bluuebunny/crossref_metadata_2025 huggingface dataset:
ACHIEVING RESTRAINT-FREE CARE of Acutely Confused Older Adults
Authors: Sullivan-Marx Eileen M
Published: May 2014

ABSTRACT

Restraint-free care has emerged as an indicator of quality care for older adults in all settings. The most difficult challenges to achieving this goal are care of hospitalized older adults who are functionally dependent and cognitively impaired. The purpose of this article is to report findings from a descriptive study of restrained hip fracture patients, and discuss approaches to achieving restraintfree care. Rate of restraint use was 33.2% among hospitalized hip fracture patients during an 11-year period in 20 metropolitan teaching hospitals. Restrained patients were older men who resided in nursing homes prior to hospitalization. Clinically, restrained patients had a diagnosis of dementia, were noted to be confused or disoriented by nursing staff, and were dependent in activities of daily living. An individualized approach to care is the best method to avoid use of physical restraints for patients with acute confusion and cognitive impairment.
Clinical Implications of Respiratory System Changes in Aging
Authors: Sheahan Sharon L , Musialowski Regina
Published: May 2014

ABSTRACT

Nurses must consider the many age-related respiratory system changes when assessing and managing respiratory-related symptoms of older individuals. This article reviews upper and lower respiratory tract changes and provides tips for clinical management of the older person. Pertinent respiratory symptom assessment scales are described. Smoking cessation and other health promotion counseling is discussed.
Evaluation of a Geriatrics Course Emphasizing Interdisciplinary Issues for Chiropractic Students
Authors: Hawk Cheryl , Byrd Lori , Killinger Lisa Z
Published: May 2014

Assessment instruments were used to measure change in students' attitudes toward care of older adults and interprofessional collaboration after participation in a model course.
A Public Policy Problem: Access to Long-Term Health Care
Authors: Dyck Mary J
Published: May 2014

The time is right for nurses to advocate Medicaid reform allowing older adults in all financial situations to receive equal care.
Continuing Care Nurses' Perceptions of Need for Physical Assessment Skills
Authors: Anderson Marjorie C , Skillen D Lynn , Knight Cheryl L
Published: May 2014

Computer-assisted instruction targeting priority learning needs is examined as a means to help nurse case managers enhance their skills.
Redesigning Nighttime Care FOR PERSONAL CARE RESIDENTS
Authors: O'Rourke Deanne J , Klaasen Kathleen S , Sloan Jeff A
Published: May 2014

ABSTRACT

This study investigated the effects of non-disruptive nighttime care for residents in a personal care setting. The sample consisted of 18 personal care home residents in an urban, 388bed, long-term care facility located in Winnipeg, Manitoba, Canada. The study used a quasiexperimental, single-arm design, exposing all residents to both intervention and control conditions. Independent variables were the current nighttime routine of regular rounds to turn and change residents, and a non-disruptive plan of care in which residents were checked hourly by staff and necessary care was provided when they were awake. Outcome variables included total sleep from evening bedtime to morning awakening, longest period of uninterrupted sleep at night, amount of time spent sleeping during the day, self-reported restfulness of cognitively intact residents, and skin condition. Findings suggested that the non-disruptive nighttime care routine increased total sleep by an average of 30 minutes a night for each resident. The amount of uninterrupted sleep increased by approximately 45 minutes with the new routine. No significant differences were noted in the amount of time spent sleeping during the day. There was no evidence of skin breakdown during any phase of the study. Clinical implications of this study demonstrate a need for gerontological nurses to re-evaluate nighttime care routines in personal care settings.
FAMILY CAREGIVER INTERVENTION RESEARCH
Authors: Farran Carol J
Published: May 2014

Where have we been?
MEN Providing Care to Older Adults in the Home
Authors: Houde Susan Crocker
Published: May 2014

ABSTRACT

Men are important providers of care to older adults who are functionally impaired in the home setting. Some results from research studies suggest that the male caregiver may provide different types of care and have different responses to caregiving than female caregivers. This article provides an overview of research related to the role of the male caregiver and discusses implications for supportive interventions. The need for more research related to the needs of the male caregivers and the value of traditional interventions for this group are addressed.
Family Caregivers' Attitudes Toward Aging, Caregiving, and Nursing Home Placement
Authors: Courts Nancy Fleming , Barba Beth E , Tesh Anita
Published: May 2014

ABSTRACT

Nursing home placement (NHP) is stressful both for older adults and for their family caregivers. This descriptive survey research investigated family caregivers' attitudes toward aging, their emotional appraisal of nursing home placement, and their reactions to caregiving roles. Eighty-eight survey packets were mailed and 35 usable packets were returned for a response rate of 39.5%. Sixty-four percent of the respondents were age 65 or older. Respondents reported that they felt "privileged to care" for their residents and that caregiving had little impact on their personal schedules. Further, they did not feel abandoned by other family members. Fifty percent reported feelings of sadness when thinking about nursing home placement though they indicated that they were mostly pleased. The respondents had mostly positive attitudes about aging. It may be that those who responded to the survey were coping at a high level. Caregiver reactions might differ in the group that did not respond. Included are specific nursing implications and needs for further research.
A Key to Successful Aging: Learning-Style Patterns of Older Adults
Authors: Van Wynen Elizabeth A
Published: May 2014

