bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.
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.
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.
Drug & alcohol intervention for older women
Authors: Eliason Michele J , Skinstad Anne Helene 
Published: May 2014

ABSTRACTPretest 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.