all fours like a lion? It’s fun to try. Don’t forget to make the appropriate animal sounds! Make a river. Put a folded towel on the grass. Tell your child the towel is really a river and ask if he/she can jump over the river without getting his/her feet wet. As your child gets better, unfold the towel for more of a challenge.

The VA Learning Opportunities Residency (VALOR) Program gives outstanding registered nursing students who have completed their junior year in an accredited clinical program the opportunity to develop competencies in clinical nursing while at a VA-approved health care facility. Learning opportunities include didactic or classroom experiences, competency-based clinical practice with a qualified RN preceptor, and participation in nursing-focused clinical conferences. VALOR participants who take a position with VA upon graduation are usually hired one-to-three steps above the entry-level salary rate established for new graduates. This is because VALOR participants are already oriented to VA and its practice requirements. VALOR students may be appointed on a full- or part-time basis during the summer months, and may continue during their senior academic year on a part-time basis. Contact the nursing education department at your local medical center for more information about the VALOR Program and how to apply. Every facility in our health care system provides a structured nursing orientation program for new graduates. The program includes the assignment of preceptors and mentors who provide experiences tailored to each individual new hire's requirements. In addition to orientation, VA provides a work environment that supports the transition from new graduate to experienced nurse, including abundant opportunities for continuing education programs, as well as clinical learning experiences. Working as a nurse at VA comes with a number of work/life benefits designed to help you achieve your best, personally and professionally. Our nursing benefits include: Nationwide job transfer opportunities Tuition reimbursement and scholarship programs (subject to funding availability) Competitive salaries and pay differential rates Generous vacation, personal, and sick leave, as well as 10 Federal holidays Stable retirement and health care plans BCLS and ACLS classes provided at no cost to employees

A nursing student at Misericordia University has filed suit against the university, claiming that the school broke federal law by denying her the ability to talk to her professor during an exam. Jennifer Burbella is suing the university, several members of the administration and staff, as well the professor after she failed a required course two times. Burbella said that she suffered from a host of mental health problems, including anxiety, depression and poor concentration, and that the university failed to make reasonable accommodations to her testing environment to account for her disability. Specifically, Burbella claims that the university did not allow her to take the test in the same building as her professor and that when she was unable to reach the professor by phone during the final exam, she broke down crying “on several occasions” during the exam. The suit raises some tricky questions about what accommodations are “reasonable” under federal disability law and whether Burbella can attribute failing her exam twice to her inability to speak with her professor during the test. “Because she was denied her statutory right to accommodations, we’re looking primarily to have her take the test or take the course over with the accommodations she needs, ” Harry McGrath, Burbella’s attorney, told The Washington Post. “And if she passes the test. fine. And if she doesn’t pass the test, fine, then she has to live with that.” According to the lawsuit, even before Burbella matriculated in 2010, she knew that she “had an existing predisposition which caused her to suffer from anxiety and depression.” At Misericordia, she began seeing a school psychologist for her anxiety, depression and poor concentration in 2011. But in spring 2014, Burbella failed a core curriculum class in her nursing program that required a minimum grade of 78 percent. She agreed to retake the class in the summer, and the school officially agreed to make accommodations during the test because of her disability: extended time on the exam and a distraction-free environment. When the time came for her to take the final exam again, the professor, Christina Tomkins, verbally offered to be available to answer questions that Burbella might have during the exam, according to the suit. The only problem with that offer was that Burbella had already been scheduled to take the exam in a building different from the one used by the rest of her peers, so that she could have a distraction-free environment. Her professor was scheduled to proctor the exam in the other building. Burbella claims that Tompkins denied her request to be moved to the same building as her classmates and instead gave Burbella a cellphone number on which she could be reached. “The unfortunate reality of the situation on the day of the exam was that Professor Tompkins did not answer her cell phone despite [Burbella’s] repeated attempts to contact her throughout the final examination, ” the suit said. “Professor Tompkins’ failure to be available to the Plaintiff on numerous occasions during the examination created an even more stressful environment for the student.”

