bluuebunny/crossref_metadata_2025_split huggingface dataset:
TOILETING: A Biobehavioral Challenge in Alzheimer's Dementia Care
Authors: Hutchinson Sally , Leger-Krall Sue , Wilson Holly Skodol 
Published: May 2014

ABSTRACT
As the trajectory of Alzheimer's disease (AD) progresses, problems with toileting become evident. This research addresses the range and variation of toileting problems, management strategies used by family and employed caregivers, and interactive and contextual conditions associated with toileting. Qualitative ethology was used to analyze data from over 1 20 hours of participant observation at an Alzheimer's Day Care Center, in clients' homes, and support groups; and interviews with families (n=16) and staff members (n=1 3). Toileting emerged as a complex event with many stages, as unaesthetic and unpleasant for caregivers and clients, and as occasionally resulting in catastrophic reactions. Caregivers read cues and interpret toileting behaviors. They provide physical and cognitive assistance while attempting to avoid accidents and catastrophic events. Client, staff member, and contextual variables affect toileting events. Recommendations for practice and research are proposed.
EXPANDING THE SCOPE OF CONTINUITY THEORY Application to Gerontological Nursing
Authors: Onega Lisa L , Tripp-Reimer Toni 
Published: May 2014

ABSTRACT
Continuity Theory is a psychosocial theory of aging which posits that as middle-aged and elderly adults adapt to changes associated with the normal aging process, their past experiences, decisions, and behaviors will form the foundation for their present and future decisions and behaviors. Regardless of the clinical setting, nurses working with elderly individuals may find Continuity Theory helpful in viewing the experience or elders in a holistic way that incorporates a life course perspective. By applying Continuity Theory to clinical practice, nurses may be better able to provide individualized, clinically appropriate care to elders.
MANAGED CARE: What is its Impact on Nursing Education and Practice?
Authors: Malloy Catherine 
Published: May 2014

ABSTRACT
Market forces present the nursing profession with an urgency to prepare gerontological nurses to assume significant roles in the managed care industry. An understanding of the current managed care environment underscores the need for training. Nurses require a "managed care" skill-set encompassing a firm grasp of the organization, financing, delivery, and policy implications of managed care as well as advanced practice clinical skills and a sound business orientation. The importance of the consumer as a significant player in managed care is highlighted.
TRENDS IN AGING CARE SCOTLAND AND SCANDINAVIA
Authors: Evans Lois K 
Published: May 2014

ABSTRACT
The proportion of older adults in Western European countries, as in the United States, continues to increase rapidly. Faced with geriatric care dilemmas decades earlier, however, these countries have had more experience on which to base lhe development of community- based, integrated care systems for the elderly. This article provides observations from a 1993 World Health Organization Fellowship study of long-term care facilities in four European countries: Scotland, Sweden, Norway and Denmark. Several emerging trends in geriatric care documented in the literature were confirmed. These included: moratoria on institutional long-term care, emphasis on informal care and support, provision of 24-hour assistance in the home, care management to individualize care, and an expanded set of providers within integrated delivery systems.
RESIDENT RIGHTS: Knowledge of and Implementation by Nursing Staff in Long-Term Care Facilities
Authors: Roberto Karen A , Wacker Robbyn R , Jewell Eva M , Rickard Mindy 
Published: May 2014

ABSTRACT
in this study, we assessed the differences between certified nursing assistants' (CNAs) and nurses' (RNs and LPNs) level of knowledge and perceived implementation of resident rights. The CNAs and nurses responded to a series of 1 1 scenarios representing rights such as privacy, choice, and respect. Their responses suggested that although they knew what the appropriate response to the situation was, it was not the typical response to that type of situation within their facilities. Implications for teaching and applying resident rights are discussed.
Changes in Health Status of Elderly Patients Following HIP REPLACEMENT SURGERY
Authors: Brodie Lyndell J , Sloman Rodney M 
Published: May 2014

