bluuebunny/crossref_metadata_2025 huggingface dataset:
SHARING STORIES: Group Therapy with Elderly Depressed Women
Authors: Phoenix Elizabeth , Irvine Yvonne , Kohr Rosemary
Published: May 2014

ABSTRACT

As the population ages, nurses are challenged to seek and use relevant and effective nursing strategies to assist clients to cope with major life events and chronic conditions. Depression in the elderly, particularly among elderly women, is increasing. This is a serious problem which pervades community, acute and chronic care settings. In order to provide proactive care in the treatment of depression, two nurses in a psychogeriatric clinic developed a unique program, consisting of 10 weekly group sessions for elderly women with a diagnosis of depression. This article describes the format, content of group sessions and outcomes. Key themes that emerged are illustrated by the stories shared by the women. These stories were central to shaping the group experience and enhanced the learning of group members and facilitators as well. The method of group process and insight into dynamic strategies for teaching/learning in the elderly are discussed. In conclusion, recommendations for future programs have been identified.
BATHING: IT'S A TOUGH JOB!
Authors: Skewes Susan M
Published: May 2014

The rigors of assisting elderly patients in and out of tubs are a leading cause of disability for nurses.
Guidelines for developing instruments to ENHANCE CASE-FINDING AMONG OLDER ADULTS
Authors: Bechtel Gregory A , Shriver Cathy
Published: May 2014

Abstract: This article discusses the necessity of developing reliable and valid instruments to enhance case finding efforts among older adults who may be at risk for alterations in their optimal level of functioning and health. Case studies are provided to demonstrate to nurses how misconceptions can occur when assessment tools are neither reliable nor valid in extracting critical information. While the use of reliable and valid case-finding instruments can detect high-risk circumstances and reduce the likelihood of premature death and disability, erroneous information can have adverse economic and health consequences for the individual, family, and community.
UNDERSTANDING Creutzfeldt-Jakob DISEASE
Authors: Nguyen Steve T , Rickman Leland S
Published: May 2014

ABSTRACT

The "mad cow disease" that decimated cattle in England has brought widespread attention to a similar disease in humans, Creutzfeldt-Jakob disease (CJD). This has led to concerns about the transmissibility and contagiousness of the infectious agent from possible OD patients to health care workers and family members. Despite these worries, the occurrence of CJD in the human population has remained stable over the years at an incidence of about one person per million in the United States population, and increasing to six individuals per million for the older-than-60 age group. This article will review the etiology, clinical manifestations, and potential for transmission of this unusual infectious agent.
POSTPRANDIAL BLOOD PRESSURE CHANGES IN THE ELDERLY
Authors: Lilley Mary D
Published: May 2014

ABSTRACT

Postprandial blood pressure reductions have been observed in frail elderly individuals. This study evaluated blood pressure and heart rate changes in 10 healthy elderly subjects at intervals before and after a morning meal. Subjects did not exhibit significant reductions in systolic blood pressure or increases in heart rate over time, rather, such changes were due to variation within subjects. They did not exhibit significant changes in diastolic blood pressure. Age, health, and meal choice may have influenced results. Further research will determine which groups of elderly are most at risk for postprandial blood pressure reductions and consequently at risk for injury from falls due to dizziness and syncope.
Incorporating SIMPLE REMINISCENCE TECHNIQUES Into Acute Care Nursing Practice
Authors: Puentes William J
Published: May 2014

ABSTRACT

Under normal circumstances, individuals perceive the world around them in terms of overlapping - interacting past, present, and future time orientations. When individuals experience overwhelming stress, normal coping skills cease to be effective and this time orientation schema has a tendency to disorganize into its constituent spheres. The overlap and interaction of the spheres disappears. Individuals focus exclusively on the present sphere and lose the abilities to use coping skills which were successful in the past and to make reasonable projections about the future. Simple Reminiscence, an activity in which individuals look back at past experiences which they perceive as positive and meaningful, is one nursing intervention that RNs can use to help the client reclaim an effective past, present, future time orientation. Questioning the client about past experiences, effectively listening to what the client has to say, and using effectual time management skills are some techniques which RNs can use to incorporate Simple Reminiscence interventions into acute care nursing practice. These interventions will encourage the client to perceive stressful situations in terms of overlapping past, present, and future time spheres and consequently cope more effectively with stress.
ASSESSMENT OF DEPRESSION IN A POPULATION AT RISK...
Authors: Ryden Muriel B , Pearson Valinda , Kaas Merrie J , Snyder Mariah , Krichbaum Kathleen , Lee Heeyoung , Hagans Elnora , Hanscom Judy
Published: May 2014

NEWLY ADMITED NURSING HOME RESIDENTS
AIDS IN OLDER PEOPLE
Authors: Johnson Merrilyn , Haight Barbara K , Benedict Susan
Published: May 2014

A Literature Review for Clinical Nursing Research and Practice
REDUCING THE BURDEN OF PAPERWORK
Authors: Blachly Bonnie , Young Heather M
Published: May 2014