Nurse jobs By Mark Swartz Monster Senior Contributing Writer Who hasn’t at one point come into contact with a nurse? There are over 360, 000 of them regulated to work in Canada. If you’ve had to visit a hospital, get homecare after an accident or illness, visit a medical clinic, or call a healthcare hotline, you’ve interacted with a nurse. Today’s nurses can do more than ever to help you with your healthcare. The field has traditionally been dominated by women: 94% are female, while 6% are male. They may have one of three designations, according to the work they do and the province they are in: Registered Nurses, commonly called RNs, exist in all provinces. An RN holds a four-year baccalaureate degree in nursing from a Canadian university or its international equivalent. Licensed Practical Nurses (LPNs) and Registered Practical Nurses (RPNs) hold two-year practical nursing diplomas from accredited colleges. They must also complete the national licensing exam before beginning a career in healthcare What follows is 10 types of nursing jobs commonly found on Monster.ca’s job post database: Clinical Study Observer (and Interviewer) Nurse Have you ever taken part in a clinical study for a new medication or healthcare procedure? Odds are the person looking after you is a specially trained clinical studies nurse. Educator Nurse Found in hospitals, post-secondary schools and travelling around to small communities, an educator nurse teaches new techniques and processes in healthcare to others. Geriatric and Retirement Nurse The aged need more healthcare, more often, than younger Canadians. Fortunately geriatric nurses are uniquely qualified to deal with medical and emotional challenges of our elders. Intensive Care Nurse For the seriously ill or injured, intensive care nurses can literally be life savers. They generally provide hands on care in hospitals. Some late night and weekend shift work may be required. Mental Health, Psychiatric and Addictions Nurse According to the Canadian Mental Health Association, 20% of Canadians will personally experience a mental illness in their lifetime. More will have a drinking, gambling or drug addiction. Nurses who are trained in these matters provide support in clinics, hospitals and schools throughout the country. Nurse Midwife Thinking of having a home birth? You’d do well to have a nurse midwife on hand. They can help if the mom or new baby needs on the spot healthcare assistance. Nurse Practitioner Provides comprehensive assessment of patients including diagnosing diseases, disorders and conditions. Initiates treatment including healthcare management, therapeutic interventions and prescribes medications.

Emily Elizabeth Clark demonstrated early in life a respect for others, a desire to help those in need and an ability to always do the right thing, especially when temptation looked her square in the eyes. As a 4-year-old, she was left in a room with an extensive ceramic bird collection at a neighbor’s home. Fearing a calamity in the making, her father set some rules: “Don’t touch the birds. If you touch any of the birds, you’ll get a timeout.” When he returned, he found Emily in the corner, having put herself in timeout. When asked why, she replied, “Because in just a minute I’m going to go over there and touch one of those birds, ” said Derek Ray, a pastor of care and counseling at Cedarcrest Church in Acworth. That memory brought a moment of levity to soothe the sorrow of the more than 400 family members and friends who gathered Sunday at Burnt Hickory Baptist Church in Powder Springs to say goodbye to the 20-year-old from Cobb County. Clark was one of five Georgia Southern University nursing students — two from metro Atlanta — killed Wednesday in an early-morning multiple-vehicle crash near Savannah that injured two others. Family and friends of fellow metro Atlantan Catherine “McKay” Pittman of Alpharetta said their goodbyes to her during services Saturday. Clark’s services included photos and a video of a happy, vibrant young woman speaking directly to the camera, telling stories, laughing at herself and throwing her face in her hands giggling in a fun moment of self-reflection. Tears welled in the eyes of loved ones as they watched. “There is a lot of pain because we can’t touch her or as her mom would say, ‘I can’t talk to her, ’” family friend Heather Woods said in a statement. “But the pain is eased with the joy she gave while here on Earth. So we realize that whatever time you got with Emily, whether it be 20 years like her parents, five years or one, it was a gift. We were given so much more than we lost.” Kevin Cash, Clark’s uncle, said her family saw in her an amazing young lady who enjoyed going to Hobby Lobby with her mother, popcorn movie nights and reaching out to her dad via text because she wanted to always let him know he was special to her. “She was exactly what any parent hoped for, ” Cash said. Cedarcrest senior pastor George Wright acknowledged the senselessness of Clark’s death, but said Clark had faith in God and would tell everyone to turn to him to help them through.

