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Biomedical subjects

Terry Fulmer

Publications and source records attributed to Terry Fulmer.

At least 19 recordsLinked to original sources
PubMed2006

Abuse and neglect in older adults with Alzheimer's disease.

Elder mistreatment is a serious issue that effects the lives of thousands of older adults and results in emotional difficulties, such as depression,feelings of inadequacy, self-loathing, and lowered self-esteem. It has been shown to result in family distress, impaired life functioning, and difficulties with cognition and has been linked to health problems,such as immunologic dysfunction, and increased mortality. As the population ages, and with it the numbers of persons afflicted by diseases such as Alzheimer's, understanding and recognizing elder mistreatment becomes an important factor in maintaining quality of life for older adults.

Activities of Daily Living↗
PubMed2005

Neglect assessment in urban emergency departments and confirmation by an expert clinical team.

BACKGROUND: Elder neglect accounts for over 70% of all adult protective services reports in the nation annually, and it has been estimated that there are over 70,000 new cases each year. The purpose of this study was to conduct elder neglect research in the emergency department (ED), using a dyadic vulnerability/risk-profiling framework for elder neglect. METHODS: Patients were recruited through four EDs in New York and Tampa from the beginning of February 2001 through the end of September 2003. Demographics, a Mini-Mental Status Examination score, and an initial elder assessment screen were collected. The diagnosis of neglect was then made by a Neglect Assessment Team (NAT) comprising a nurse, physician, and social worker, with extensive clinical experience in elder neglect. RESULTS: Of the 3664 ED screens of adults 70 years and older, 405 (11%) met the inclusion criteria and agreed to participate. Neglect was diagnosed by the NAT in 86 of the 405 cases reviewed. Demographic differences between neglect versus no neglect cases were examined using Fisher's exact test, and differences emerged between the 2 groups. CONCLUSION: This study documents the underreporting of cases of neglect as evidenced by differences in diagnoses by screeners versus experts. The research assistants screened positive for neglect in 5% (N=22) of the 405 cases. The NAT made the diagnosis of neglect in 22% (86/389) of the cases. This markedly different rate of neglect may mean that ED screens are important but may underestimate the true number of cases. Conversely, an NAT may make the diagnosis of neglect in an older adult more often given a higher sensitivity and a more robust knowledge base of the problem.

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PubMed2005

Dyadic vulnerability and risk profiling for elder neglect.

PURPOSE: Neglect of older adults accounts for 60% to 70% of all elder-mistreatment reports made to adult protective services. The purpose of this article is to report data from research, using a risk-and-vulnerability model, that captures the independent contributions of both the elder and the caregiver as they relate to the outcome of neglect. METHODS: Between February 2001 and September 2003, older adults were screened and recruited through four emergency departments in New York and Tampa. The diagnosis of neglect was made by an expert neglect-assessment team. Elders and their caregivers were then scheduled for separate face-to-face interviews after discharge. RESULTS: Constructs within the risk-and-vulnerability model were examined for scale-score significance based on the outcome diagnosis of neglect. In the risk domain, caregivers' functional status, childhood trauma, and personality were statistically significant. In the vulnerability domain, the elders' cognitive status, functional status, depression, social support, childhood trauma, and personality were significant. IMPLICATIONS: Findings from this study underscore the value of interdisciplinary assessment teams in emergency departments for screening elder neglect, with attention given to risk factors related to the caregiver and elder vulnerability factors, including reports of childhood trauma. The risk-and-vulnerability model may provide a link between the caregiving and neglect research. Data should be collected independently from both members of the elder-caregiver dyad in order for clinicians to understand factors related to elders who receive the diagnosis of neglect from interdisciplinary teams.

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PubMed2005

Geriatric interdisciplinary team training program: evaluation results.

Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implications of the program as a model of interdisciplinary education are discussed. Evaluation data from 537 student trainees are presented. At posttest, GITT trainees demonstrated improvement on all measures of attitudinal change, no change on the geriatric care planning measure, and a change in some of the questions on the test of team dynamics that varied by discipline. Changes were greatest for all the attitudinal measures with the self-reported Team Skills Scale indicating the most significant change--a change that is significant across medicine, nursing, and social work trainees.

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PubMed2005

Dentistry, nursing, and medicine: a comparison of core competencies.