Modified Charting by Exception for Medications
Renal Disease and Diet Therapy in the Elderly
Authors: Menzies Jacqueline
Published: May 2014

ABSTRACT

Renal disease is a disease closely associated with aging. Although kidney disease can occur at any age, the prevalence and severity of renal disease is far more prominent in the elderly. As the geriatric population continues to grow, nurses can anticipate treating significant numbers of elderly people with renal disease. Research suggests that with early dietary intervention the progression of renal disease can be altered. Therefore, knowledge of the characteristics and goals of diet therapy are necessary to provide effective client education and promote compliance.
Healthy Endings: A Collaborative Health Promotion Project for the Elderly
Authors: Slaninka Susan C , Galbraith Anna Mae
Published: May 2014

ABSTRACT

This article describes a collaborative health promotion project between a graduate nursing program at a state university and a small community hospital. The Healthy Endings program provided health promotion education to groups of older adults at a local senior center. Health promotion in this population is vital to prevent complications and decrease risks that affect quality of life. Health promotion programs were designed to be accomplished through three major components: education, health screenings/services, and the referral process. Specific project objectives focused on safety, sensory deprivation, exercise, screening, compliance with medications, and a variety of psychosocial issues. Graduate nursing students functioning proactively in a senior center on a consistent basis were viewed as valuable by both members and staff.
A Pilot Study on Improving Oral Care in Long-Term Care Settings Part I: Oral Health Assessment
Authors: Pyle Marsha A , Massie Michelle , Nelson Suchitra
Published: May 2014

ABSTRACT

Surveys of oral health in long-term care (LTC) settings have consistently documented low levels of health. In the complex LTC environment, programs to improve oral health have yet to be well defined. The purpose of this pilot project was to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.
A Pilot Study on Improving Oral Care in Long-Term Care Settings Part II: Procedures and Outcomes
Authors: Pyle Marsha A , Massie Michelle , Nelson Suchitra
Published: May 2014

This pilot study attempts to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. Twelve residents of a county long-term care (LTC) facility cared for by a group of nursing assistants who completed a 6week oral health training program constituted the experimental group. Resident Plaque Index (Pl) and Gingival Index (Gl) scores were compared at baseline, and 6 weeks and 12 weeks after nursing assistant training to a matched group of residents (n = 11) cared for by nursing assistants who had not completed oral health training. Both the Pl and Gl scores of the experimental residents improved significantly compared to the control residents between baseline and 12 weeks (Student t test, p = .039, p = .017, respectively). This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.
Goal Attainment Scaling: A Responsive Measure of Client Outcomes
Authors: Forbes Dorothy A
Published: May 2014

ABSTRACT

Goal Attainment Scaling (GAS) was developed by Kiresuk and Sherman in 1968. Although highly criticized in the early years of its conception, GAS is beginning to be recognized as a reliable, valid, and responsive outcome measurement approach. This article describes the application of GAS, using elderly home health care clients as an example. Reliability and validity issues are examined. Criticism of GAS is often based on traditional psychometric assumptions associated with normative assessment and does not reflect the evaluative nature of the GAS methodology. The advantages and limitations of GAS are discussed. Goal Attainment Scaling has the potential to demonstrate the important contribution home health care programs make to clients by measuring the change that has occurred during their admission to the program. This kind of information is required by policy makers, case managers, and home health care providers to develop policy, allocate limited resources, and offer appropriate and effective services.
Interventions for DISRUPTIVE BEHAVIORS: USE AND SUCCESS
Authors: Bair Byron , Toth Weldonna , Johnson Mary Ann , Rosenberg Charles , Hurdle John F
Published: May 2014

ABSTRACT

Health care providers deal with disruptions from geriatric patients routinely. Despite the negative impact on provider efficiency, provider-patient relations, and patient well-being, there have been no systematic clinical studies of the impact of disruptive behaviors on geriatric inpatient care. This article presents a taxonomy for these behaviors, applying them to a study of disruptive behaviors and concomitant nursing interventions on a geriatric evaluation and management (GEM) unit. The sample, consisting of 23 nursing staff (16 RNs, 4 LPNs, and 3 nurse aides), was followed over 8 weeks (five shifts per week, distributed randomly over day, evening, and night shifts). An experienced pair of RN observers logged all disruptive behaviors and the associated interventions employed by the nursing providers. The taxonomy was validated on 97 disruptive events (113 disruptive behaviors) initiated by 87 patients. The major findings of the study were: (a) disruptive behaviors are common on a GEM unit; (b) behaviors that disrupt care are recognized only 50% of the time by nursing staff; (c) interventions, when used singly, were found successful 45% of the time; (d) multiple simultaneous interventions may be more successful than single interventions but were used in only 16% of cases; and (e) selection of interventions may be associated with staff education level.
ASSESSING PATIENTS in the Early Stages of Irreversible Dementia
Authors: Burgener Sandy C , Dickerson-Putman Jeannette
Published: May 2014

