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Biomedical subjects

T Fulmer

Publications and source records attributed to T Fulmer.

At least 19 recordsLinked to original sources
PubMed1998

Home health nurses' initial experiences with wireless, pen-based computing.

Eight home health nurses from the Visiting Nurse Service of New York participated in a focus group discussion after their initial experiences using wireless, pen-based computing in the inner-city, home care environment. Transcripts of the nurses' responses to open-ended questions were analyzed and central themes were found, following the method of concept analysis described by Strauss and Corbin (1990). The central concepts were "Readiness," "A thousand pounds on my back," "Call for support," "Problems with transmission," "Using the computer as an assistant," "Nurses discovered glitches," and "Everybody has to have a computer." These themes reflected the nurses' initial experiences with the wireless computers and also revealed their concerns. This article will describe these themes and will discuss the implications of current improvements in wireless computing for health care. The focus group themes aided in understanding how this group of experienced home health nurses began to transition from handwriting on several different forms to checking-off items on a small, hand-held computer screen, from innovating methods to communicate when telephones were not available, to using a wireless computer to send and receive data involved in the patient admission process

Attitude of Health Personnel↗
PubMed1998

Rethinking geriatric nursing.

Geriatric nursing has radically progressed in the past 2 decades, moving from a custodial approach, to one that is anticipatory, evidenced-based, and proactive. This article provides a brief overview on the new thinking that is shaping geriatric nursing practice. Active interventions are discussed within the interdisciplinary mandate.

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PubMed1998

Neglect in the elderly patient.

This article provides a brief overview of elder mistreatment, and then focuses on the major problem of elder neglect. Neglect is the most prevalent and least well understood component of elder mistreatment, and it is crucial that nurses who work with older people gain a better understanding of this problem. The article also presents models for understanding the problem, as well as provides recommendations for practice.

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PubMed1997

Evaluating the caregiver's intervention in the elder's task performance: capacity versus actual behavior.

As an elder's functional impairment increases, so in general does the tendency for the caregiver to intervene in the elder's daily activities and initiatives. To a certain extent, such intervention is necessary to compensate for the elder's loss of independent ability, and without such intervention, adverse outcomes for the elder are a possibility. The need for some intervention is usually clear-cut for advanced dementia, given its associated severe disability and handicap, but less clear in elders who are just beginning to show signs of cognitive decline. This study used the paradigm of medication management to look at whether the discrepancy between capacity for self-medication administration and actual self-administration behavior as demonstrated by the Medication Management Test (MMT) is greater for elders with poorer cognitive functioning. A sample of 51 cognitively impaired elders and 74 cognitively normal elders was used to look at the relationship between predicted capacity and actual self-administration of medication, stratifying by level of cognitive status. The highly significant concordance between the MMT score and caregivers' report of medication administration supports the expectation that capacity is influenced by cognitive status. In those discordant cases, further information is needed to interpret help in medication administration as excessive or insufficient intervention.

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PubMed1997

Introduction of wireless, pen-based computing among visiting nurses in the inner city: a qualitative study.

The purpose of this qualitative study is to understand how a sample of visiting nurses experienced the practice of home health nursing in the inner city and how they perceived the anticipated introduction of wireless, pen-based computing into their practice. Focus groups were held with visiting nurses 1 week before the introduction of the wireless, pen-based computers. The data were analyzed using Strauss and Corbin's (1990) method for concept development. The following central concepts emerged from the focus groups with visiting nurses: "Missing contact in the field," "Consumption of time writing on forms," "Using the computer to help with the practice of home health nursing," and "Home nursing is a lifeline." These concepts, based on the commentaries by visiting nurses, help one to understand the problems encountered by visiting nurses in the delivery of home health care, identify ways to incorporate evolving technologies to enhance nursing practice, and consider approaches to computer skill acquisition.

Community Health Nursing↗
PubMed1996

Substrate binding causes movement in the ATP binding domain of Escherichia coli adenylate kinase.

