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Dr. Joan Earle Hahn
Dr. Joan Earle Hahn

Health education. That was the most common service provided in home visits by nurse practitioners to aging developmentally disabled adults – followed by nutrition and weight management counseling – in a study conducted by Keene State’s Director of Nursing Joan Earle Hahn. The idea of the study was to give nurse practitioners a tool for helping adults with developmental disabilities stay healthy and manage their own health needs to avoid being placed in long-term care facilities. The results have implications for nurse practitioner training and the development of nursing curricula as well.

Dr. Hahn published the results of the study, “Using Nursing Intervention Classification in an Advance Practice Registered Nurse–Led Preventive Model for Adults Aging with Developmental Disabilities,” in the Journal of Nursing Scholarship. It was based on a larger study, conducted in Santa Monica, CA, by a team from UCLA, that sent nurse practitioners to visit over 400 community-dwelling adults, aged 75 or older, for an in-home assessment and follow up at three-month intervals. During the visits, the nurse practitioners conducted an in-home comprehensive geriatric assessment and assessed the adults, through a basic physical exam and screenings for hearing, vision, depression, and more, and set goals with the patient. Based on health needs, nurse practitioners then conducted appropriate “nursing interventions” – the term for actions taken to benefit the patient.

Typical interventions could include coaching on oral hygiene, routine health screenings, management of incontinence, or referral to a specialist. When it came to implementing similar studies with people with developmental disabilities, Dr. Hahn wanted to know what the nurses were actually doing for interventions. “We took a look at that data,” she says, “and if you look at frequencies, you can see that there are certain interventions that are used more often than others. What I wanted to know was, were there certain interventions that commonly occurred with one another?”

Fortunately, a group of researchers at the University of Iowa had identified over 400 nursing interventions in a taxonomy called “Nursing Intervention Classifications,” so the interventions delivered by nurse practitioners working with the adults with disabilities could be categorized and analyzed. Dr. Hahn, who began work on the study while she was teaching at UCLA and continued to work on it at the University of New Hampshire (she moved to Keene State’s Nursing Department last summer), turned to UNH statisticians Ernst Linder and Beth Roberts to make sense of the data.

The statisticians suggested doing an analysis known as “market basket,” which works like this: Say researchers catalogued all of the items that a group of grocery shoppers put into their carts. They could then see which items are more likely to be purchased in tandem. It could be, for instance, that a purchase of peanut butter may up the chances that a shopper has also purchased jelly, bread, and bananas.

So which nursing interventions were often found together? “What was interesting,” says Dr. Hahn, “was that the interventions that clustered together were really aimed at health promotion and health behaviors. For example, if a person had nutrition management help, they usually had weight management help. If they had weight management, they typically had behavior management.”

The results suggest that promoting healthy aging in people with developmental disabilities requires coupling the health screenings and promotion that all people need with those that focus on health risks and issues particular to people with developmental disabilities, Hahn writes in her paper on the study. The market basket analysis highlights nutrition, weight, and behavior management, along with health screenings, as key interventions. Health education was shown to be the most central nursing intervention in this in-home preventive intervention program for patients with developmental disabilities. “Knowing this validates the need for nurse practitioners to have the skills to teach persons with varying learning needs,” Dr. Hahn writes.

The study concludes that providing a model – a set of standardized interventions to address health promotion, illness prevention, and health education aimed specifically at older people with developmental disabilities – will help nurse practitioners address the needs of that population through in-home prevention.

Dr. Hahn has long been immersed in the fields of aging and developmental disabilities. Before becoming a nurse, she worked in group homes for people with intellectual disabilities. As a nursing student, she came to love gerontology. Her PhD dissertation focused on people with intellectual disabilities who lived in nursing homes.

“I’ve continued working in this field,” she says, “and what I really like about this project is, it’s really nursing focused. I’m very happy that this could be published in such a well-read journal, and I’m hoping that this work will be taken up and moved forward by other people.”

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