ABSTRACT
This study investigated changes in health status following a total hip replacement among a convenience sample of 22 male and 23 female patients, all of whom had been suffering from hip dysfunction and associated arthritic pain and impaired mobility. Subjects were pretested in an orthopedic pre-admission clinic with the Arthritis Impact Measurement Scales questionnaire and were posttested with the same instrument 3 ½ months after the initial contact and subsequent to hip replacement surgery. Analysis of pretest and posttest mean differences showed significant improvement in scores for pain and physical activity. No significant changes were demonstrated in the psychological and social domains of health status.
FILIAL PIETY
Authors: Dai Yu-Tzu , Dimond Margaret F 
Published: May 2014

A Cross-Cultural Comparison and its Implications for the Well-Being of Older Parents
ABSTRACT
The purpose of this article is to compare and contrast the concept of filial piety in Chinese culture and American culture and to discuss the relationship between expectations of filial piety and the well-being of older adults. In both cultures, filial piety is a socially approved virtue and contains attributes of respecting, caring for, and loving the parents. The differences include: obedience versus confrontation of parents; limited versus unlimited responsibility to parents; and a difference in the concept of legitimate support. Based on previous literature, the relationship between the expectations of filial piety and parents' well-being was explored, and nursing implications were suggested. Nonetheless, there is no single intervention that could fit all clients from one culture. Nurses need to examine to what extent clients value their culture of origin.
Special Care Units for People With ALZHEIMER'S DISEASE: Only for the Privileged Few?
Authors: Maas Meridean L , Specht Janet P , Weiler Kay , Buckwalter Kathleen C , Turner Betty 
Published: May 2014

ABSTRACT
The number of Special Care Units (SCUs) for people with Alzheimer's disease (AD) in nursing homes have increased dramatically in the past 10 years. Despite the rapid increase in number of SCUs and the concern that most SCUs report higher costs than traditional nursing home units where residents with AD are integrated with cognitively intact residents, the evaluation of costs has been largely unsystematic and noncomparative. Studies are urgently needed to assess comparative costs so that administrators and policy makers can make informed decisions. This article reviews studies that examine the costs of care in SCUs and presents cost-related data comparing the outcomes of care for residents with AD on a SCU and on traditional units in one long-term care setting.
Nursing Home Dementia Care Units PROVIDING A CONTINUUM OF CARE RATHER THAN AGING IN PLACE
Authors: Kovach Christine R 
Published: May 2014

ABSTRACTExperience from the first 24 months of a new Dementia Special Care Unit is presented with an emphasis on admission and discharge criteria, length of stay, and reasons for discharge. Maintaining residents with moderate functional abilities on a Special Care Unit is examined relative to relocation stress, aging in place, and staff needs. The benefits of providing a continuum of dementia care and the risk of potential harm of frequent intra-institutional moves are discussed.
EFFICACY BELIEFS IN GERIATRIC REHABILITATION
Authors: Resnick Barbara 
Published: May 2014

ABSTRACTMotivation is an important variable in older adults' ability to recover from any disabling event. The theory of self-efficacy states that efficacy beliefs affect behavior, motivational level, thought patterns, and emotional reactions in response to any situation. This study explored the impact of efficacy beliefs on older adults in a rehabilitation program and tested interventions to strengthen efficacy beliefs related to participation in rehabilitation and functional performance.An experimental ? retest- posttest design was used. Participants were randomly assigned to: the usual care control group or the treatment group. The study was completed on an inpatient geriatric rehabilitation unit. The sample consisted of 77 participants, 55 women and 22 men with a mean age of 78 ± 7.2. Individuals in the treatment group received three efficacy enhancing interventions: role modeling, verbal persuasion, and physiological feedback. Baseline data were collected within 48 hours of admission and included four investigator-developed efficacy measures: Functional Inventory Measure, Participation Index, Numeric Rating Scale for pain, amount of analgesic used for pain, and Health Status. With the exception of Health Status, these measures were again completed within 48 hours of discharge.Admission performance was the only statistically significant predictor of efficacy beliefs. All efficacy beliefs increased over time and were significantly correlated with performance behaviors and length of stay. The treatment group had stronger efficacy beliefs regarding participation, higher participation at discharge, and less pain than the control group.Efficacy beliefs, both self-efficacy and outcome expectations, are related to participation, functional performance, and length of stay. Interventions to strengthen these beliefs improved participation in rehabilitation and decreased pain. Consideration of motivation can facilitate rehabilitation and help older adults obtain and maintain their highest functional level.
Pain & Cognitive Status in the Institutionalized Elderly
Authors: Kaasalainen Sharon , Middleton Joan , Knezacek Sandy , Hartley Terry 
Published: May 2014