Health care providers need to understand older adults' style of learning to more effectively teach this population how to live longer, healthier lives.
"I hated those darn chickens...": The Power in Stories for Older Adults and Nurses
Authors: Hirst Sandra P , Raffin Shelley
Published: May 2014

ABSTRACT

Attention to stories provides a holistic view of an older adult and offers the potential for quality nursing intervention. Explored in this article is the power of stories to advance the well being of older adults and the implications for gerontological nurses of a commitment to support storytelling in this population.
Perceptions of Older Latino Adults Regarding Physical Fitness, Physical Activity, and Exercise
Authors: Melillo Karen Devereaux , Williamson Eileen , Houde Susan Crocker , Futrell May , Read Catherine Y , Campasano Marie
Published: May 2014

ABSTRACT

Healthy People 2000 has identified the importance of physical activity for healthy aging, but little is known about what motivates older individuals, older Latino adults, in particular, to be physically active. The purpose of this research was to examine the perceptions of older Latino adults toward physical fitness, physical activity, and exercise. This study used a qualitative focus group design. The sample of Latino adults age 60 and older resided in Northeast Massachusetts and was recruited from community settings which serve older Latino adults. Three focus groups, consisting of four to eight individuals in each group, were conducted and audiotaped. Data analysis used a combination of open, axial, and selective coding procedures. Focus group participants viewed physical fitness as being able to do anything; the mind and body working together; and feeling "light," being healthy. Support was viewed as a motivator of physical activity and exercise and included community resources, group support, cultural unity, and health provider assistance. Barriers of fear and a feeling of inappropriateness were identified by focus group participants. Although the study was exploratory and the sample size small, it provides useful cultural knowledge and information for community health and gerontological nurses. Knowledge about older Latino adults' perceptions of motivators and barriers to physical activity and exercise is a necessary first step for nurses to prescribe activities that will help improve functional independence and quality of life. Nurses can serve as links for older Latino adults in accessing community resources. Sociocultural factors that influence Latino adult perceptions must be assessed if health promotion program planning is to be tailored to meet individual and group needs.
The Effect of Physical Restraints on Fall Rates in Older Adults Who Are Institutionalized
Authors: Dunn Karen S
Published: May 2014

ABSTRACT

Since the Omnibus Budget Reconciliation Act (OBRA) of 1987, there has been a significant reduction in the use of physical restraints to prevent falls in older adults who are institutionalized because of the developing awareness of the physical and psychological problems associated with them. The purpose of this ex post facto descriptive study was to determine if there is a difference in falls when physical restraints are allowed or prohibited in one older adult population. Data from incident reports from a purposive sample of 97 older adults in one long-term care facility were analyzed before and after the implementation of a restraint-free policy. The results indicated no significant difference in the number of falls before and after the policy change. However, there was a significantly lower number of falls with injuries and a significantly higher number of falls without injuries. These findings suggest older adults will continue to fall with or without the use of physical restraints because of changes associated with the aging process and risk factors. Removing physical barriers from older adults and allowing freedom of movement may decrease the severity of injury sustained in a fall.
THIS IS Heaven's WAITING ROOM
Authors: Forbes Sarah
Published: May 2014

End of Life in One Nursing Home
Conceptualizing Resilience in Women Older Than 85
Authors: Felten Beverly Sigl , Hall Joanne M
Published: May 2014

ABSTRACT

Resilience in women older than 85 is defined as the ability to achieve, retain, or regain a level of physical or emotional health after devastating illness or loss. This concept analysis of resilience in women older than 85 is based on the strategy suggested by Meléis. Resilience in women older than 85 is symbolized by a coiled wire, enclosed within a box similar to a jack-in-the-box. Environmental factors within the jack-in-the-box include frailty, determination, previous experience with hardship in learning how to cope, access to care, culturally based health beliefs, family support, self-care activities, caring for others, and functioning like efficiently working machines. External factors that influence the ability of the wire to recoil include the structure of the box itself and stress. More study is needed regarding diverse older women's experiences of resilience to develop a workable, clinically focused theory.