The Relevance of Patient Perspectives
WATER INTAKE of Nursing Home Residents
Authors: Gaspar Phyllis Meyer
Published: May 2014

ABSTRACT

This study describes the adequacy of water intake among nursing home residents and identifies variables associated with the adequacy of water intake. Ninety-nine nursing home residents were observed for two 24-hour periods to record food and fluid ingested, ingestion behaviors, and function. Mean water intake (based on food and fluid) was 1,968 mL per day, ranging from 597 mL to 2,988 mL. Only eight subjects met their standard water requirement of 1,600 mL/m
p 2
body surface area. Subjects with inadequate water intake were older, more independent, had few ingestion sessions per day, had intact speech, were semidependent with eating, did not drool, and had inadequate nutrient intake.
Institutionalized Older Adults' PERCEPTIONS OF Nurse Caring Behaviors: A PILOT STUDY
Authors: Marini Barbara
Published: May 2014

ABSTRACT

The purpose of this article is to identify which behaviors performed by nursing staff were important indicators of caring as perceived by older adults residing in institutional settings. Using Watson's Theory of Transpersonal Care as the framework for the study, the Caring Behavior Assessment (CBA) instrument, which is congruent with Watson's carative factors, was used to interview residents. A convenience sample of 21 residents residing in long-term care and assisted-living facilities answered the 63-item CBA. Descriptive statistics were used to analyze the importance of each identified behavior. The analyses revealed that the highest indicator of nurse caring focused on the nurses' technical competency (instrumental activities). This study noted a significant gender-specific perception of caring. This may reflect differences in gender communication styles and interpersonal processes which may affect connotations of caring expressions. Humanistic caring (expressive activities) was the second most important indicator of care. Older adults desired care which preserved and enhanced individual dignity.
Preventing Cerumen Impaction in Nursing Facility Residents
Authors: Stone Christine M
Published: May 2014

Attention to the hearing health of residents is necessary to maintain their functional independence and psychosocial well-being.
The Effectiveness of SLOW-STROKE MASSAGE
Authors: Rowe Marian , Alfred Danita
Published: May 2014

in Diffusing Agitated Behaviors in Individuals With Alzheimer's Disease

ABSTRACT

Agitated behaviors of individuals with Alzheimer's disease (AD), often endured or unsuccessfully treated with chemical or physical restraints, markedly increase the stress levels of family caregivers. The Theoretical Model for Aggression in the Cognitively Impaired guided the examination of caregiver-provided slow-stroke massage on the diffusion of actual and potential agitation for community-dwelling individuals with AD. Characteristics and frequency of agitation were quantified by two highly correlated instruments, the Agitated Behavior Rating Scale Scoring Guide and the Brief Behavior Symptom Rating Scale. Expressions of agitation of patients with AD increased in a linear pattern from dawn to dusk. Verbal displays of agitation, the most frequently cited form of agitation in community-dwelling individuals with AD, were not diffused by slow-stroke massage. However, the more physical expressions of agitation such as pacing, wandering, and resisting were decreased when slow-stroke massage was applied. This study contributes to building a body of knowledge regarding the phenomenon of agitated behaviors in cognitively impaired elderly individuals-its nature, frequency of occurrence, measurement, associated factors, and management.
BREAST CANCER in Older Women: Treatment, Psychosocial Effects, Interventions, and Outcomes
Authors: Kantor Deborah E , Houldin Arlene
Published: May 2014

ABSTRACT

It is estimated that 48% of women with breast cancer are age 65 and older; yet, scant research focuses on this cohort. Recent advances in breast cancer management have raised many questions regarding appropriate treatment of older patients with cancer. Despite recent emphasis on medical interventions for older women, there is little focus on the unique clinical presentation and psychological sequelae of breast cancer in this population. While elderly women who survive breast cancer seem to cope better than their younger counterparts, their distress must not be overlooked. Interventions such as use of social support, spirituality, and exercise demonstrate therapeutic benefits for older women with cancer and should be explored. Nurses play a key role in educating and supporting older women with breast cancer and can help dispel many age-related myths and misconceptions.
Physical and Pharmacologic Restraints in Long-Term Care Facilities
Authors: Middleton Helene , Keene Richard G , Johnson Christine , Elkins Allan D , Lee Ann E
Published: May 2014

ABSTRACT

This study examined the effects of education on the attitudes and practices of long-term care staff toward use of restraints. The intervention, a 1-day educational seminar, used a collaborative team of speakers from the Utah Survey Agency and medical professions. Seminar goals were threefold: first, to provide information about best practices for managing behaviors of individuals with dementia in long-term care settings; second, to provide an explanation of the Omnibus Budget Reconciliation Act regulations pertaining to restraint use; and third, to present alternative strategies to link best practice guidelines to the provision of care. Results showed significant changes in participants' attitudes toward use of restraints. Participants reported replicating the seminar for nursing home staff, revisiting facility policies on restraints, and modifying resident care plans.
Comparison of Three Instruments in Predicting Accidental Falls in Selected Inpatients in a General Teaching Hospital
Authors: Eagle D Joan , Salama Suzette , Whitman Dee , Evans Lois Ann , Ho Enoch , Olde Jan
Published: May 2014