Telecommuting provides an attractive option for nurses seeking flexibility and work-life balance. Many large companies hire nurses to work from home doing a variety of jobs. Here's a look at three options: triage (also called telehealth), medical transcription and case management. Telehealth Over the past three years, McKesson Health Solutions, a healthcare services and IT provider, has increased its at-home worker population from 13 to more than 500 agents. Most are RNs who provide over-the-phone triage and disease-management services. Patients can call in with health questions, while nurses make outbound calls to patients with chronic conditions such as asthma and diabetes. To qualify as a telehealth nurse for McKesson, candidates should have at least an associate's degree in nursing, three to five years of recent acute nursing experience, and strong clinical documentation and assessment skills. They should also be self-motivated and enjoy working independently. In addition, they must have strong Internet and typing skills and a working knowledge of Windows. "We can offer nurses the kind of flexibility they often can't find in other jobs, " says Linda Casey, senior operations manager at McKesson. "We can ensure their schedule allows them time to attend their children's soccer games as well as other personal appointments." Salaries and benefits for telehealth nurses are very competitive, and openings exist nationwide, Casey says. Medical Transcription Another option for nurses seeking to work from home is medical transcription, an occupation the Bureau of Labor Statistics projects will experience faster-than-average growth through 2014. Transcriptionists transcribe recordings made by physicians and other healthcare professionals into medical reports, correspondence and other administrative material. Flexibility and the opportunity to set their own hours make medical transcription a viable career choice for nurses with young children or for those seeking a less-demanding job than traditional hospital work. Community colleges and online providers, such as Career Step and Education to Go, offer medical transcription courses. Prices may vary significantly. "Nurses who work in the medical transcription field can either obtain assignments from medical transcription service providers such as MedQuist and Spheris or become independent contractors and market their skills to local doctors and medical groups, " says Chris Dunn, president of Career Step, whose nine- to 12-month, self-paced online course has qualified many nurses to work in the field.

First of all, let’s establish what each one stands for. A BSN is a Bachelor of Science in Nursing, while an ADN is an Associates Degree in Nursing. Both degrees lead to getting your RN but there are some differences between the two. The main difference is the length of time and the amount of credits required to complete the program. An ADN typically takes 2 years to complete while a BSN will take 4 years to complete (including the time spent taking the prerequisites to enter the program.) There are also accelerated BSN programs (18-21 months) for students who have already obtained a previous Bachelor’s degree. Both programs would include the following in their core curriculum: Adult health, Maternal and newborn nursing, and pediatrics. Psychiatric nursing, community health nursing, and gerontological nursing are sometimes included as well. A BSN program would typically offer more courses in nursing theory, including nursing research, and nursing informatics, which is a field of study that examines how nurses use technology. Generally speaking, the starting rate is the same for an ADN or a BSN prepared nurse, but because many advanced positions require a BSN, the BSN prepared nurse does have the potential to earn more money. In 2006 the state of California conducted a survey of registered nurses. This survey showed that BSN prepared nurses have a mean income of $75, 017 while ADN prepared nurses had a mean income of $70, 804. Advantages to taking an ADN program: It is usually less expensive It is less time consuming – You will become a nurse quicker Advantages to taking the BSN: You will have more opportunities to advance to higher positions in nursing (for example as a nurse manager.) You will be prepared to enter a advanced degree program (for example, nurse practitioner, nurse midwife, or nurse anesthetist.) How common is one over the other? In the state of California in 2006, 46.6% of RN licenses were obtained through ADN programs, while 37.7% of RN licenses were obained through a BSN program. The rest of the RN licenses were obtained through hospital based diploma programs. This is a type of nursing program which is administered by a hospital. When completing a diploma program, one is eligible to sit for the NCLEX (the exam to become an RN), however, no degree is obtained. Earn Your Nursing Degree! Campus or Online Programs – Featured Opportunity Do you enjoy working with people and helping them feel better? When you pursue a degree in nursing, you can learn how to help people get healthy and stay healthy.