Missing Incidents in Community-Dwelling People with Dementia

Overview: At every stage of dementia, people with the condition are at risk for both missing incidents, in which they are unattended and unable to navigate a safe return to their caregiver, and “wandering,” a term often used to describe repetitive locomotion with patterns such as lapping or pacing. By understanding the differences between these two phenomena, nurses can teach caregivers how to anticipate and prevent missing incidents, which are not necessarily related to wandering. The authors differentiate missing incidents from wandering, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents

For Caregiver Sleep: Not All Stressors are Created Equal

Background: Disturbing behavioral symptoms of dementia, including delusions, hallucinations, nighttime behavior, and so forth, are reported by caregivers as some of the most difficult aspects of providing care. Caregivers also report interrupted and inadequate sleep. This may be, in part, due to the particular stress experienced when managing difficult behavioral symptoms in the relative with dementia. This study examines whether caregiver sleep may be affected by these behavioral problems in terms of the total number of behaviors, the severity of the behaviors and the distress the caregiver perceives. Methods: In a controlled clinical trial 47 dementia caregivers were followed for five months; 23 caregivers received a night monitoring system (NMS) intervention to awaken the caregiver when the person with dementia left the bed. Sleep was measured for 7-day intervals at five points in time using (1) Actigraphy, an objective, noninvasive method of monitoring sleep/wake cycles and, (2) a sleep diary. Hierarchical linear modeling statistical techniques were used to examine the relationship between behavioral problems [the Neuropsychiatric Inventory Questionnaire (NPI-Q)] and caregiver sleep [total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO)]. System effects will be explored with further analyses to determine between-group differences in caregiver sleep based on the NMS intervention. Conclusions: Caregivers who spend more time awake after sleep onset reported more behavioral symptoms of dementia than their counterparts. This study\u27s findings suggest that having to manage high numbers of behaviors results in a high stress burden and the difficulty of remaining asleep through the night, but not total burden scores. This lends credence to the theory that not all stressors are created equal, and certain stressors, such as a high number of behavioral symptoms, have a large impact on caregivers

The impact of full practice authority on nurse practitioner compensation, collaboration, and billing

BACKGROUND: Although there is a substantial body of evidence regarding full practice authority\u27s (FPA) effects on health care access and quality, very little research has examined how nurse practitioner (NP) licensure laws affect the status of NPs as clinicians, employees, and leaders in health care organizations. PURPOSE: This study examined whether states\u27 implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs\u27 and whether NPs\u27 gains from FPA increase over time in states where FPA has been in effect longer. METHODOLOGY: Data from a nationwide survey of licensed NPs (N = 5,770) were used to compare NPs\u27 employment conditions between FPA and non-FPA states. After balancing the FPA and non-FPA groups on demographic characteristics (e.g., urbanicity, education), adjusted mean differences in outcomes between the groups were estimated using weighted multivariable regression. RESULTS: Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings (p \u3c .05), were more likely to be practice owners or shareholders (p \u3c .01), and billed a greater percentage of their patient visits under their own National Provider Identifier (p \u3c .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA \u3c10 years. CONCLUSIONS: States\u27 adoption of FPA for NPs is associated with improved conditions of employment among NPs. IMPLICATIONS: Untethering NPs from physicians establishes a cascade of modest gains in income and practice ownership that may indicate changes over time. Additional research is needed to determine the trajectory of these increases and if they are consistent