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Biomedical subjects

Karen Zulkowski

Publications and source records attributed to Karen Zulkowski.

At least 19 recordsLinked to original sources
PubMed2007

Certification and education: do they affect pressure ulcer knowledge in nursing?

OBJECTIVE: To determine whether wound care certification and education affect nursing knowledge. This study examined pressure ulcer knowledge among registered nurses who were (1) certified in wound care, (2) certified in specialty areas other than wound care, or (3) not certified in any specialty area. DESIGN: A convenience sample of 460 nurses, located in both urban and rural areas, provided demographic information and completed a standardized pressure ulcer knowledge test using (Pieper Pressure Ulcer Knowledge Tool). RESULTS: The mean standardized test score for the total sample was 78%, with nurses certified in wound care scoring 89%, nurses certified in specialties other than wound care scoring 78%, and nurses receiving no certification scoring 76.5%. CONCLUSION: Wound care certification and education significantly affect nursing knowledge.

Adult↗
PubMed2006

Nutrition and aging: a transdisciplinary approach.

Numerous factors may predispose the elderly to decreased nutritional status. These include physical (illness, physiological changes related to aging, pain, and gastro-intestinal issues), psychological (depression), and socio-economic (income and decreased mobility that leads to isolation and loneliness). The latter may affect food insecurity and the ability to nourish and hydrate. When nutrition suffers, wellness and healing cannot be sustained. Healthcare providers should 1) be aware of the care implications associated with decreased nutritional status, 2) assess nutritional status, and 3) individualize treatment plans, providing and/or pursuing assistance for persons at risk for nutritional deficiency by interceding with commercially prepared products, medications, and supplements and securing consultations with dietitians. A transdisciplinary team approach (multidisciplinary across specialties and settings) can provide the needed care.

Aged↗
PubMed2005

Patient perceptions and provider documentation of diabetes care in rural areas.

Measures of effective diabetes management usually include laboratory results and the provider's point of view, omitting the patient perspective. To address this oversight, a descriptive study was conducted to examine congruence between rural patient self-reported and provider-documented information on American Diabetes Association recommended guidelines. Provider medical record information and patient questionnaires were matched for 149 patients with a diagnosis of type 2 diabetes being treated at rural healthcare facilities. Chi-squared testing showed a significant difference (P < 0.05) between patient and provider information in answers to questions on blood pressure and cholesterol testing, eye examination, influenza and pneumovax rates, and diabetic and nutrition education. Patients' perception of diabetes and blood pressure control did not always match documented values. To achieve diabetes control, providers must implement clinical practice guidelines and patients must take an active role in their disease management. Both must communicate effectively. This does not seem to be the case in rural areas.

Aged↗
PubMed2004

Bedrails: restraints or enablers?

Bedrails presently are used as both mobility restraints and enablers in long-term care facilities. As enablers, bedrails facilitate movement and may reduce the risk of pressure ulcer development. As restraints, they impede movement and may increase risk of ulcer development. Omnibus Budget Reconciliation Act regulations on restraint use have led to confusion for state Medicare surveyors and facilities regarding the definition of appropriate bedrail use and need for supportive documentation. Consequently, some facilities receive deficiency citations for inappropriate use or documentation while others do not. The purpose of this survey was to compare responses of Directors of Nursing in long-term care facilities and Medicare state surveyors to determine how each interprets the Omnibus Budget Reconciliation Act bedrail language for use and documentation. Questionnaires on bedrail use and documentation were sent to state surveyors and Directors of Nursing. One hundred, three (103) Directors of Nursing in 45 states and 65 surveyors from 39 states participated in the survey (response rate 61%). Study results demonstrated general acceptance of bedrail use as an enabler but not as a restraint by both Directors of Nursing and state surveyors. Four percent (4%) of Directors of Nursing reported receiving a citation for bedrail use and 59% of surveyors reported issuing citations for bedrail use. Significant differences were noted between the two groups regarding appropriate bedrail use and necessary documentation. The intent of Medicare guidelines and the Centers for Medicare and Medicaid Services is to standardize care for nursing home residents in the United States; yet, current regulations are open to individual interpretation by state surveyors and confusion exists between the intent of the Omnibus Budget Reconciliation Act and the daily operations of nursing homes. Educating clinicians about the risks and benefits of bedrail use, either as restraint or enabler, and developing interventions and policies for appropriate use would be an important first step in resolving this issue.

