Articles

The ABCD approach for managing neuropsychiatric symptoms of dementia

Article Link – https://pubmed.ncbi.nlm.nih.gov/37471361/

Published 2023 Aug 1;53(8):24-28. doi: 10.1097/01.NURSE.0000942784.14340.1f.
The ABCD approach for managing neuropsychiatric symptoms of dementia
by Amy Siple

Affiliation

Amy Siple is a national speaker on healthcare issues that impact older adults and the empowerment of healthcare givers. She has served the primary care needs of residents in long-term care as an NP for over 2 decades.

PMID: 37471361 PMCID: PMC10355332 DOI: 10.1097/01.NURSE.0000942784.14340.1f
Free PMC article

The neuropsychiatric symptoms associated with dementia, often referred to as unwanted behaviors, are one of the most difficult aspects of this disorder for caregivers to navigate. This article presents strategies to manage dementia-related neuropsychiatric symptoms.

AANP State Award for Excellence Recipient Stands for Those Who Cannot Stand

Article Link – https://www.aanp.org/news-feed/aanp-state-award-for-excellence-winner-stands-for-those-who-cannot-stand

Published August 22, 2023

Become inspired by this Kansas nurse practitioner’s story advocating for the profession and prioritizing patient care.
Every year, the American Association of Nurse Practitioners® (AANP) honors deserving nurse practitioners (NPs) and NP advocates with the State Award for Excellence. This award is comprised of both the NP State Award for Excellence and the Advocate State Award for Excellence — the former is given to an NP “in each state who has demonstrated excellence in clinical practice and has shown efforts to advance the image, profile and visibility of NPs at the state level,” and the latter “is given to an individual in each state who has made a significant contribution toward increasing awareness and recognition of NPs.”

Recipients of the State Award for Excellence are individuals who have raised awareness of and advocated on behalf of NPs and the transformative, person-centered work they provide for their patients and communities. Each state, district or territory may be represented by one NP and one NP advocate. In 2023, 51 NPs and 47 NP advocates were honored with a State Award for Excellence.

Amy Siple, APRN, FNP, GS-C, is one NP who received the NP State Award for Excellence in 2023. Hailing from Kansas — one of the most recent states to pass full practice authority (FPA) — Siple was involved in the passage of that legislation both as a member of AANP and president of the Kansas Advanced Practice Nurses Association. Speaking with AANP about her State Award, Siple also discussed what she believed helped her coalition pass FPA, her passion for helping older adults and her hopes for the future of health care.

Leading in Geriatric Care
Siple found her passion in geriatrics. “That has been such a blessing,” says Siple about working within this specialty. “I really enjoy the complexity of the clientele that I care for. Every day requires me to use lots of neurons, as I’m dealing with multiple comorbidities, polypharmacy and the opportunity to impact lives.” This impact was especially felt by her patients during the pandemic. “I was one of the only people allowed to go in [to see patients],” she remembers. “My management of their multiple comorbidities was not as critical at that time as me holding their hand, making eye contact with them and listening,” she says. “They had touch starvation, and the ability to just be a physical presence became more important than my knowledge about medicine and health care.”

Securing FPA for Patients and NPs in Kansas
Kansas became the 26th state to pass FPA on April 15, 2022. NPs and other advocates for high-quality health care access had worked for a decade to turn the proposed legislation into law. “It was nothing like I thought it would be,” said Siple of the political process. “You can’t come in with a bunch of evidence and think that’s going to work. First of all, you have to just sit and listen.”

What helped make the campaign for FPA successful was — in part — coalition building, which required bringing together multiple organizations and crisscrossing political lines. “We said, ‘We are going to keep the main issue the main issue. Everybody else is politically divided in this world, but we are not going to be.’” Building a coalition, related Siple, “was a game changer.” In addition to working with AANP, Siple and other NPs “went out and we gave speeches to these organizations, we met with their leaders and pulled in 25 outside organizations to fight with us.”

In addition to showing up in person, listening to legislators and making sure her organizations included “NPs on both sides of the political aisle,” Siple stressed the importance of patience in leadership. “It can be hard to lead really independent professional people. Don’t give up and recognize that your colleagues have a lot on the line. Just stay the course and make sure that you’re listening.”

Inspiring Broader Change
In addition to her work as an NP and organizational leader, Siple is a national speaker on aging and caring for older adults. One of the goals of her advocacy, she explains, is to give the families of geriatric patients the tools they need to support their elders in the comfort of their homes before moving them to an outside provider of long-term care. “I am confident this can be done if we can come alongside those caregivers and give them real, practical tools and resources for engaging with their loved ones,” Siple says. Right now, however, “so many people just really struggle with how to manage neuropsychiatric symptoms associated with dementia in particular.”

Siple is also an advocate for mindful prescribing of psychotropic medications for geriatric patients. Working directly with other health care providers, she is able to assist them in managing certain neuropsychiatric symptoms without psychotropic medication. Siple recounts assisting one facility move from being in the 91st percentile and I got them down to the 9th percentile. “We saw a decline in the report of behaviors. I’m really thrilled to have the opportunity to maybe repeat that.”

When asked what all her work has in common — her advocacy on behalf of the elderly, for increasing health care access and more — Siple spoke of her faith. “My personal mission for my life is to serve the Lord to the best of my ability, and to positively impact those in my sphere of influence,” she said. “I used to tell my nursing students — what your role is as a nurse or a NP is to stand for people when they cannot stand, and to speak for people when they cannot speak. A big part of your job is to be their advocate.”

