2.5 ANCC contact hours
The CE test for this article is available only online at www.NursingCenter.com/ CE/CNJ.
by Casey R. Shillam, Valorie J. Orton, Debbie Waring, and Sandy Madsen
Faith Community Nurses &Brown Bag Events Help Older Adults Manage Meds
ABSTRACT: Brown Bag Medication Review (BBMR) events, traditionally offered by pharmacists, improve medication manage- ment for older adults. This study incorporated faith community nurses (FCNs) in BBMR events, hypothesizing that support by the FCN during and following the event would reduce medication related problems and improve medication self-care practices of older adults. Results describe and support the role of FCNs in brown bag events.
KEY WORDS: brown bag events, faith community nursing, geriatrics, medication safety, polypharmacy
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Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. MEDICATION (MIS)USE? 76% use two or more prescription Other considerations in medication lder adults, the fastest drugs while 37% use five or more (Gu, management include financial hardship growing segment of the Dillon, & Burt, 2010). Older adults and the use of multiple pharmacies, United States popula- also have concomitant use of prescrip- especially when pharmacy data banks tion, are recognized as a tion medications and dietary supple- are not synchronized with one another. vulnerableO population with multiple ments that can cause problems (Nahin Drug interactions and side effects often health challenges (National Center et al., 2009). Although this high level are not reported as older adults don’t for Health Statistics, 2012). Although of medication use associated with want to bother their providers, so they an estimated 40 million people age 65 chronic illness conditions found with adjust doses or omit taking medications and older account for only 13% of the increasing age is often therapeutically without reporting these actions. total population (Federal Interagency necessary, excessive prescribing still Forum on Aging-Related Statistics contributes to multiple complications. HEALTHCARE ACCESS [FIFARS], 2012), they purchase at (Gu et al., 2010). Access to healthcare goes beyond least one-third of all U.S. prescriptions Many factors influence safe medi- having insurance coverage or adequate (Werder & Preskorn, 2003). In 2008, cation management in older adults. numbers of healthcare providers (HCPs) 16% of healthcare costs for Medicare Polypharmacy, the concurrent use of in a geographical area; neither insurance enrollees were spent on prescription several different medications, can be nor availability of providers guarantees drugs, with an average cost of $2,834 a serious issue contributing to poor that those who need healthcare will receive healthcare. The Institute of Medicine (IOM, 2011) determined that increased access to timely, quality care that achieves the best possible health outcomes can be expanded by Approximately 50% of older increasing the use of nursing roles outside of acute care settings such as adults do not take medications in transitional care, primary care, and as prescribed. through roles such as faith community nursing. This distinction highlights the importance of two different concepts determining access to healthcare: attaining health services to reach optimal health outcomes, and the role per person. Around 15% of Medicare health outcomes (Fulton & Allen, that nurses have in that determination. enrollees incurred costs of $5,000 or 2005; Gu et al., 2010). Simply tak- Faith community nurses (FCNs) more (FIFARS, 2012). For American ing multiple medications does not are in favorable positions to assist adults age 60 and older, more than necessarily create the problem; rather vulnerable populations with access problems begin when more medica- to healthcare. The American Nurses’ Casey R. Shillam, PhD, RN-BC, is an Assistant tions are prescribed than is clinically Association and Health Ministries Professor at the Johns Hopkins University School of necessary for the underlying chronic Association (2005) define the scope Nursing. Her clinical practice is in case management for assisted living residents and her research is in pain conditions, or patients become of FCN practice as a