Use of these tools helps identify elderly individuals at the highest risk for falls and aids in intervention planning.
Infection With HIV in the Elderly Population
Authors: Szirony Tracy A
Published: May 2014

ABSTRACT

Infection with HW among older adults in the United States needs to be investigated in greater detail because little substantive knowledge currently is available about HIV/AIDS in the elderly population. The Centers for Disease Control and Prevention reports that 10% of all cases of diagnosed HIV/AIDS are in people age 50 and older. The problem is that very little is known about the effects of HIV/ AIDS in this population. The majority of the literature is based on limited case reports, and very little empirical research is available. This lack of knowledge limits health care professionals' ability to properly diagnose and adequately treat individuals who may be infected.

This article considers various sources of infection, potential risk factors, the difficulty of diagnosis, and the rapid progression of the disease process in older adults. Signs and symptoms of common opportunistic infections are explored. Treatment challenges, nursing care of older adults infected with HIV, and psychosocial aspects of the disease are discussed.
Caring for Elderly Individuals in Nursing Homes
Authors: Coccia Rebecca J , Cameron Elizabeth A
Published: May 2014

Gerontological nurses must advocate for improved quality of nursing staff and remember the importance of balancing cost and quality in nursing homes.
Prostate Cancer Elder Alert
Authors: Bruner Deborah Watkins , Pickett Mary , Joseph Angela , Burggraf Virginia
Published: May 2014

EPIDEMIOLOGY, SCREENING, AND EARLY DETECTION
Consequences of Not Recognizing Delirium Superimposed on Dementia in Hospitalized Elderly Individuals
Authors: Fick Donna , Foreman Marquis
Published: May 2014

ABSTRACT

Objective: The purpose of this study was to describe the recognition and management of delirium in hospitalized patients with and without dementia.

Design: A descriptive, exploratory design was used with a convenience sample of 20 hospitalized older patients who were observed indepth using qualitative interviews and observations of 13 family members and 11 staff members.

Setting: This research was conducted on the medical-surgical units of a 550-bed, nonprofit, state-supported teaching hospital in the southeastern United States. The facility provides primary and tertiary care with five intensive care units and eight medical-surgical units.

Participants: This study did not exclude individuals with dementia or pre-existing delirium. Subjects were not excluded on the basis of race or gender. Twenty patients in the sample underwent observation and mental and functional status testing. Thirteen family members and 11 staff members were interviewed and observed.

Measurements: in Phase 1 of the study, patients had daily mental status testing performed by the investigator. In Phase 2, family members and staff members were interviewed about the confusion event. For each patient, demographics and information regarding their health status and current diagnosis and treatment were obtained. The Mini-Mental State Examination (MMSE) and the Confusion Assessment Method were completed on each subject within 36 hours of being admitted to the hospital. The Cornell Depression Scale and Katz Activities of Daily Living scale were completed within 48 hours of admission.

Results: The prevalence of delirium in this study was 60%. The incidence, or new onset of delirium, was 30%. The presence of delirium was associated with new onset incontinence, lower baseline MMSE scores, depression, weight loss, and comorbidity. Of the eight individuals with delirium superimposed on dementia, 63% (n = 5) were re-admitted to the hospital within 30 days, compared to none of the individuals with delirium in the absence of dementia. Delirium superimposed on dementia also was less likely to be recognized by nurses and physicians.

Conclusions: Delirium in individuals with dementia should be assessed and treated routinely because the failure to recognize delirium superimposed on dementia promptly has significant negative personal, social, and financial consequences.
Functional Performance and Exercise of Older Adults in Long-Term Care Settings
Authors: Resnick Barbara
Published: May 2014

ABSTRACT

Performing functional activities and exercising are important for older adults living in long-term care settings. Participation in these activities not only improves and maintains function in older adults but also can improve physical and emotional health and quality of life. The purpose of this study was to explore the variables that influence functional performance and exercise activity in a group of nursing home residents. Participants includ- i ed 59 residents in a long-term care facility. The mean age of partici- | pants was 88 ± 6.9, and the majority were women (76%), White (97%), and unmarried (76%). Residents participated in a single face-to-face interview. Chart reviews for demographic and health information also were performed. Based on stepwise multiple regression analyses, upper and lower extremity contractures and cognitive status were the only variables that significantly influenced functional performance and accounted for 49% of the variance in function. Self -efficacy and outcome expectations were the only variables to significantly influence exercise behavior and accounted for 57% of the variance in this behavior. These findings can be used to help develop and implement effective restorative nursing care programs in long-term care settings.
Improving Quality of Care in Nursing Facilities: Gerontological Clinical Nurse Specialist as Research Nurse Consultant
Authors: Popejoy Lori L , Rantz Marilyn J , Conn Vicki , Wipke-Tevis Deidre , Grando Victoria T , Porter Rose
Published: May 2014