OVERCOMING ADVERSITY FROM ILLNESS OR LOSS
Who Will Look After my Grandmother?
Authors: Happell Brenda , Brooker Jenny
Published: May 2014

Attitudes of Student Nurses Toward the Care of Older Adults

Gerontology is an unpopular area of study among Australian nursing students. Nurse educators are challenged to foster the development of more positive attitudes.
Barriers to Nutrition Care for Nursing Home Residents
Authors: Crogan Neva L , Shultz Jill A , Adams Carolyn E , Massey Linda K
Published: May 2014

ABSTRACT

The prevalence of protein-calorie malnutrition (PCM) in nursing home residents has reached 85% in some nursing homes and is linked to increased mortality among residents. Separate survey questionnaires were developed and administered to 99 nursing assistants and 44 nurses (35 RNs, 9 LPNs) from five eastern Washington nursing homes. The purpose was to assess nurse (RN, LPN) and nursing assistant perceived beliefs and views related to nutritional needs of nursing home residents that have a potential impact on PCM of residents. Experienced nursing assistants did not view the nurse as an active participant during mealtime. Specific barriers such as a lack of time and training, too many residents working short staffed, poor food quality, and a lack of nurse-nursing-assistant teamwork may contribute to residents not getting enough food to eat. An education program addressing staff relationships and nutrition training of nursing assistants could improve the ability of nursing staff to ensure residents' food intake and improve the quality of life for residents in nursing homes.
Nurse Caregiver FEELINGS About Agitation in ALZHEIMER'S DISEASE
Authors: Roper Janice M , Shapira Jill , Beck Alicia
Published: May 2014

ABSTRACT

This study examines the feelings of nurse caregivers of patients with Alzheimer's disease (AD) who are agitated. Methods included participant observation, examination of medical records, and ethnographic interviews of 17 nurse caregivers from one inpatient setting. Two patterns of feelings emerged from the data. One pattern was associated with caregiver expressions of personal identification with and vulnerability to AD. These nurses endorsed feelings of helplessness, hopelessness, and frustration when providing care to agitated AD patients. A second pattern situated nursing interactions within the realistic context of the patient's response to the illness. Caregiver feelings of confidence, competence, and satisfaction were associated with the second pattern. The relationship between the feeling states of nurse caregivers and their reported management of agitation in AD is discussed. Recognition and awareness of distressing feelings is a necessary first step for nurses to learn less personalized reactions to patients and respond more objectively to agitated behaviors.
Four Acute Confusion Assessment Instruments: Reliability and Validity for Use in Long-Term Care Facilities
Authors: Cacchione Pamela Z
Published: May 2014

Early detection of acute confusion may be helpful in avoiding lethal consequences in older adults who are frail. This study attempts to identify appropriate instruments for assessing for this condition.
CHRONIC PAIN IN THE OLDER PATIENT: Management Strategies
Authors: Herr Keela
Published: May 2014

ABSTRACT

This is the second of a two-part series, which highlights issues and strategies related to pain assessment in older adults and current problems of pain management in older adults and analgesic regimens pertinent to this population. The complexities of assessing pain in older adults and assessment techniques for accomplishing a careful evaluation of pain were presented in the first part of this series, which was published in the January issue of the Journal of Cerontological Nursing (Vol. 28, No. 1). This article addresses issues and strategies related to management of pain, particularly analgesic use, in this challenging population.
Thriving A Life Span Theory
Authors: Haight Barbara K , Barba Beth E , Tesh Anita S , Courts Nancy F
Published: May 2014

ABSTRACT

There is a need for aging theories to become holistic and multidisciplinary with a life span focus. A theory is the construction of explicit explanations in accounting for empirical findings. A good gerontological theory integrates knowledge, tells how and why phenomena are related, leads to prediction, and provides process and understanding. In addition, a good theory must be holistic and take into account all that impacts on a person throughout a lifetime of aging. Based on these criteria, the authors created the Theory of Thriving, with a holistic life span perspective for studying people in their environments as they age. This article proposes a theory for studying people over time in a holistic, encompassing manner.
Characteristics of Nursing Homes: Adopting Environmental Transformations
Authors: Tesh Anita S , McNutt Kathy , Courts Nancy F , Barba Beth E
Published: May 2014

ABSTRACT

During the past few years, many nursing homes in North Carolina have formulated plans to transform or enhance their environments to make the facilities more desirable places to live and work. The purpose of this study was to compare characteristics of facilities adopting one specific model for environmental transformation, the Eden Alternative™; with those adopting other environmental transformations or making no changes. Surveys were mailed to administrators of all (n = 378} certified nursing facilities in NC. A total of 167 surveys were returned, for a return rate of 44%. Of these, almost three fourths were planning or implementing some sort of environmental transformation. Thirty-seven facilities (22%) indicated they were currently adopting the Eden Alternative, and 47 (28%) were planning to adopt it. Twenty-six facilities (16%) reported they were currently adopting an environmental transformation other than the Eden Alternative, and another 9 (5%) were planning to adopt another environmental transformation. The facilities adopting or planning environmental transformations other than the Eden Alternative reported adopting (or planning to adopt) various components of the Eden Alternative. Forty-six facilities (28%) indicated they had no plans for environmental transformation. Facilities making environmental transformations were found to be similar to those making no changes on most variables examined, supporting the conclusion that environmental transformation is feasible for facilities with a wide range of characteristics.
The North Carolina Eden Coalition: Facilitating Environmental Transformation
Authors: Hamilton Nadine , Tesh Anita S
Published: May 2014