Health care, including oral health care and oral health education, is under great stress in the United States. The cost of and access to care, the cost of dental education, and a shortage of educators have led leaders in dental education, organized dentistry, and the public sector to underscore the problem. One of the proposed solutions is to find synergies and new health care and education models by building bridges among the health professions. One potential solution is being implemented at the NYU College of Dentistry (NYUCD). Dentistry and nursing are seemingly unrelated professions, and they are rarely if ever modeled together. That is about to change with the joining together of NYUCD and the Division of Nursing of the NYU Steinhardt School of Education in creating a College of Nursing within the College of Dentistry. This process has not been without controversy. Following the Division of Nursing's request to join NYUCD, and the subsequent announcement of the proposed combination by NYU in December 2004, some members of the dental profession responded by questioning the appropriateness of the merger and the similarity of the two programs. Nevertheless, substantial parallels exist in the education and practice of dentists and nurse practitioners (NP) including basic, social, and some clinical science education, practice models, research synergies, and community service. However, similarities in the core competencies of these professions have not been analyzed formally and in detail. Accordingly, the purpose of this study was to compare the core competencies of nurse practitioner and dental education programs. The results show a surprising overlap of the core competencies of the dental and nursing professions (38 percent partial or total overlap). A similar overlap with medicine also exists, albeit lower (25.4 percent). These results are notable because they demonstrate that the three health professions, independently of one another, developed very similar basic competencies and learning objectives. These data should encourage other health professions programs to seek new collaborative models for education, beyond the current silos of training, and new health care delivery systems as has been strongly recommended by the Institute of Medicine. Such collaborative education redirects health care toward providing truly interdisciplinary comprehensive primary care for patients.

Competency-Based Education↗
PubMed2004

Nurses Improving Care to Health System Elders (NICHE): implementation of best practice models.

Nurses Improving Care to Health System Elders (NICHE) is a comprehensive program that hospitals use to foster system-wide improvements in the care of older patients. The authors report on a survey of 103 NICHE hospitals to determine perceptions of the NICHE program, the adoption of NICHE models and protocols, and the educational outcomes, policy changes, and benchmarks related to care of older patients established by the participating NICHE hospitals.

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PubMed2004

Progress in elder abuse screening and assessment instruments.

The responsibility of identifying elder mistreatment (EM) often falls on the healthcare professional. Many different screening and assessment instruments have been developed to aid healthcare professionals in making determinations about EM. The purpose of this article is to review existing EM screening and assessment instruments to examine progress in this field. The value and limitations of these instruments with regard to their use in different clinical and healthcare settings are discussed. The settings in which EM screening and assessment are conducted are also considered. The authors conclude that there is much to be done in terms of achieving consensus on what constitutes an appropriate screen or assessment instrument for detecting EM. Effort must be focused on instruments that can be used for brief, rapid screenings and those that can be used for more-detailed diagnostic assessments.

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PubMed2004

Using PDAs for data collection.

Advances in handheld computer technology are making data collection faster, easier, and more accurate. In this article, the use of personal digital assistants (PDAs) to collect data for a study on elder neglect is described and evaluated. Methods for integrating this technology into a research study are discussed as are suggestions for increasing the performance of data collectors using these devices. The authors offer some practical solutions for researchers and clinicians planning to use PDAs in their research.

Attitude of Health Personnel↗
PubMed2003

Themes from a grounded theory analysis of elder neglect assessment by experts.

PURPOSE: This paper describes one program that has developed a screening procedure for assessing elder mistreatment, with a special focus on elder neglect. The aim is to understand how expert neglect assessment teams process and diagnose complex geriatric cases referred for suspected elder neglect. What are the key themes that must be understood in order to determine if neglect should be suspected and confirmed? DESIGN AND METHODS: Transcripts of audio recordings of neglect assessment team meetings were analyzed by using grounded theory analysis. RESULTS: Four major themes emerged from the analysis of the transcripts. These themes were understanding the underlying health status of the elder and caregiver, understanding the socioeconomic and life circumstances of the dyad, credibility of data collected by others, and the consequences of the assessment outcome. IMPLICATIONS: These findings offer insight into the development of future clinical screening and assessment procedures used to make diagnoses about elder neglect, as well as the guidelines that govern neglect assessment. Understanding not only the high-risk signs and symptoms but also the context and consequences of neglect is critical. Future screening and assessment procedures should be developed with these data in mind.