ABSTRACT

It is becoming increasingly common for nursing facilities to use Quality Indicators (Ql) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review Ql reports, investigate problems areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activities in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.
Reliability and Validity of a Community Needs Assessment Instrument for Nursing Homes in Taiwan
Authors: Chen Shu-li
Published: May 2014

The Perception Evaluaù'on Tool is used to demonstrate a need for nursing home services, contribute to the development of services, ensure services meet demands, and improve existing services.
Individualized Care: Perceptions of Certified Nurse's Aides
Authors: Curry Leslie , Porter Martha , Michalski Marion , Gruman Cynthia
Published: May 2014

ABSTRACT

Despite substantial attention devoted to the development of individualized care in nursing homes during recent years, empirical research assessing progress is limited. Further, few studies have explored the experiences of certified nurse's aides (CNAs) in this regard. This survey examines the perceptions and experiences of CNAs in providing individualized care. CNAs (n = 254) were asked to describe a number of current practices and obstacles to implementing individualized care in nursing homes. The majority of respondents reported experiencing: flexibility to change daily schedules; supervisor assistance with challenging residents; active participation in care planning; freedom to test new approaches to care; and supervisors who are open to CNA suggestions. Several barriers to individualized care were also described, including: inadequate staffing; poor team communication; staff attitudes; and a lack of knowledge and training in alternative approaches. These findings provide important insights into the supports and obstacles to implementing individualized care in nursing homes from the perspective of CNAs.
Strength Training for Older Adults: Prescription Guidelines for Nurses in Advanced Practice
Authors: Schlicht Jeffrey
Published: May 2014

Moderate- to heavy-resistance exercise is a safe and effective way to promote strength gain and help increase the quality of life in older adults.
The National Center on Women & Aging
Authors: Philbin Ellen K
Published: May 2014

With the increasing number of aging women in America, it is important for gerontological nurses to keep informed of research targeting this population.
Legal Guidelines Related to End-of-Life Decisions: Are Nurse Practitioners Knowledgeable?
Authors: Schlegel Kristen Lee , Shannon Sarah E
Published: May 2014

ABSTRACT

Public demand and professional standards dictate that primary care providers must be prepared to offer guidance and advance care planning for end-of-life decisionmaking to their patients. The purpose of this study was to describe the relationship between nurse practitioners' (NPs) knowledge of legal guidelines for end-of-life decision-making, their knowledge of the clinical application of advance care planning (ACP), and their comfort in counseling patients on these issues and personal attitudes toward end-of-life care. This descriptive, correlational study used survey data from a convenience sample of 145 Washington State NPs. Most NPs in this study were reasonably knowledgeable about the legal guidelines for end-of-life decision-making and clinical applications for ACP. They were somewhat comfortable with counseling patients on end-of-life decisions and expressed positive attitudes toward end-of-life care. However, a significant number of NPs were ill-informed about the legal guidelines and few actually incorporated ACP into their clinical 3 practice. The authors suggest educational programs J should focus on addressing the problem of stable misin-Îf formation related to legal guidelines. In addition, education should offer NPs didactic information and role mod-\ eling to skillfully incorporate ACP into clinical practice.
Special Challenges of Withholding Artificial Nutrition and Hydration
Authors: Daly Barbara J
Published: May 2014

ABSTRACT

Despite society's increasing understanding of and comfort with end-of-life decision-making, questions about the appropriate use of artificial hydration and nutrition remain particularly challenging to both professional and family members. These decisions are complicated by misunderstandings about likely benefits and burdens, concern about patient suffering, and ambivalence regarding the moral status of feeding. Data regarding the effectiveness of tube feedings in terms of prolonging survival, improving wound healing, or preventing aspiration do not support the widespread use of this intervention in states of severe dementia or end-stage disease. Further, there is evidence that withholding feeding is not associated with suffering, so long as adequate mouth care and desired sips of water are provided. Nonetheless, surveys of both long-term care residents and family members of persons with dementia indicate that at least 30% to 50% of those queried expresses a preference for artificial feeding if they (or their relative) could not eat. Given the absence of conclusive data about the efficacy of feeding and the apparent plurality of values surrounding the provision of this intervention, health professional must focus efforts on using a careful, deliberate approach to decision-making that involves all interested parties and make uses use of valid empirical data.
ASSESSING THE Educational Needs and Concerns OF NURSING HOME STAFF REGARDING End-of-Life Care
Authors: Ersek Mary , Kraybill Beth Miller , Hansberry Jennifer
Published: May 2014