ABSTRACT

The Eden Alternative™, created by Harvard educated physician Dr. William Thomas, is a model for transforming skilled care facilities from institutions based on a medical model of care into human habitats that promote human growth. This change is accomplished through decen- : tralizing the organizational structure of the facility to empower front-line care-delivery staff, and through introduction of plants, animals, gardening, and children into the daily lives of residents. Because the Eden Alternative is a trademarked name, only facilities recognized by the Eden Alternative registry are allowed to use the name. However, any facility may adopt the philosophies embodied by the Eden Alternative, and implement the principles for transforming their facility.

In 1996, the North Carolina Division of Facility Services formed the North Carolina Eden Coalition (originally named the North Carolina Eden Alternative Coalition). This was the first organization of its kind in the country. The success of the Coalition has led it to , become a model for implementation in other states. Currently, North : : Carolina leads the country in the number of registered Eden Alternative facilities, and has a large number of other facilities that have instituted some form of environmental enhancement. The Coalition functions as a consumer-driven advisory and educational body rather than a formal regulatory standard body, and endorses implementation of the principles and philosophies embodied in the Eden Alternative. The Coalition has proved to be a successful, cooperative effort among regulators, providers, advocates, and other experts to implement the philosophies of the Eden Alternative without regulatory basis. Because the Coalition was formed under the auspices of the Division of Facility Services and operates with its ongoing cooperation, it is in an excellent position to clarify and influence policies and regulatory issues concerning transformation of long-term care environments in North Carolina.

This article explores the history, structure, function, mission, and goals of the North Carolina Eden Coalition. Examples of issues the Coalition has addressed in promoting environmental transformation in North Carolina's skilled care facilities are also included.
Snoezelen®: A Multisensory Environmental Intervention
Authors: Chitsey Amanda M , Haight Barbara K , Jones Melaina M
Published: May 2014

ABSTRACT

Snoezelen® is a multisensory intervention delivered in a specially designed room with high-tech instruments. It is especially useful for end-stage patients with Alzheimer's disease. Snoezelen provides an enabling atmosphere in a failure-free environment. It has been a popular intervention in Great Britain and is just beginning to appear in the United States.
Decreasing Aggressive, Agitated, or Disruptive Behavior: PARTICIPATION IN A BEHAVIOR MANAGEMENT UNIT
Authors: DeYoung Sandra , Just Gloria , Harrison Ruth
Published: May 2014

ABSTRACT

A 32-bed Behavior Management Unit was opened in a long-term care facility to care for dementia patients who exhibit aggressive, agitated, or disruptive (AAD) behaviors. The purpose of the study was to evaluate the effectiveness of the Behavior Management Program (BMP) in decreasing such behaviors. The sample consisted of all patients (N = 32) who resided in the unit for at least 3 months. The Nursing Home Behavior Problem Scale (NHBPS) was used to collect data.

Hypothesis 1, predicting participation in the BMP would decrease the total number of AAD behaviors was supported, with a significant decrease from the baseline to 6month measurements. Hypothesis 2, predicting participation in the BMP would decrease the frequency of occurrence of specific AAD behaviors was supported, with 7 behaviors being significantly reduced by 6 months.

Nurses in long-term care often treat patients with AAD behavior. Because staff members on general long-term care units and even in dementia units may not be experts in caring for patients with AAD behaviors, the implications of this study might be helpful. The interventions that were effective in reducing AAD behaviors included verbal distraction, time-outs, activity diversion, getting to know the patient well, and managing the environment.
TESTING THE EFFECT OF THE WALC Intervention on EXERCISE ADHERENCE in OLDER ADULTS
Authors: Resnick Barbara
Published: May 2014

ABSTRACT

The purpose of this study was to test the feasibility of the WALC intervention (Walk; Address pain, fear, fatigue during exercise; Learn about exercise; Cue by self-modeling), and determine its effects on self-efficacy and outcome expectations, exercise activity and free living activity, physical and mental health status, and falls and fall-related injuries. A total of 17 sedentary older women with a mean age of 88 ± 3.7 years were randomly assigned to receive either the WALC intervention or routine care. Ninety percent of those in the treatment group initiated and engaged in a regular exercise program during the 6 months of the study. There was a statistically significant difference in self-efficacy expectations, exercise behavior, and overall activity between the two groups. Those in the treatment group had stronger self-efficacy expectations related to exercise; engaged in more exercise and more free living activity; and although not statistically significant, had stronger outcome expectations following exposure to the WALC intervention when compared with those who received routine care. To help older adults initiate and adhere to an exercise program, nurses can easily implement the WALC intervention in a variety of settings.
Staff Development and Long-term Care OF PATIENTS WITH DEMENTIA
Authors: Kaasalainen Sharon
Published: May 2014