specialty that management for older adults. confused about their medications. “focuses on the intentional care of Valorie J. Orton, MS, RN-BC, CNL, is an Polypharmacy becomes especially the spirit as part of the process of Instructor at Seattle Pacific University. Her teaching responsibilities include nursing leadership and transition problematic for older adults when promoting holistic health and pre- into practice. the medication regimen includes venting or minimizing illness in a Debbie Waring, MSN, RN, is the former Direc- overlapping drugs for the same faith community” (p. 7). Faith com- tor of Education at Northwest Parish Nurse Ministries. She is currently in the ThD program at HOLOS therapeutic effect, with the prescrip- munity nursing has been identified as University Graduate Seminary. tion of optional drugs for an effect a dynamic process of working with Sandy Madsen, BSN, RN, is a Parish Nurse that could be managed by nonphar- faith community members and their Coordinator for Tuality Healthcare, a community-based hospital, and Education Coordinator for Northwest macological approaches, or with families to reach a wholeness of body, Parish Nurse Ministries. prescribing to treat adverse effects of mind, and spirit (Patterson, 2003). Accepted by peer review 11/14/12. medications (Shillam, 2011). Another Limitations in access to healthcare for Supplemental digital content is available for this complication: approximately 50% of older adults, including insufficient in- article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of older adults do not take medications surance coverage, inadequate numbers this article at journalofchristiannursing.com. as prescribed (Blackburn, Dobson, of providers, the inability to develop The authors declare no conflict of interest. Blackburn, & Wilson, 2005; Lee, long-standing therapeutic relation- DOI:10.1097/CNJ.0b013e3182831eff Grace, & Taylor, 2006). ships by many providers, and complex journalofchristiannursing.com JCN/April-JuneJCN/April-June 2013 2013 9191
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. healthcare needs, creates an ideal role distinguish color, shapes, and numbers? on medication self-care behaviors for the FCN to facilitate community Can they read the print on the label? (Swanlund et al., 2008). This includes healthcare. Can they clearly hear the directions? hoarding, improper storage, sharing Can they process complex directions? medications, intentional “flexibility” IMPROVING MEDICATION Many adults, regardless of age, fail to in dosing based on real or perceived SELF-CARE acknowledge they do not understand interference with lifestyle issues, and The concept of “self-care” in medica- instructions, especially in the context adherence to prescribed regimens tion administration is as complex as the of a hurried office visit or at a busy based on symptoms or how one feels chronic illnesses that require medications, pharmacy counter. Many medication from day-to-day (Banning, 2006; and the activities involved in taking directions are complex. When the Griffiths et al., 2004). Social network- medicines. Medication administration complexity of a medication regimen ing and family dynamics, that is where entails multiple aspects of cognitive increases, compliance decreases patients seek medication information (thinking/processing) skills, psychomo- (Griffiths, Johnson, Piper, & Langdon, and obtain support for medication tor competencies, and affective domains. 2004) and there is higher risk for management, also can influence self- All areas must be assessed and evaluated medication administration error. care for older adults. to collaboratively decide successful strat- Addressing knowledge deficits about egies for older adults to safely maintain medications and assessing cognitive/ BROWN BAG EVENTS medication self-administration. Because processing abilities is the first step to The community-based medication of their long-term relationships with improving safe self-medication review program known as Pharmacy older adults, FCNs are ideally suited to management practices for older adults. Brown Bag events has demonstrated
Medication administration entails multiple aspects of cognitive skills, psychomotor competencies, and affective domains.