Aged↗
PubMed2004

Comparison of nutritional risk between urban and rural elderly.

Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nutrition. Looking at commonalties and differences between urban and rural elderly that are associated with nutritional risk is an important first step in identifying and correcting nutritional insufficiencies. To examine health behaviors and nutritional information associated with nutritional risk in urban and rural areas and to develop a profile of nutritional risk for rural and urban elderly, data from one retrospective and two prospective studies were analyzed. One hundred, eighty-three (183) urban-living and 167 rural-living older adults (average age 77 years old) participated in the studies. More than 60% of participants were women. Overall health ratings were significantly higher for urban than for rural elderly. Rural dwellers had significantly fewer dental visits (41% versus 76%) but higher albumin values than their urban counterparts. Results from the synthesis of these four studies indicate that as people become more physically debilitated and lose independence in daily activities, their risk for malnutrition increases and their quality of life decreases. Although rural residents are believed to be at higher risk of malnutrition, these results suggest that this may not be the case. Physical, social, and environmental factors may affect the nutritional status of seniors regardless of where they reside.

Aged↗
PubMed2003

Hydrogel wound dressings: where do we stand in 2003?

Among the many categories of advanced wound dressing products available today, hydrogels are popular because they are effective, comfortable, easy to use, and cost effective. With proper use, these agents provide control of wound surface hydration, sometimes absorbing excess exudate and often providing moisture. This review describes the chemistry of hydrogels, the physiology of their interaction with the wound surface, and their role in patient care. Hydrogels have been proven effective in facilitating repair of pressure, diabetic, vascular, burn, and other wounds, and they have supplanted saline-moistened gauze for many applications. Clinical evidence suggests that no particular hydrogel is significantly more efficacious than any other, implying that other factors such as cost and ease of use may guide clinician choice of product within this class of wound dressings.

Acrylic Resins↗
PubMed2002

Utilization and scope of practice of Nurse Practitioners and physician assistants in Montana.

PURPOSE: To explore the licensing, certification, governance and education requirements of nurse practitioners (NPs) and physician assistants (PAs) in the state of Montana. Services provided and privileges retained in employment were also analyzed. DATA SOURCES: This was a descriptive study using a survey of rural hospital administrators (N = 34). CONCLUSIONS: Survey results show that 92.5% of PAs in Montana meet their supervision requirement by a telephone contact provision outlined by the state board of medicine. In contrast, 54.2% of NPs, who are autonomous by legal definition, have a telephone supervision requirement imposed on them by their employers. IMPLICATIONS FOR PRACTICE: These findings have implications for the current and prospective professionals and the businesses for which they work. Nurse practitioners and their professional organizations need to consider the implications these findings have on the professional image and marketability of all NPs.

Certification↗
PubMed2002

Adherence to American Diabetes Association standards of care by rural health care providers.

OBJECTIVE: To determine whether rural health care providers are compliant with American Diabetes Association (ADA) clinical practice guidelines for glycemic, blood pressure, lipid management, and preventative services. RESEARCH DESIGN AND METHODS: This study was performed using a retrospective chart review of 399 patients 45 years of age and older, with a definitive diagnosis of diabetes seen for primary diabetes care at four rural health facilities in Montana between 1 January 1999 and 1 August 2000. RESULTS: Glycemic testing was adequate (85%), and glycemic control (HbA(1c) 7.43 +/- 1.7%) was above the national average. Comorbid conditions of hypertension and dyslipidemia were not as well managed. Mean systolic blood pressure (SBP) was 139 +/- 18.8 mmHg and LDL was 119 +/- 33 mg/dl. Of 399 patients, 11 were considered as needing no additional treatment based on ADA guidelines of an HbA(1c) level <7%, a BP <130/85 mmHg, and a LDL level <100 mg/dl. Monofilament testing and dilated eye examinations were poorly documented, as were immunizations. There were few referrals for diabetic education. CONCLUSIONS: Rural health care practitioners are not adequately following the ADA standards for comprehensive management of their patients with diabetes. Glycemic testing is being ordered, but HbA(1c) values indicate that patients do not have their diabetes under optimal control. The comorbid conditions of hypertension and dyslipidemia are not optimally managed according to the ADA guidelines.

Blood Pressure↗