ABSTRACT

Staff development and training programs focusing on the care of patients with dementia is important in providing staff with the specialized knowledge and skills essential in the management of these patients. In this article, the nature of staff development is explored with an analysis of conceptual visions or definitions of staff development. Secondly, the Cervero (1985) framework for continuing professional education and behavioral change is used as a guide to describe the factors that influence the effectiveness of staff development (i.e., social system, individual learner characteristics, type or design of program). Next, the literature related to the outcomes of staff development programs is analyzed. In particular, do staff development programs lead to increased staff morale and job satisfaction and improved client care? An analysis of orientation and educational programs developed for staff working with patients with dementia in long-term care settings is conducted. Using aspects of the RSA evaluation model (Abruzzese, 1996), each program is examined in terms of its process, content, outcome, and impact, along with its feasibility in clinical settings. This critical analysis provides some direction for the development and evaluation of staff development programs in longterm care settings for those staff who work with patients with dementia.
The Quality of Nursing Home Care in Taiwan
Authors: Yeh Shu-hui , Sehy Yvonne A , Lin Li-Wei
Published: May 2014

Nursing homes are relatively new in Taiwan and, therefore, education and research are needed to assess quality of care and resident satisfaction.
Older Adults with Hip Fractures: TREATMENT OF PAIN FOLLOWING HOSPITALIZATION
Authors: Feldt Karen S , Finch Michael
Published: May 2014

ABSTRACT

This study examined pain experiences and treatment for older adults in long-term care or rehabilitation settings 3 weeks after surgical repair of a hip fracture. Pain report and pain treatment for cognitively intact residents were compared with cognitively impaired residents. Two thirds of all participants reported pain. Most rated pain as slight or mild in severity. Pain report was similar for cognitively impaired and intact participants. Pain was reported as severe or worse by 17% of the residents. Nursing care pians documented comfort as a goal for fewer than half the participants. Almost 40% (n ~ 23) of the participants were receiving no pain medication 3 weeks postoperatively, five of these rated their pain as moderate or severe. Pain documentation, including effective nonpharmacological treatments, needs to be improved for cognitively impaired and intact older adults who are recovering from hip fracture surgery.
Written and Computerized Care Plans
Authors: Daly Jeanette M , Buckwalter Kathleen , Maas Meridean
Published: May 2014

ORGANIZATIONAL PROCESSES AND EFFECT ON PATIENT OUTCOMES

ABSTRACT

The purpose of this study was to determine how use of a standardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care (LTC) facility would affect patient outcomes, as well as organizational processes and outcomes. An experimental design was used to compare the effects of two methods of documentation: Computer care plan and paper care plan. Twenty participants (10 in each group) were randomly assigned to either group. No statistically significant differences were found by group for demographic data.

Repeated measures ANOVA was computed for each of the study variables with type of care plan, written or computerized, as the independent variable. There were no statistically significant differences between participants, group (care plan), within subjects (across time), or interaction (group and time) effects for the dependent variables: Level of care, activities of daily living, perception of pain, cognitive abilities, number of medications, number of bowel medications, number of constipation episodes, weight, percent of meals eaten, and incidence of alteration in skin integrity. There were significantly more nursing interventions and activities on the computerized care plan, although this care plan took longer to develop at each of the three time periods. Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions, but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting.
Advance Directives: Why Community-based Older Adults do not Discuss Their Wishes
Authors: Inman Lisa
Published: May 2014

ABSTRACT

Health care providers and family members need direction when making health decisions for individuals who are unable. Advance directives allow individuals to maintain control of health care decisions. Despite that the majority of the population supports the right to express wishes related to end-of-life care, few implement advance directives. The purpose of this study was to determine reasons why community-based older adults discuss, do not discuss, or formalize advance directives. A convenience sample of 55 adults age 50 or older, participated in the study by answering a 31 -question self-report questionnaire. Death or serious illness of a loved one was the most influential factor prompting formulation of an advance directive. However, the majority of the population has not expressed their health care wishes in the form of advance directives. Therefore, continuing to educate and encourage discussion of advance directives is imperative.
Self-Transcendent Views and Behaviors: Exploring Growth in Caregivers of Adults with Dementia
Authors: Acton Gayle J
Published: May 2014

ABSTRACT

Literature suggests difficult life experiences such as fear, loss, and grief can provide an impetus for moving from self-centeredness toward a broader personal identity and self-transcendence. Caring for a family member with dementia may provide the context for such a movement; thus, the purpose of this study was to investigate self-transcendent views and behaviors in family caregivers of adults with dementia. A naturalistic field study design was used to collect data from individuals caring for family members with dementia. Findings showed little evidence of self-transcendent views and behaviors and little opportunity for caregivers to engage in activities that might facilitate self -transcendence. Conclusions of the study reveal social isolation, ambivalence, burden of care, and emotional fragility may inhibit the development of selftranscendence and interfere with healthy growth and development in family caregivers.
Turnover Reinterpreted: CNAS TALK ABOUT WHY THEY LEAVE
Authors: Bowers Barbara J , Esmond Sarah , Jacobson Nora
Published: May 2014