ABSTRACT

The purpose of this study was to explore and describe the educational needs and concerns of licensed nursing staff and certified nursing assistants (CNAs) regarding end-of-life (EOL) care. Focus group interviews were conducted at two nursing homes in the Pacific Northwest. Separate interviews were conducted for licensed staff (RNs and LPN/LVNs) and CNAs. A total of 15 licensed staff and 39 CNAs participated in the study. Interviews were transcribed and themes were extracted through consensus reached by three investigators. The major concerns of these nursing home staff focused on symptom management, communication and interactions, goals of care, role delineation, time constraints, self-care needs, and emotional attachment to residents. Although both groups described similar themes, specific issues within each topic often were different for licensed staff and CNAs. These findings can be used to guide the design of educational programs aimed at assisting nursing home staff in providing high level end-of-life care.
ADVANCE DIRECTIVES AND DEMENTIA
Authors: Rempusheski Veronica F , Hurley Ann C
Published: May 2014

ABSTRACT

Since the 1990 Patient Self-Determination Act, increasing numbers of adults are completing advance directives (ADs), but unfortunately many adults seen in a dementia evaluation program have not completed an AD. This article discusses the issue of individuals with dementia completing ADs. Situational factors that frame this issue are the stage of dementia, degree of certainty of an individual's wishes for end-of-life care, the decision-making act required by care providers, and the degree of contentment or distress experienced by an individual with dementia. Several investigators have demonstrated successful completion of ADs by individuals with mild and moderate dementia. A nurse's knowledge about the stages of dementia is essential to helping an individual through the AD decision-making process. Nurses caring for individuals with dementia should assess decision-making context; recognize the emotions of family, friends, and staff; understand the substance and logic of AD requests; and support individuals and their decisions.
Phases of the Qualitative Research Interview with Institutionalized Elderly Individuals
Authors: Robinson Joanne Patterson
Published: May 2014

ABSTRACT

The in-depth, open-ended formal interview is a mainstay of qualitative nursing research. However, difficulties with this method of data collection are common with institutionalized elderly individuals. During a qualitative study of urinary incontinence among nursing home residents, six distinct phases of the formal interview were identified: introducing, personalizing, reminiscing, contextualizing, closing, and reciprocating. These phases were discovered in the course of analyzing field notes and verbatim transcripts from open-ended formal interviews with 10 respondents. Allowing qualitative research interviews with institutionalized elderly individuals to unfold in this fashion may help researchers studying this group overcome problems with recruitment, retention, and "thin" data. In turn, more institutionalized elderly individuals would reap benefits associated with participation in research interviews and staff would ultimately have the opportunity to understand and appreciate life in an institution from the resident's perspective.
Use of Multidimensional Assessment to Provide Testimony on Behalf of Residents in a Life-Care Home
Authors: Daly Jeanette M , Buckwalter Kathleen C , Morris Woodrow
Published: May 2014

Gerontological nurses expand their consultation roles by using systematic data collection strategies to advocate for a life-care home's tax-exempt status.
FACTORS AFFECTING CAREGIVERS' ABILITY TO Make Environmental Modifications
Authors: Messecar Deborah C
Published: May 2014

ABSTRACT

This study explored factors that family caregivers described as affecting their ability to use environmental modifications. Intensive interviews and participant observation were used to collect detailed data from 24 primary family caregivers. Several factors that affect the caregivers' ability to implement modification strategies were identified in the analysis. These factors included attributes of the elderly individual, attributes of the modification, quality of the caregiver-elderly relationship, caregivers' skills, personal resources of the caregiver, and the informal and formal supports available. Of these factors, the most important were the salient skills that caregivers need to implement environmental modifications. These findings point to the importance of caregivers receiving skills training in this important dimension of caregiving. Intervention should be based on a collaborative approach that ensures the caregiver and care receiver's needs and preferences are respected.
A Nursing Application Of Telecommunications
Authors: Johnson-Mekota Judith L , Maas Meridean , Buresh Kelli A , Gardner Sue E , Frantz Rita A , Specht Janet K Pringle , Wakefield Bonnie , Flanagan James
Published: May 2014

Measurement of Satisfaction for Patients and Providers

ABSTRACT

Consumer and provider satisfaction is key to the continued use and expansion of telehealth technology. This pilot study compared satisfaction of providers and patients with wound consultations done in person with those done via real-time interactive video technology. Eleven telehealth consultations with a nurse expert were immediately followed by an in-person consultation with a second nurse expert. Satisfaction questionnaires were administered to patients, referring nurses, and the consultant nurse expert following both the in-person consultation and the telehealth consultation. The referring nurses (100%) were satisfied with both the telehealth and inperson consultations, noting the ability to provide better care for their patients. The patients (55%) were "very satisfied" with the telehealth consultations versus 40% satisfied with the in-person consultations. Difficulty in hearing for the patients was equal in both groups, which resulted in changes in the consultation process. The patients' difficuity in seeing the telehealth consultant was addressed through larger screens and strategic positioning to provide easier viewing for the patient and providers. The telehealth nurse consultant was satisfied overall but had some difficulty communicating. This pilot study helped provide useful information for both the telehealth and inperson consultations.
MODELING NURSING SCIENTIFIC INQUIRY
Authors: Holland Diane E
Published: May 2014