Activities of Daily Living↗
PubMed2003

The geriatric interdisciplinary team training (GITT) program.

Geriatric interdisciplinary team training (GITT) is an initiative funded by the John A. Hartford Foundation since 1995. Building from the substantial knowledge gained from the Veteran's Administration project in interdisciplinary team training and lessons from the Pew Foundation initiative, GITT was reconceived by the Foundation to address the need for teams in the care of older adults in the new era of managed care and health care cost containment. This training program has served to help us understand attitudes toward teams, how teams function, and how teams should be trained in the changing health care environment, where length of stay is dramatically different from the earlier team training projects. This introductory paper provides an overview of GITT, and the companion papers give detail of the GITT curricula, measures and lessons learned.

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PubMed2003

Using case studies to evaluate students' ability to develop a geriatric interdisciplinary care plan.

The Geriatric Interdisciplinary Team Training (GITT) program, an educational intervention funded by The John A. Hartford Foundation of New York City, has trained more than 1800 health care professions students and clinicians throughout the United States. Evaluating the effectiveness of this training intervention has proven to be quite a challenge. Core measures were collected pre- and post-GITT training to evaluate student development as a result of GITT. This paper focuses on one of these core measures, the Test of Geriatric Interdisciplinary Care Planning (TGICP). This instrument, developed for the GITT program, is one mechanism created to test trainees' ability to develop an interdisciplinary plan of care. Using a case study methodology, this two-part instrument provides an innovative approach to quantifying and correlating responses from an interdisciplinary cohort of students. This paper will describe the development of the TGICP, including the creation and validation of the case studies, the framework for the questionnaire, and the coding and scoring mechanism created to evaluate trainee responses.

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PubMed2003

Using scripted video to assess interdisciplinary team effectiveness training outcomes.

As part of the Geriatric Interdisciplinary Team Training (GITT) Program funded by the John A. Hartford Foundation, the authors of this article worked to create an instrument, the Trainee Test of Team Dynamics, to assess health care trainees' understanding of team dynamics. The Trainee Test of Team Dynamics is a five-question written test designed to capture GITT trainees' knowledge of team process and skills in addressing conflict that is administered after watching a five-minute videotape of a simulated interdisciplinary health care team meeting. The test was created to measure health professions students' abilities to recognize effective geriatric health care teams, to respond to effective and ineffective team behaviors, and to determine whether or not the team meeting achieved its purpose: to meet the patient's needs for an interdisciplinary care plan. Scripts and test items developed and tested by practitioners in social work, medicine, public health, nursing and others assured a product that compensated for differences in educational level and occupation, yet captured accurate and appropriate responses. The results reported here include an analysis of 740 trainees' baseline responses from the multi-site educational programs to determine the construct validity of the new measure.

Adult↗
PubMed2002

The future history of gerontological nursing.

Having established an academic and clinical infrastructure, geriatric nursing is well positioned to play a central role in improving the health of the nation's older adults now and in the future. Currently, whether working independently, in collaborative practice with physicians, or as members of geriatric teams, geriatric nurse practitioners and clinical specialists have been shown to improve care to older adults in the community, in hospitals, and in skilled nursing facilities. Sixty-three master's programs now prepare advanced practice geriatric nurses. Geriatric nurse researchers have contributed to our understanding of the most pressing problems that impact profoundly on the health and quality of life of older adults. Despite these advances, the number of geriatric nurse specialists remains small, with only 4200 certified specialists and a serious shortage of geriatric nursing faculty. Geriatric nursing is moving to ensure geriatric competency in all nurses who work with older adults in the future. The future should see the benefits of current efforts to infuse geriatric content into baccalaureate programs that prepare registered nurses, into master's programs that prepare adult and family nurse practitioners, and into the day-to-day practice of the nation's 2.2 million practicing registered nurses.

Adult↗
PubMed2002

Implementing a geriatric resource nurse model.

The aging of the American population and its effects on healthcare centers require strategies and programs to ensure best practices for older patients. The authors describe an educational program, modification of a Geriatric Resource Nurse Model, and the use of a Geriatric Nurse Practitioner in implementing and integrating the clinical, psychosocial, and financial aspects that influence care needed by elderly patients and their families.

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