ABSTRACT

This study's purpose was to contribute to the development of a theory of turnover by understanding how CNAs employed in long-term care facilities conceptualize the factors that cause them to leave their jobs. Using grounded dimensional analysis, the authors conducted in-depth interviews with CNAs currently and formerly employed by three nursing homes. The CNAs' perception that they are unappreciated and undervalued by the organizations for which they work contributes significantly to turnover. The origins of this perception lie in policies and practices that lead CNAs to feel personally and professionally dismissed. The authors suggest how long-term care facilities might change their staffing and personnel policies to better demonstrate respect and appreciation, thus reducing turnover and enhancing the quality of work and care.
Urinary Incontinence Among Older Women
Authors: Bradway Christine
Published: May 2014

Measurement of the Effect on Health-Related Quality of Life

Treatment of urinary incontinence is often delayed because of reluctance to discuss symptoms. It is important to identify the existence of this dysfunction and extend research to clinical practice.
Cognitive Function in Community-Dwelling Elderly Women: ATTENTIONAL DEMANDS AND CAPACITY TO DIRECT ATTENTION
Authors: Jansen Debra A , Keller Mary L
Published: May 2014

ABSTRACT

As individuals get older, their capacity to direct attention (CDA) appears to decline. The decline in CDA may be caused by age-related changes in the brain and demands on attentional mechanisms. These demands require older adults to expend significant attentional effort to maintain focus and achieve mental clarity while negotiating activities of daily life. The purpose of this study was to examine the relationship between attentional demands and CDA among a convenience sample of 72 community-dwelling older women with normal mental status. Findings indicate attentional demands correlated significantly with CDA and accounted for a significant proportion of the variance. No relationship was found between depressive symptoms and CDA. Implications for practice are nursing interventions aimed at decreasing attentional demands, thereby supporting attentional processes and functioning by communitydwelling older adults.
Geriatric Nursing Assessment
Authors: Olenek Katherine , Skowronski Teresia , Schmaltz Dianne
Published: May 2014

A holistic approach to patient care incorporating the "giants of geriatric nursing" and patient psychosocial issues can improve nursing assessment.
Vigilance: Evolution and Definition for Caregivers of Family Members with Alzheimer's Disease
Authors: Mahoney Diane Feeney
Published: May 2014

ABSTRACT The language of caregiving relies heavily on terms that are frequently negative such as caregiver stress and burden, but these are not universally accepted phenomenon. The purpose of this article is to report on the development of caregiver vigilance and to suggest it offers both neutral terminology and a means to include caregivers' perceptions of their supervisory role. The concept of vigilance emerged from a qualitative study of caregivers of family members with Alzheimer's disease. Vigilance is defined as the caregivers' continual oversight of their care recipients' activities. The five key components of vigilance were watchful supervision, protective intervening, anticipating, always on duty, and being there. Vigilant caregivers saw themselves as "on duty" even when they were not "doing things." The findings of this study support caregivers' perceptions of 24-hour-a-day responsibility. Nurses need to realize that caregiver vigilance is not necessarily diminished when professional caregivers intervene or institutionalization occurs. Debriefing caregivers about their unique family caregiving knowledge and incorporating it into caregiving is a key strategy for nurses to use to build caregiver trust and reduce their vigilance time.
Disruptive Behaviors of Older Adults in an Institutional Setting
Authors: Souder Elaine , O'Sullivan Patricia
Published: May 2014

Staff Time Required to Manage Disruptions

ABSTRACT

This study, as part of a larger project, examined the actual time recorded by nursing staff to manage 36 disruptive behaviors in older adults who are institutionalized. Disruptive behaviors were defined as socially unacceptable or isolating, observable actions with negative consequences. A prospective study was conducted using a sample of 153 patients in a Veterans Affairs institution (mean age = 72.6, SD = 10.8). Data related to time to manage disruptive behaviors were collected during 21 consecutive shifts for each patient. Nursing staff did not always intervene in all disruptive behaviors that occurred. When they did intervene, total time to manage a disruptive behavior ranged from 5.7 to 201 .5 minutes (mean = 23.1 minutes, SD = 31 .9).
Exercise Training Program for Older Adults Incentives and Disincentives for Participation
Authors: Schneider Joanne Kraenzle , Eveker Ann , Bronder Deborah Rilling , Meiner Sue E , Binder Ellen F
Published: May 2014