assess knowledge levels and cognitive Difficulty with psychomotor com- effectiveness in evaluating current functioning, physical abilities, and be- petencies can pose a significant bar- medication use and identifying potential liefs and attitudes affecting medication rier in medication self-care activities. polypharmacy issues for older adults management. Adequate hand dexterity is essential, (Demarzo, Skyer-Branywene, & Feudo, Basic medication knowledge is whether that be removing pills from 2011). Brown bag events involve older essential for effective medication bottles or blister packs (Griffiths et al., adults bringing their current medica- management and patient safety (National 2004), drawing up liquids in drop- tions, vitamins, and other dietary Research Council, 2007). Patient and pers or syringes, or squeezing tubes or supplements in a brown paper bag to a family engagement is a key factor in inhalers. Many prescriptions include community location where the event preventing adverse medication-related directions such as “Take one-half pill is being held. Brown bag events can be events. All HCPs should seek to ensure two times a day.” This requires using held in conjunction with a health fair that patients and/or families and commercial pill-cutters or cutting or other community-based events, or caregivers are knowledgeable about the medication with a knife. Posture, held individually at key locations such what medications they are taking, why mobility, and joint flexibility must be as senior centers, libraries, churches, or they are taking them, and common side considered. A prescription for a foot community pharmacies. The event effects. However, simply providing cream will pose a significant problem allows for one-on-one evaluation of relevant information is not adequate for for patients who cannot easily reach the medication list with the older adult. changing behavior. Older adults may their feet. Unless intentionally assessed, This makes possible a comprehensive be challenged with cognitive decline psychomotor deficits can become an discussion of potential medication (Swanlund, Scherck, Metcalfe, & Jesek- unanticipated barrier to medication management problems, and offers a more Hale, 2008) and sensory-processing self-care. complete picture of an individual’s deficits. Vision and hearing are critical Attitudes, values, beliefs, and cultural current medication usage than medical pathways to assess: Can patients practices can have a significant impact or pharmacy records.
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Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Many brown bag events have improvement in medication self-care members. Persons meeting inclusion included only pharmacists. Although practices. criteria were invited to participate in this provides the opportunity for This study used a pretest–posttest the study prior to the BBMR. Inclu- older adults to receive important design with purposive sampling of sion criteria were (1) members of faith medication information, often there members of multiple faith communi- communities; and (2) taking at least is difficulty in reaching community- ties in the Pacific Northwest Portland one medication (either prescription, based populations of older adults. In Metropolitan area. The study proto- herbal, and/or over-the-counter) on a addition, pharmacists have limited col was approved by the Institutional daily basis. follow-up after the event to ensure Review Boards of the sponsoring The announcements for BBMR the information was understood academic institution and informed events included a medication history and recommended follow-up with consent was obtained by all partici- sheet for clients to complete and bring the primary care provider has been pants. The BBMR teams included an to the event along with their brown obtained. FCNs offer the consistency FCN and a pharmacist on location paper sack(s) of medications. Clients of continued relationship with the at two hospitals and four churches. were greeted by a volunteer then older adult within their faith com- The original template for this BBMR met privately with the FCN. Larger munity as well as the knowledge for was developed for Northwest Parish BBMR events hosting more than one supporting the older adult in success- Nurse Ministries (NPNM) by Yves congregation matched FCNs with ful medication practices. In a 2002 Vimegnon, MD. The FCN was added clients from each FCN’s own faith study, the introduction of an FCN to to the program with the intent of community. Even if the FCN was not the interprofessional team to coor- enhancing positive client outcomes. part of a client’s specific church, the dinate a Brown Bag Event resulted An added benefit of including role of the FCN was known to the in successful recruitment of higher FCNs is their ability to network with majority of clients. numbers of older adults and greater community partners. In