Nominate an NP or Advocate for a State Award
Do you know an NP who you believe should be recognized for excellence in clinical care, or an NP or advocate who should be recognized for increasing awareness and recognition of NPs? If so, consider nominating (or self-nominating, if the NP or advocate is you!) a deserving individual for the 2024 State Award for Excellence by Sept. 11. Nominees are not required to be members of AANP, but they cannot be current AANP elected leaders. Recipients of this prestigious award will receive either an AANP membership or an extension on an existing membership, and many other advantages related to the 2024 AANP National Conference.

The Impact of Isolation

I have witnessed first hand the devastating effects of the lockdown and isolation of our long term care residents. Some facilities have required them to eat all meals alone in their rooms for the past six months. Weight loss and depression have been unprecedented. Eating is a social activity, after all. Services they previously had access to like podiatry, physical therapy, occupational therapy, speech therapy, and others were stopped. We have seen an increase in falls, weakness, bedsores, aspiration pneumonia, and many other complications including death. I was asked to do telehealth (which was basically face time) each month. This means the residents did not have a physical examination for up to 6 months in some instances.

The impact on the LTC staff has been extreme. Overnight they lost access to support from families, volunteers, entertainment for the residents (musicians, children, dog therapy…), the professionals listed above, and many others. The nursing staff was asked to provide all of these needs for the residents while their paperwork requirements increased. Compassion fatigue and burnout are at an all-time high. The best way for residents to receive socialization in some cases is to make a medical complaint like pain. Otherwise, they may be confined to their room. As you can imagine, resident concerns have increased due to this as well as the stress they are under. In addition, the risk of dementia is 50% higher for those in isolation. This further increases the workload of the staff.

The mortality risk of social isolation has been compared to smoking 15 cigarettes a day. Please refer to this article regarding the evidence around this issue: https://www.cdc.gov/aging/publications/features/lonely-older-adults.html. All-cause mortality is absolutely increased when we isolate residents. The complaint I hear from residents the most, besides the inability to see their family, is the lack of hair and foot care. This is a dignity issue. It is hard on our residents’ self-esteem to be denied access to these services. I literally have clients who I am allowed to see in person ask me to cut their hair.

CMS has come to recognize the unintended harm our lockdowns have caused. Last week they made the following recommendations:

Outdoor visits
Indoor visits if no new cases in the past 14 days with certain guidelines
clarify compassionate care situations – visits typically only allowed if someone is hours from death. CMS states there are many other reasons to allow visits like when a resident is experiencing emotional distress, needs help with eating, is grieving, recent admit with adjustment problems…

I hope the facilities choose to implement these suggestions. Yesterday someone informed me he was going to stop going to dialysis because he was so tired of being isolated and alone. He is choosing death over loneliness. This is only one case. I could give you countless more. We need to protect our older adults from COVID 19 and the unintended consequences of isolation. There must be a balance.

Has COVID-19 Flipped QSEN on its head?

Quality and Safety Education for Nurses (QSEN) has provided a theoretical framework for patient care delivery for the past fifteen years. COVID-19 has required us to rethink how we incorporate QSEN competencies, especially in our long-term care environments. The first three competencies of QSEN involve patient-centered care, teamwork, and evidence-based practice. How can you accomplish this in the face of a novel virus in the middle of a pandemic?

Are we poisoning our seniors?

Through the years, I have seen many clients who transitioned to hospice show considerable improvement in their condition. The primary reason for this is probably secondary to the cessation of all meds not related to comfort. Polypharmacy has become an epidemic in our older adult population. The World Health Organization recognizes medication-related harm as a global health issue. When two drugs are used in combination, the potential for interaction is about 6%. When someone is on five drugs, the risk of interactions increases to 50% and by the time someone is taking more than eight medications, the risk of drug to drug interactions rises to almost 100%. Some of these interactions can result in morbidity and mortality often masquerading as falls or delirium and are thus misclassified and unrecognized. Furthermore, older adults undergo physiologic changes in absorption, distribution, metabolism, and excretion of medications that compound their risk of harm.

Nursing Professor Amy Siple Shows Students Many Ways to Help Others

This article was originally posted by Newman University. View original article.

When Associate Professor of Nursing Amy Siple learned that several children in Wichita needed glasses but couldn’t afford them, she began looking for people who had the ability to meet that need.

Student Mary Cracraft Saves Grandmother’s Life Using Skills Learned in Nursing Program

Originally posted by Newman University’ Inside Newman. View original article.

Mary Cracraft is a third-semester nursing student at Newman University. During the 2016 Christmas break, she traveled to Blythdale, Mo., to spend time with her family. One night Cracraft felt a strong gut feeling to check up on her grandmother. The feeling was so strong she knew she could not ignore it.

Kansas Governor Invites Nursing Professor to Help with Alzheimer’s Group

Written by Scarlett Olsen and originally posted on the Newman University news site, Newman Today. View original article.

Amy Siple, associate professor of nursing, has been appointed by Kansas Gov. Jeff Colyer to serve as a member of the Alzheimer’s disease Plan Working Group for the state.

Nursing students help Wichita’s under-served

Written by Jack Schafer and originally posted on the Newman University’s student newspaper, The Vantage. View original article.

At least six Newman staff, students and faculty members volunteered for the second year of Medical Mission at Home, a free healthcare event at Mueller Magnet Elementary School on April 14 that allowed the local underserved to get treatment for their needs.

Amy Siple: A Calling to Care

This article was originally published by Newman University. View original article.

Amy Siple, associate professor of nursing at Newman University, has been helping patients with dementia and their families since the beginning of her nursing career.