ABSTRACT

The purpose of this study was to describe the incentives and disincentives for participating in an exercise training program for community-dwelling individuals 78 and older. One hundred forty-seven women and 62 men participated in this descriptive study, and ages ranged from 78 to 95 years (mean 82.7, ± 4.1). Individuals were interviewed by phone about their decision to participate in an exercise program. Qualitative responses were analyzed using content analysis. Three main incentive themes emerged: Health Benefits, Psychological Benefits, and Positive Program Features. Disincentive themes included Competing Commitments, Doubts about Exercise, and Negative Program Features. To better tailor an exercise program to the needs of this older age group, nurses working with older adults should keep in mind the lifestyle, agespecific obligations, and set of values affecting this cohort's participation.
Exploring Professional Caregivers' Perceptions Balancing Self-Care with Care for Patients with Alzheimer's Disease
Authors: McCarty Ellen F , Drebing Charles
Published: May 2014

ABSTRACT

With the are hundreds of studies about caregiver burden related to family caregivers that exist, little has been written about caregiver burden as it pertains to professional caregivers. The purpose of this study was to explore professional caregivers' perception and meaning associated with their caring for patients with Alzheimer's disease (AD). Twentytwo professional caregivers were interviewed. Content analysis was used to clarify respondents' interview data. Several themes emerged from the data related to beliefs about choosing and maintaining AD caregiving role, beliefs about self-efficacy, commitment and self-satisfaction, nature of family interaction of individuals with AD, grieving responses, and ability to maintain self-care through social support as well as solitary time. Implications include AD professional burden measurement; study related to recruitment, orientation, and staffing patterns; and effect on the quality of care provided to patients and their families.
Bladder Management in Adult Care Homes: Review of a Program in North Carolina
Authors: Kincade Jean E , Boyington Alice R , Lekan-Rutledge Deborah , Ashford-Works Carolyn , Dougherty Molly C , Busby-Whitehead Jan
Published: May 2014

ABSTRACT

In North Carolina there are approximately 34,000 residents in adult care homes (ACHs). Approximately 40% of these residents have urinary incontinence, and others require assistance with toileting. High prevalence of cognitive impairment, few licensed staff, and low staff -to- resident ratios in ACHs make behavioral techniques used in community-dwelling populations and toileting programs used in nursing homes inappropriate for these residents. This program was implemented using a twolevel approach (facility and individual resident) and uses an education consultation approach for implementation.
Getting the Basics Right: Care Delivery in Nursing Homes
Authors: Rantz Marilyn J , Grando Victoria , Conn Vicki , Zwygart-Staffacher Mary , Hicks Lanis , Flesner Marcia , Scott Jill , Manion Pam , Minner Donna , Porter Rose , Maas Meridean
Published: May 2014

This study reveals the critical processes of care that are essential for staff to consistently achieve good resident outcomes.
BedSAFE: A Bed Safety Project for Frail Older Adults
Authors: Hoffman Stephanie B , Powell-Cope Gail , MacClellan Leah , Bero Kim
Published: May 2014

ABSTRACT

In response to heightened awareness of patient safety, restraint reduction, and the potential for life-threatening entrapment caused by bed rails, a quality improvement program entitled BedSAFE was conducted to systematically and safely decrease the use of bed rails in three nursing home care units. This article describes an interdisciplinary process of individualized patient assessment, selection of appropriate alternatives for residents, compliance monitoring, training, and monitoring of patient outcomes including falls and injuries related to falls from bed.
Shifting Paradigms: Teaching Gerontological Nursing from a New Perspective
Authors: Quinn Mary Ellen , Berding Christine , Daniels Elizabeth , Gerlach Mary Jo , Harris Karen , Nugent Katherine , Green Cathy , Clarke Geraldine
Published: May 2014

ABSTRACT

Gerontological health care is undergoing a revolution, much like that of the feminist movement of the 1960s. Fundamental changes in health care require revisions in nursing education to ensure appropriate care of older adults in the least restrictive environment. The purpose of this study is to promote the preparation of future nurses who have the knowledge and the skills necessary to provide nursing care for the growing cohorts of older adults. A theoretical rationale for a new perspective in nursing education is discussed. An experiential clinical learning activity based on the functional model of gerontological health care is examined. This home visit clinical learning activity provides nursing students with the opportunity to practice nursing reflective of the health care needs of older adults. Strategies for replication of this clinical learning activity are provided.
Maintaining the Square: How Older Adults with Parkinson's Disease Sustain Quality in Their Lives
Authors: Whitney Christina M
Published: May 2014