our study, this The intake assessment consisted of follow-up after the event. A program was helpful in engaging a small, local reviewing general health status and involving a pharmacist, the primary community hospital for hosting one ensuring documentation of all medi- care provider, and an FCN resulted in BBMR event. This hospital was inter- cation information. Lifestyle issues significant decreases in the number of ested in addressing this issue due to the and real or perceived problems with medications, fewer medication-related high numbers of emergency depart- medications by the client or a family health problems, and improved health ment visits as a result of medication member were evaluated. A pharmacist outcomes including increased knowl- errors. The hospital offered a comfort- provided a private consultation based edge about not only medications, but able facility with easy access (parking, on standard principles of brown bag also underlying medical conditions bus, and lightrail access), along with review (Table 1) to evaluate the medi- (Schommer et al., 2002). library resources including Internet cation regimen with the older adult. Including the FCN in the brown access to the Micromedex system, as An exit interview with the FCN was bag medication event recognizes that well as reference periodicals (Physi- conducted individually with each par- holistic, faith-based nursing includes, at cians Drug Reference [PDR], Nursing ticipant to clarify follow-up recom- the very center of practice, the spiritual Drug Reference, Herbal Reference mendations, reinforce plans to follow dimension. Characteristics of spiritual Guides, etc.). For smaller faith com- recommendations, and to schedule nurturing include caring, presence, munities, it was ideal to host the event nursing follow-up visits. Follow- acceptance, patience, and compassion at the hospital where multiple faith up visits included interventions for as FCNs bring their practice to brown communities worked collaboratively to education and support, advocacy, and bag medication events. host the event. referrals, and to answer emerging Flyers, newsletters, and verbal an- questions. Privacy areas for consulta- DO FCNs IMPROVE BROWN nouncements for the BBMR events tion were provided at all events. BAG EVENTS? were distributed in various faith Each of the FCNs conducting the We conducted a study to describe community settings through FCNs in exit interviews attended a training the role of the FCN and medication the Northwest Parish Nurse Ministry session regarding the investigator- practices among older adults who Network. Many participants received designed survey. After the BBMR participated in Brown Bag Medication personal invitations from their FCN events, ongoing follow-up was provided Review (BBMR) events provided by due to ongoing relationships where the by the FCN during personal interactions pharmacists and FCNs. It was hypothe- FCN had personal knowledge of the within the faith community or during sized that with ongoing support by the client’s polypharmacy situation based a scheduled follow-up telephone call at FCN during and following the BBMR on home visits, hospital visits, blood 6 weeks after the BBMR. The survey event, participants would experience pressure screenings, or other FCN was re-administered via telephone or a reduction in problems associated activities. Additionally, the BBMR was in-person at 3 months after participa- with medication administration and an open to all surrounding community tion in the BBMR. journalofchristiannursing.com JCN/April-June 2013 93
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. STUDY RESULTS (range 50–95 years). Participants were time 1 and time 2. At time 1 the The FCNs collected data during predominantly female (73%); 61% had sample took an average of 9.7 ± 5.1 the exit interview on an investigator- a high school degree or some college, medications daily. After the BBMR developed survey. The 12-item survey and 31% held a college or postgraduate and FCN follow-up, time 2 data included demographic information degree. Time spent with clients be- revealed 6.7 ± 5.5 medications daily and questions to indicate the number tween the pharmacist and FCN at the (t(66) = 3.83, p < .001). In addition, at of times participants visited urgent BBMR events was 1.5 to 2 hours. time 1, 14.3% of participants reported care, the emergency department, their Exit interview data immediately they received important medication primary care provider, or talked with a after the BBMR (time 1) indicated that information from their FCN, and at pharmacist or FCN about medication- 37.3% of the sample had experienced a time 2 this increased to 30.9%. At time related issues. The survey also con- problem with medications in the previ- 2, 32% of the sample reported they tained questions with yes/no responses ous 6 months requiring a visit to their changed their medication behaviors