Crystallographic evidence suggests that there is a large hinged domain motion associated with substrate binding in adenylate kinase. To test this hypothesis, resonance energy transfer measurements of substrate binding were initiated. Adenylate kinase from Escherichia coli consists of three domains: the main body of the enzyme with alpha-helical and beta-sheet secondary structure, and domains that close over the AMP and ATP binding sites. Four single tryptophan mutants were constructed to map distances. Two tryptophan mutants were positioned at residues 133 (Y133W) and 137 (F137W), which are in the domain that closes over the ATP binding site. Mutant F86W that is located at the AMP binding site, and mutant S41W that is in the loop that close over AMP, complete the mapping library. Energy transfer was measured between each of these tryptophans and 5-[[2-(acetylamino)ethyl]amino]naphthalene-1-sulfonic acid (AEDANS) covalently bound to the single cysteine residue at position 77, which is located in the main body of adenylate kinase. The distance between the tryptophan of the F137W mutant adenylate kinase and the AEDANS-labeled Cys-77 decreased by 12.1 A upon the binding of the bisubstrate inhibitor P1, P5-bis(5'-adenosyl) pentaphosphate (AP5A). There were only small alterations in the tryptophan to Cys-77-AEDANS distances in the Y133W, F86W, and S41W mutants upon the binding of AP5A, ATP, or AMP, implying that movement of residues 133, 86, and 41 in relation to the Cys-77 residue was minimal. These results suggest that there is significant closure of the ATP binding domain upon the binding of ATP or AP5A. Unexpectedly, exposure of the enzyme to AMP also introduced a partial closure of the ATP hinged domain.

Adenosine Triphosphate↗
PubMed1994

A prospective community-based pilot study of risk factors for the investigation of elder mistreatment.

PURPOSE: To identify risk factors for the investigation of elder abuse, neglect, self-neglect, exploitation, and abandonment in a population-based observational cohort of community living elders. STUDY POPULATION: Population-based sample of 2,812 community-living men and women in New Haven, Connecticut who were over age 65 in 1982. METHODS: Matching process whereby cohort members who were investigated by Connecticut's State Ombudsman on Aging in 1985 or 1986 were identified. ANALYSIS: Relative risks for ombudsman investigation in 1985 or 1986 were calculated based on risk factors status at baseline interview in 1982. RESULTS: Sixty-eight (2.4%) members of the cohort received investigation. Features at cohort entry significantly associated with investigation in multiple logistic regression included: requiring assistance with feeding (Adjusted OR 3.5, 95% CI 1.2, 11.7), being a minority elder (Adj. OR 2.3, 95% CI 1.4, 2.8), over age 75 at cohort inception (Adj. OR 1.9, 95% CI 1.1, 3.1), and having a poor social network as defined by a social network index (Adj. OR 1.7, 95% CI 1.0, 2.7). When stratified by race, requiring assistance with feeding was associated with ombudsman investigation in minority elders (Adj. OR 10.8, 95% CI 2.8, 40.5) but not non-minority elders (Adj. OR 1.1, 95% CI 0.5, 7.5). CONCLUSION: Functional disability, minority status, older age, and poor social networks were associated with investigation for elder mistreatment in this prospective, community-based population of men and women over the age of 65.

Activities of Daily Living↗
PubMed1993

The Yale Geriatric Care Program: a model of care to prevent functional decline in hospitalized elderly patients.