ABSTRACT

In this article, the author's objective is to uncover the common practices that help sustain quality in the lives of older adults with Parkinson's disease. Interpretive phenomenology was the method used to gather and analyze the stones of six men and six women with idiopathic Parkinson's disease. The results show a constitutive pattern of Maintaining the Square. Five relational themes, including Learning How, Accepting Limitations, Seeking Knowledge, Engaging in Meaningful Experiences, and Living for Today, emerged from the participants' stories. The participants' ability to sustain continuity in their lives indicates their successful maintenance of the square. By identifying markers of continuity, they are able to maintain quality in their lives. As nurses, we can promote continuity in the lives of our patients if we take the time to learn what gives them meaning and purpose in life and then facilitate ways to help them maintain this connection.
Blood Pressure Monitoring: Older Adults' Perceptions
Authors: Viverais-Dresler Gloria , Bakker Debra A
Published: May 2014

ABSTRACT

The purpose of this article is to report the qualitative findings on older adults' perceptions of blood pressure measurement and its meaning to their health. The convenience sample consisted of 51 community-dwelling older adults who were recruited from either wellness clinics or a senior citizens' club. Data were collected through in-depth audiotaped interviews. Participants' responses were analyzed by identifying topics, patterns, and themes. The following three themes emerged: provision of reassurance, decision-making leading to serf-care activities, and reliance on health care professionals. These findings can be used by community health nurses, especially those in gerontology to gain insight into how a sample of ofder adults perceived blood pressure monitoring. In addition, the findings can serve as guidelines for nurses in the provision of effective hypertension management with older adults.
Improving Nursing Home Food Service: Uncovering the Meaning of Food Through Residents' Stories
Authors: Crogan Neva L , Evans Bronwynne , Severtsen Billie , Shultz Jill A
Published: May 2014

ABSTRACT

The meaning of food to nursing home residents is explored to examine residents' perspectives related to nursing home food and food service, and to identify strategies for improving food and food service in nursing homes. An interpretive phenomenological approach was used to uncover meaning in a series of "tell me a story" interviews about food and food service with nine residents from an eastern Washington nursing home. Analysis revealed 14 domains of meaning, each containing multiple codes with specific descriptions and exemplars of resident expression about food service. Themes that cut across these codes were generated and further organized into three rubrics. They were: Mimicking Home, Making Choices, and Tailoring the System. Specific information found under these three rubrics can be used as a blue print for quality improvement interventions implemented by nursing home staff and management, thereby improving quality of life for nursing home residente.
Moving to Evidence-Based Practice in Long-Term Care: The Role of a Best Practise Resource Centre in Two Long-Term Care Settings
Authors: Brazil Kevin , Royle Joan A , Montemuro Maureen , Blythe Jennifer , Church Anne
Published: May 2014

By providing staff with access to research, facilities can improve the care their patients receive.
Wisdom in the Fourth Age
Authors: Sherrell Kathleen E
Published: May 2014

Viewing Aging with Optimism
Pain Treatment and Quality of Life
Authors: Kenefick Amy Laufer
Published: May 2014

Reducing Depression and Improving Cognitive Impairment

ABSTRACT

The purpose of this study was to identify implications for the care of nursing home residents based on exploration of the relationship of depression to pain, cognitive impairment, and communication impairment in this population. A descriptive, crosssectional, post-hoc design was used. Methods of statistical analysis included bivariate correlation coefficient calculation, stepwise multiple regression, and analysis of variance. A complex triad of cognitive impairment, pain, and depression was identified. The strength of the relationship between depression and cognitive impairment increases as cognitive impairment increases and in the presence of pain. This relationship is strongest among residents with severe cognitive impairment, severe communication impairment, and advanced age. Nurses may be able to relieve symptoms of depression in nursing home residents by using strategies based on knowledge of the resident's cognitive, communication, and pain status. Treating pain may lead to improved cognitive performance in residents who are depressed or reduced depression in residents who are cognitiveIy impaired. The most elderly adults and adults with severe communication impairment may benefit most from these interventions.
Caring for Self While Caring for Others: The Two-Track Life of Coping with Alzheimer's Disease
Authors: Farran Carol J , Loukissa Dimitra A , Lindeman David A , McCann Judith J , Bienias Julia L
Published: May 2014

ABSTRACT

Relationships between depressive symptoms and altered immune function have been documented in the literature; however, the links between depressive symptoms, altered immune function, and changes in physical health are less clear. Although a number of caregiver descriptive studies have examined immunological outcomes, only one intervention study with caregivers of individuals with Alzheimer's disease, known to the authors, has included immunological outcomes. The purpose of this pilot study was to assess the effectiveness of a caregiver skill-building intervention to decrease caregiver depressive symptomatology and care-receiver behavioral symptoms; and to assess the feasibility and stability of the delayed type hypersensitivity (DTH) skin test with this population. Caregiver depressive symptoms decreased, while carereceiver behaviors did not. Findings suggested that the DTH skin test could be successfully administered to caregivers of individuals with Alzheimer's disease and that this skin test had short-term stability. There were no significant relationships between caregiver depressive symptoms and immune function. Study findings suggest that nurses can play a pivotal role in intervening with family caregivers and potentially decreasing their depressive symptoms.