The University of Iowa Hospitals and Clinics Research Utilization Residency Program for Geriatric Nurse Practitioners and Gerontological Clinical Nurse Specialists

ABSTRACT

The application of research findings to achieve nursing outcomes sensitive to the effects of nursing care remains a challenge for the nursing profession. The Research Utilization Nursing Residency Program is a project implemented by the University of Iowa Gerontological Nursing Interventions Research Center. For a discharge planning coordinator serving a largely geriatric patient population, the residency experience provided support to apply scientific nursing knowledge to outcomes. Resources from both dinical and academic settings are discussed within the context of the resident's experience.
Benefits of a Nurse-Managed Wellness Program: A Senior Center Model
Authors: Campbell Judy , Aday Ronald H
Published: May 2014

Using community-based sites for older adult intervention and self-care activities may promote an ability to maintain an independent lifestyle.
Acute Confusion/Delirium Protocol
Authors: Rapp Carla Gene
Published: May 2014

ABSTRACT

This abbreviated version of the Acute Confusion/Delirium Research-Based protocol provides clinical guidelines for the assessment and management of acute confusion/delirium in the elderly individual. A screening and ongoing surveillance program that is based on identified risk factors is recommended to prevent or minimize episodes of acute confusion in this age group. This protocol is part of a series of protocols developed to help clinicians use the best evidence available in the care of older adults.
Acute Confusion in Terminally Ill Hospitalized Patients
Authors: Wakefield Bonnie , Johnson Julie A
Published: May 2014

ABSTRACT

Knowledge about acute confusion (AC) has grown rapidly during the past decade, but very few studies have focused specifically on AC episodes associated . with the end of life. Although experienced oncology clinicians accept that AC is common near the end of life, little is known about the frequency, nature, course, and timing of AC during this critical stage of life in patients with terminal cancer. Data suggest patients with advanced cancer have reversible causes of delirium, where appropriate treatment can result in improved outcomes. The data for this article are drawn from a larger study investigating the incidence, prevalence, behaviors, and outcomes of AC in acutely ill medical patients. The diagnosis of AC was ascertained using the NEECHAM Confusion Scale. Of the 117 participants included in the larger study, 16 developed delirium (cumulative incidence estimate, 14%) and 10 died within 1 year of the index hospitalization. These 10 cases were categorized in two groups: those with a cancer-related diagnosis (n = 6) and those without cancer (n = 4). To further describe the nature of AC near the end of life, two case studies are presented. Because all previous studies were conducted using samples consisting of patients with cancer, it is unknown whether the findings reported in previous studies hold for other terminal illnesses, such as chronic obstructive pulmonary disease or heart failure. The data presented in this article suggest there are differences in baseline vulnerability (e.g., cognitive status) and the timing of AC in relation to death. These differences need to be explored in a larger sample of individuals both with and without a diagnosis of cancer. The severity and course of AC in the terminally ill population needs to be described to gain a better understanding of end-of-life AC phenomenology (e.g., signs, patterns, subtypes). Armed with this information, health care providers will then be able to develop and test AC-specific treatments of patients, as well as counsel and support family members of patients experiencing AC.
Therapeutic Recreation in the Nursing Home: Reinventing a Good Thing
Authors: Buettner Linda L
Published: May 2014

Involvement in recreation therapy programs has a positive impact on the mental functioning and quality of life in older adults, and nurses should consider this rehabilitation treatment option.
Easy Rider Wheelchair Biking: A Nursing-Recreation Therapy Clinical Trial for the Treatment of Depression
Authors: Fitzsimmons Suzanne
Published: May 2014

The results of this study show a positive effect on depression levels in older adults through use of a psychosocial intervention and physical activity.
Development of an Intervention to Cope With Depression Following Myocardial Infarction: A Nurse-Facilitated Cardiac Support Group
Authors: Warren Judith R , Whall Ann L
Published: May 2014

Nurses with a holistic approach can initiate and facilitate support groups, a cost-effective and successful way to promote health.
Nurses Who Care for Survivors of the Holocaust: Is Special Education Necessary?
Authors: Rosenfield Sharon N
Published: May 2014

Teaching staff to be empathetic to patients with post-traumatic stress disorder may be challenging, especially when staff are not well-educated about the event which caused the trauma.
AGING, ETHNICITY, & SOCIAL SUPPORT: A REVIEW - Part 1
Authors: Johnson Rebecca A , Tripp-Reimer Toni
Published: May 2014

ABSTRACT

The increasing diversity of the population of older adults is reflective of the worldwide demographic trends. These trends present nurses with special challenges in assessing and meeting the needs of ethnic elderly individuals. Nurses must be willing and capable of assessing the social support networks and beliefs of older adute from any ethnic group to plan and implement culturally sensitive care. The success of this care will be closely related to the extent to which nurses recognize and include existing support networks and individual preferences.
Smoking and Health: Views of Elderly Nursing Home Residents
Authors: Wolfsen Connie R , Barker Judith C , Mitteness Linda S
Published: May 2014