OBJECTIVE: To describe the structure and implementation of the Yale Geriatric Care Program, an innovative, nursing-centered model for developing geriatric nursing expertise throughout an acute-care hospital. DESIGN: Descriptive study of an intervention in a prospective cohort of patients. SETTING: University teaching hospital. PATIENTS: Two hundred forty four patients aged 70 years and older on four non-intensive care intervention units during the study period (July 9, 1990 to July 31, 1991). INTERVENTION: The Geriatric Care Program involved an integrated model of primary nurses, specially trained unit-based geriatric resource nurses, gerontological nurse specialists, and geriatric physicians. The intervention included surveillance and identification of frail older patients, unit-based geriatric educational programs for all nurses, special education and support for the geriatric resource nurses, and twice-weekly rounds of the Geriatric Care Team. RESULTS: The Geriatric Care Program has been successfully implemented on four units. The interventions ranged from general clarification of goals in 226 (92%) to specific recommendations for management of immobility in 100 (41%), bladder/bowel problems in 99 (41%), pressure ulcer treatment or prevention in 61 (25%), confusion evaluation or management in 62 (25%), and adjustment of medications in 43 (18%). Overall, 68% of the specific recommendations were documented to have been implemented. Barriers to implementation of the program have included initial difficulties with recruitment and retainment of geriatric resource nurses (due to high nursing turnover and the increased time commitment required), breakdown in communication and carryover of recommendations between nursing shifts, and obstacles to communication between the nursing and medical staff. CONCLUSIONS: An innovative model of care, in which geriatric nursing was integrated as part of standard nursing care on selected medical and surgical units, has been designed and implemented. Evaluation of the effectiveness and costs of this intervention are currently underway.

Activities of Daily Living↗
PubMed1993

Recognizing elder abuse and neglect.

The signs and symptoms of elder abuse and neglect may mimic the signs and symptoms of many common chronic medical conditions in elderly persons. A complete assessment for elder abuse and neglect is time consuming and is best performed as a regimented evaluation that includes separate histories from the patient and suspected party and a clinical assessment that emphasizes function, cognition, and specific aspects of the physical examination. The management of elder abuse and neglect should be multidisciplinary with several key personnel participating. An elderly person in immediate danger should be removed from his or her environment. For less acute cases, a variety of interventions aimed at decreasing the stress of caregiving or ameliorating other family stressors may be appropriate. Most states require that clinicians who suspect elder abuse and neglect report their concerns to a designated authority. There are many gaps in our knowledge about elder abuse and neglect. It is hoped that with the future application of rigorous epidemiologic methodology as has been employed in the study of child abuse, this social ill can be better understood and prevented. Until then, clinicians must integrate their clinical experience and social skills to recognize the problem and provide thoughtful and compassionate intervention.

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PubMed1992

Elder mistreatment assessment as a part of everyday practice.

The prevention of elder mistreatment can be improved greatly with an effective strategy for assessment with a well-publicized protocol in the care setting involved. There are now several protocols available throughout the country (Figure 2), and it is up to each setting to organize a response that meets their needs while providing for the safety and well-being of the elderly with whom they come in contact.

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PubMed1992

Elderly patients in the emergency department.

Emergency department nursing care of the older individual requires a specific knowledge base to ensure optimal outcomes. Health-care resource utilization specific to elderly patients in the emergency department and selected common health problems that bring older people to the emergency department are described. Distinctions between normal age-related changes and disease signs and symptoms are explained to provide emergency department nurses with the requisite information to care for the elderly appropriately.

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PubMed1991

Cancer control and the older person. Issues in treatment.

The Committee on Treatment acknowledged the paucity of information related to the management of cancer in older patients and identified short-term and long-term efforts to study these issues. Short-term efforts should focus on effects of cancer and cancer treatment on survival and quality of life, efficacy and toxicity of antineoplastic therapy, barriers to adequate treatment, alternative settings of cancer care, and special supportive care needs. Long-term efforts should focus on unique features of cancer in older patients, long-term effects of cancer and cancer treatment, and prevention and detection of new primary malignancies. The Committee recognized that our recent advances in cancer treatment including palliative surgery, limited surgery, radiosurgery, and antidotes to drug toxicity may improve the tolerance of antineoplastic therapy by older patients and be beneficial in terms of survival and quality of life.

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PubMed1986

Geriatric nursing in acute settings.

In conclusion, it is important to reiterate the interdependent nature of the functional health patterns as they relate to the geriatric patient in the acute care setting. Further, the combination of the primary nursing model with the functional health pattern approach that leads to subsequent nursing diagnoses provides a comprehensive care approach, which is so important for the elderly patient. As elders live longer, become frailer, and are subject to increasingly frequent hospitalizations, it will become more and more important to provide care in a manner that decreases fragmentation, increases individualization, and makes provisions for comprehensive and wholistic continuing care.

Activities of Daily Living↗