as for general experiences with taking primary care provider, a pharmacist, or instructed by the FCN. medications such as forgetting to take the emergency department/urgent care medications, storage and proper center. Keeping old medications (51%), FCNs MAKE A DIFFERENCE disposal of medications, and use of forgetting to take a medication (31%), FCNs serve as educators, advocates, multiple pharmacies to fill prescrip- and using more than one pharmacy to and social supports to members of tions. Copies of the exit-interview fill a prescription (30%) were the most their faith communities, connecting (time 1) and 3-month follow-up encountered medication management their clients with multiple healthcare surveys (time 2) are available as problems. More medication characteris- resources within the community. supplemental digital content at tics for the sample are found in Table 2. The FCNs participating in this study http://links.lww.com/NCF-JCN/A18. A one-tailed t-test was used to reported they were able to provide Twenty FCNs from a variety of evaluate if a significant difference than ongoing education and follow-up Christian faith groups (including Cath- could be explained by random chance with their clients on critical medica- olic, Lutheran, Protestant) enrolled 67 alone occurred in the number of tion issues as shown in Table 3. Table participants in the study at time 1 (at medications taken before and after the 3 also reveals that in addition to end of BBMR), with 49 still enrolled BBMR and 3-month follow-up. A standard procedures undertaken in a at time 2 (3 months after BBMR) for statistically significant decrease oc- BBMR (Table 1), the use of the FCN a 73% retention rate. The mean age of curred in the number of medications role added unique elements to the the 49 participants was 75.8 ± 8.9 years taken daily by participants between events and to follow-up. Stories from
Table 1. Standard Components of Pharmacy Brown Bag Medication Review (BBMR) Events Action Important Points for Execution 1. Provide a clear description in • All prescription medicines (including oral, inhaled, injected, rectal, liquids, creams) advertisements to bring all • All over-the-counter medicine they take regularly medications in a sack/bag to • All vitamins and supplements the event • All herbal medicines 2. Emphasize potential for reduc- • Many older adults see quality of life and financial value in reducing the number of medications they tion in number of daily medica- are taking daily tions taken 3. Introduce the review process; • Are you taking any new medications since your last visit to your primary healthcare provider (HCP)? ask participants if they have • Have you stopped taking any medications since your last visit to your HCP? questions or areas of concern • Please show me what you take for your
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Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. the FCN’s relay the importance of Table 2. Self-Reported Medication Practices of Older their role in medication review. One FCN reported a case identi- Adults Attending the BBMR Events fying a male client using two dif- Medication n (% of sample) n (% of sample) Change from a ferent pharmacies—one supplying a Practices: Time 1 (N = 67) Time 2 (N = 34) Time 1 to Time 2 Coumadin prescription, and another Take medications 57 (85%) 30 (88%) 3% supplying a Warfarin; the client did as directed not realize he was receiving a double- Ask pharmacist dose of the same medication. At questions about new 51 (76%) 26 (76%) no change 2 weeks, the FCN called to confirm medications Knowledgeable about his follow-up appointment with his 48 (72%) 33 (97%) 25% physician. At that time, the client medications taken Keep old medications still had not made the appointment, 34 (51%) 18 (53%) 2% and the FCN was able to speak with not currently taking his wife on the phone emphasizing Use more than one the critical nature of the medication pharmacy to fill 20 (30%) 6 (18%) 12% error. The follow-up appointment prescriptions was finally made and his prescriptions Sometimes forget to 21 (31%) 7 (21%) 10% were corrected. take medications The 20 FCNs reported signifi- Sometimes take an 3 (4%) 0 (0%) 4% cant time was spent researching what extra dose resources were available to help with aTime 1 was at end of event; time 2 at 3 months after event. Total participants at time 2 was 49; however, two medication self-care. In one case, a FCNs did not complete this portion of the follow-up evaluation, so participants with missing data were not included woman who used syringes/needles in analysis of these medication practices. to administer medications reported having multiple full needle boxes in Table 3. Unique Contributions Reported by Faith her home, but did not know how to Community Nurses in the BBMR Events and Follow-Up properly dispose of them. The FCN explored what the client had been • Recruitment of ideal “at-risk” clients/participants told by her primary care provider, • Nursing assessment (generalized health, review of health history, evaluation of concerns what resources were available in the with medications) community for disposal procedures, • Review/verification of medication records including prescription, over-the-counter, herbal, and the cost involved for disposal. and supplement medications prior to meeting with pharmacist Eventually the FCN helped the client • Follow-up visits to confirm the clients’ understanding of recommendations at conclusion of identify a mail order disposal service. BBMR, 6 weeks, and 3 months after event Additional stories demonstrate the • Mobilize local medication safety/efficacy resources (education materials, prescription drug impact of financial strains when mak- assistance programs, medication disposal information, insurance information) ing decisions about taking medica- tions. One client stated “eating half an • Individualized medication reminder systems, fold-up pocket instruction cards apple is better than eating no apple” • Education on use of multiple pharmacies increasing potential for medication errors and he had applied this to his medi- cations. Not understanding dosing • Instruction in disposal of needle boxes as biohazard material and therapeutic medication levels he • Instruction for clients who reduce their medication doses to save money; advocacy efforts told the FCN, “At least I get some to assist in paying for medications, attain free samples, use of less-expensive pharmacies, benefit if I make it [the medication] discussing generic medications with their provider; enlisting the help of family members, last longer.” Another client described community partners, and friends keeping her house at 50 degrees in • Exit nursing assessment including personal health counseling, health education, advocacy, the winter and wearing many layers of referral, integration of faith and health as directed by client clothes along with using blankets so that money was available for medica- tions. The FCN’s found it difficult needed items or services. The FCN STUDY LIMITATIONS AND to uncover such information due to who discovered the client who kept RECOMMENDATIONS patient shame and embarrassment. her home at 50 degrees collected A limitation of this study was lack Interventions included connecting the funds to pay the client’s electric bill of control over and assessment of clients with community resources, and and also provided gift certificates to a what the FCNs did with clients at the collecting money from the church for local grocery store. BBMR events and in follow-up. The journalofchristiannursing.com JCN/April-June 2013 95
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. small sample size and a low retention These findings suggest that the FCN rate at time 2 (3 months after BBMR) can be instrumental to coordinate and Web Resources and only 33% at time 3 (6 months after facilitate the effective management • Brown Bag Toolkit—http://www. BBMR), limit the broad application of of medications in older adult popula- ohiopatientsafety.org/meds/ study results. Because the sample was tions. Older adults comprise the largest default.htm predominantly female, it is not known group of those attending churches, • Brown Bag Event Planning— what impact having more male partici- synagogues, or other meeting spaces for http://www.ca.uky.edu/hes/ pants would have had on study results. faith groups: over 65% of older adults fcs/heel/factsheets/HEEL- LEJ.100d.pdf To more fully understand implications identify themselves as religious and of the FCN role in BBMR events, over 55% attend religious services on future studies need to control and mea- a weekly basis (Pew Research Center, sure the delivery of the FCN interven- 2008). The FCN scope-of-practice Griffiths, R., Johnson, M., & Langdon, R. (2004). A tions more closely, attempt to recruit emphasizes facilitation of interdisci- nursing intervention for the quality use of medicines by males and females equally, and engage plinary teamwork and communication elderly community clients. International Journal of Nursing participants to remain in the study. to decrease risks and maximize optimal Practice, 10(4), 166–176. Despite these limitations, this study health outcomes for members of the Gu, Q., Dillon, C. F., & Burt, V. L. (2010). Prescription drug use continues to increase: U.S. prescription drug data for 2007- supports the FCN role in promoting faith community. This definition of 2008. National Center for Health Statistics (NCHS) Data medication self-care in older adults. nursing practice aligns itself well with Brief Number 42 September 2012. Retrieved from http:// Although FCNs are not typically a part the role of the FCN described in this www.cdc.gov/nchs/data/databriefs/db42.htm of BBMR events, the FCN added a intervention of the BBMR event. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: valuable dimension to the program The integration of faith and health in National Academies Press. (Table 3), allowing for sustained conjunction with the often long-term Lee, J. K., Grace, K. A., & Taylor, A. J. (2006). Effect relationships and follow-up with relationship within the faith commu- of a pharmacy care program on medication adher- older adults of the faith community. nity strengthens older adults’ level of ence and persistence, blood pressure, and low-density lipoprotein cholesterol: A randomized, controlled trial. Future studies may consider adding a trust and willingness to participate in Journal of the American Medical Association, 296(21), measure of spiritual care or religious BBMR events conducted by FCNs, 2563–2571. practice to the evaluation to allow thereby improving their medication Nahin, R. L., Pecha, M., Welmerink, D. B., Sink, K., quantifying the many components self-care practices. DeKosky, S. T., & Fitzpatrick, A. L. (2009). Concomi- tant use of prescription drugs and dietary supplements FCNs provide in their nursing care. in ambulatory elderly people. Journal of the American We also recommend incorporating Acknowledgments Geriatrics Society, 57(7), 1197–1205. reliable, valid measures for capturing The authors presented the findings National Center for Health Statistics. (2012). Summary the concepts of quality of life and of this study at the 43rd Annual Health Statistics for the U.S. Population: National Health Interview Survey, 2011 DHHS Publication No. (PHS) quality of health in the older adult Western Institute of Nursing “Com- 2013-1583. Retrieved from http://www.cdc.gov/nchs/data/ participants. municating Nursing Research” series/sr_10/sr10_255.pdf Conference in Las Vegas, Nevada. This National Research Council. (2007). Preventing medication SUSTAINED BENEFITS study was funded by the Omicron errors: Quality chasm series. Washington, DC: National Academies Press. Our findings suggest that includ- Upsilon Chapter of Sigma Theta Tau Patterson, D. (2003). The essential parish nurse: ABCs ing an FCN in the BBMR results in International. for congregational health ministry. Cleveland, OH: sustained follow-up and in improved Pilgrim. medication management behaviors American Nurses’ Association and Health Ministries Pew Research Center. (2008). Religious affiliation: Association. (2005). Faith community nursing: Scope and in community-dwelling older adults. Diverse and dynamic. U.S. Religious Landscape Survey. standards of practice. Silver Springs, MD: Author. Retrieved from http://religions.pewforum.org/pdf/ Because the FCN already is a member Banning, M. (2006). Medication review: The role report-religious-landscape-study-full.pdf of the faith community to which the of nurse prescribers and community matrons. Nurse Schommer, J. C., Byers, S. R., Pape, L. L., Cable, G. L., client belongs, a level of trust is formed Prescribing, 4(5), 198–204. Worley, M. M., & Sherrin, T. (2002). Interdisciplin- or already present when participating Blackburn, D. F., Dobson, R. T., Blackburn, J. L., & ary medication education in a church environment. Wilson, T. W. (2005). Cardiovascular morbidity associated American Journal of Health-System Pharmacy, 59(5), in the BBMR. The already-present with nonadherence to statin therapy. Pharmacotherapy, 423–428. bond facilitates an acceptance by the 25(8), 1035–1043. Shillam, C. R. (2011). Geriatric patients. In T. Woo & FCN of clients and their medication Demarzo, L., Skyer-Branywene, N., & Feudo, D. (2011). A. Wynne (Eds.). Pharmacotherapeutics for nurse practitioner practices, as well as honest disclosure Assessing older adults’ perceptions of medication prescribers (3rd ed., pp. 1423-1438). Philadelphia, PA: reviews offered by pharmacists. Journal of the American F.A. Davis. by the client to the FCN so self-care Pharmacists Association, 51(2), 271. Swanlund, S. L., Scherck, K. A., Metcalfe, S. A., & Jesek- medication practices can be enhanced. Federal Interagency Forum on Aging-Related Statistics. Hale, S. R., (2008). Keys to successful self-management The trusting and supportive relation- (July 2012). Older Americans 2012: Key indicators of of medications. Nursing Science Quarterly, 21(3), 238–246. ship with the FCN can lead to educa- well-being. Retrieved from http://www.agingstats.gov/ Werder, S., & Preskorn, S. (2003). Managing poly- Main_Site/Data/Data_2012.aspx tion, advocacy, and effective inter- pharmacy: Walking the fine line between help and Fulton, M. M., & Allen, E. R. (2005). Polypharmacy in harm. Current Psychiatry Online, 2(2). Retrieved from ventions that maximize therapeutic the elderly: A literature review. Journal of the American www.currentpsychiatry.com/2003_02/0203_poly benefits and limit safety concerns. Academy of Nurse Practitioners, 17(4), 123–132. pharmacy.asp
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Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.