Nurses should assess the smoking status of residents in long-term care, educate the resident about the risks, and devise a care plan respecting the resident's decision to smoke or not to smoke.
A Review of Research on Religious and Spiritual Variables in Two Primary Gerontological Nursing Journals: 1991 to 1997
Authors: Weaver Andrew J , Flannelly Laura T , Flannelly Kevin J
Published: May 2014

ABSTRACT

All articles published between 1991 and 1997 in the Journal of Gerontological Nursing and Geriatric Nursingwere classified as qualitative research, quantitative research, or non-research. Of the 784 articles reviewed, 5.1 % mentioned religion or spirituality. Research articles (7.7%) were more likely than non-research articles (2.8%) to address religion and spirituality. No statistical difference was found between the percentage of qualitative (10.7%) and quantitative (6.8%) studies addressing religious and spiritual factors. The percentage of quantitative studies including religious and spiritual variables was found to be higher than that found by systematic reviews of the research literature in various health professions.
Selecting Patients for Falls-Prevention Protocols: An Evidence-Based Approach on a Geriatric Rehabilitation Unit
Authors: Patrick Louise , Blodgett Angela
Published: May 2014

To preserve quality of life and reduce hospital costs, assessments should be performed upon admission to rehabilitation units to determine patients at greatest risk for falls.
Delivering Health Information About Self-Medication to Older Adults
Authors: Neafsey Patricia J , Strickler Zoe , Shellman Juliette , Padula Antoinette T
Published: May 2014

Use of Touchscreen-Equipped Notebook Computers
Big Public Policy Issues Face Gerontological Nursing
Authors: Mohler Martha M
Published: May 2014

Nurses are encountering barriers to effective care and need to examine how the standards are being interpreted, implemented, and enforced.
Drug & alcohol intervention for older women
Authors: Eliason Michele J , Skinstad Anne Helene
Published: May 2014

ABSTRACT

Pretest and posttest information was gathered from 26 older women attending educational programs related to alcohol and drug use. The goals of the study were to determine current knowledge about alcohol and drugs among older women and to gather some initial information about the potential for alcohol and drug interactions and misuse. The intervention included a 60-minute presentation on the metabolism of alcohol and drugs in the aging body, the potential for alcohol-drug interactions, and a discussion of healthy lifestyles e.g., diet, exercise). Older women, especially those who were moderate to heavy drinkers, were found to have many misconceptions about alcohol and drug use, but their knowledge improved dramatically after the brief educational intervention. This finding may suggest that most of the women had knowledge deficits rather than deeply entrenched attitudes about alcohol and drug use or alcohol dependence. Therefore, simple educational interventions may be very effective with mis subset of women.

A PILOT STUDY
CHRONIC PAIN: Challenges and Assessment Strategies
Authors: Herr Keela
Published: May 2014

ABSTRACT

Older adults are a rapidly growing segment of the world population, and long-term care will continue to be a major concern for most health care institutions in this century. Pain management remains at the forefront of long-term care issues, with ofder patients more subject than younger patients to chronic disease states that predispose them to pain. Assessment and management of chronic pain, however, are impeded by a lack of patient and caregiver education regarding pain, widespread misconceptions about pain in older patients, and special concerns and cautions for appropriate analgesic use in this population. This is the first of a twopart series highlighting issues and strategies related to pain assessment in older adults.
A Comparison of AFRICAN AMERICAN & CAUCASIAN AMERICAN FEMALE CAREGIVERS of Rural, Post-stroke, Bedbound Older Adults
Authors: Cuellar Norma G
Published: May 2014

ABSTRACT

As changes in health care take place, the care of older adults in the home becomes a greater responsibility of informal caregivers. The purpose of this study was to compare African American and Caucasian American female caregivers of post-stroke, bedbound older adults in rural Mississippi. A purposive sample of 74 caregivers reported bedbound older adults' functional impairments, along with caregivers' stress and self-efficacy, social support, coping, depression, and life satisfaction. Significant differences were determined for self-efficacy between the African American and Caucasian American caregivers. Disordinal interactions existed between race and caregiving seff-efficacy on the variables of stress and life satisfaction. Nurses must be cognizant of the many Stressors influenced by cultural factors, such as race, faced by these caregivers. This is important to include in the curricula of nursing programs for the 21st century.
Nursing Assessment of Ill Nursing Home Residents
Authors: Barry Cathy R , Brown Kathy , Esker Debbie , Denning Mary Dee , Kruse Robin L , Binder Ellen F
Published: May 2014

To provide quality care, nurses must be competent in assessment and documentation practices. This study reveals a need to update nursing skills related to early identification of acute changes in residents' conditions.
End-of-Life Treatment Decisions in Long-term Care
Authors: Wurzbach Mary Ellen
Published: May 2014

The greatest protection for resident rights and autonomy is the policies of the nursing home. In this study, the consistency of nursing home policies in Wisconsin is examined.