ABSTRACT
The purposes of this study were t examine the relationship between: (1) nurses' ratings of pain and corresponding administration of pain medication to elderly long-term care residents, and (2) cognitive status the elderly and pain medication orders/administration. Participants were 83 residents, 60 years of age and older, in two groups: cognitiveIy impaired (n = 64), and cognitively intact (n = 19). For comparison purposes, 19 of the cognitively impaire subjects were matched on age an diagnosis to provide control fi potentially painful conditions. A retrospective medication review of the residents' charts was conducted to compare medication orders and administration on analgesics that were scheduled and p.r.n. (given needed). The pain ratings of 25 RN using a visual analogue scaie wen correlated with pain medication given to the resident on the day o the rating. Results indicated that RNs' ratings of resident pain and the administration of pain medications were not significantly correlated. In addition, cognitively impaired residents were prescribed significantly less scheduled medication and received significantly less pain medication (either p.r.n. or scheduled) than the cognitively intact elderly. Implications for practice and research are discussed.
EXAMINING PAIN in Aggressive Cognitively Impaired Older Adults
Authors: Feldt Karen S , Warne Mary A , Ryden Muriel B 
Published: May 2014

ABSTRACT
Few studies have explored the phenomenon of pain in people with severe cognitive impairment. Pain assessment, which depends primarily on people's ability to describe dimensions of pain, becomes problematic when clients' cognitive impairment is so severe they cannot respond to pain assessment tools. The purpose of this study was to describe the phenomenon of pain for a subgroup of aggressive cognitively impaired nursing home residents who were enrolled in a larger study of aggressive behavior. To determine if pain was a possible factor influencing aggression, information was sought from five sources: family members, nursing assistant (NA) caregivers, medical record listings of pain-related diagnoses, use of analgesics, and observations of aggressive behaviors. Families reported pain in 44% of subjects, while NAs reported pain in 66% of subjects. Seventysix percent of subjects had one or more pain-causing diagnoses. Sixty-four percent of subjects whose family members thought they may have pain were being treated with analgesics, compared to 44% of subjects whose NA reported they may be experiencing pain. Aggression scores were significantly higher in subjects who had two or more pain-related diagnoses and in subjects with arthritis. Nurses who are aware of a history of pain, reports of pain by families and caregivers, presence of pain-related medical diagnoses, and who realize pain may be a trigger for aggressive behavior may be more likely to recognize pain in cognitively impaired older adults. Better pain assessment should lead to improved treatment of pain in this population.
UNMET HEALTH CARE NEEDS: Comparison of Rural and Urban Senior Center Attendees
Authors: Clark Darlene , Dellasega Cheryl 
Published: May 2014

ABSTRACT
Rural-dwelling older adults are in poorer health and have less access to health care resources than urban older adults. However, little is known about specific unmet needs which exist for urban and rural populations. This study compared self-reported health status, use of services, and unmet health care needs of 106 elderly individuals residing in rural and urban settings to determine if these variables differed based on geographic location.
Data were gathered on the three dependent measures using the Elderly Health Care Needs Assessment Questionnaire. Findings revealed rural older adults were not in poorer self-reported health (x2 = 1.85, p = .60). However, a t test showed rural subjects were significantly poorer in objective health as measured by the number of reported symptoms (t = 224, p = .02). Despite having a greater number of specific heath complaints, these rural elderly individuals did not use significantly more services (t = 1.16, p = .24) or report more unmet needs (x2 = 3.67, p = .055), thereby reinforcing traditional views of rural older adults being in poorer health but also more self-reliant in matters related to health care.
The results of this study provide information which will improve nursing practice in rural and urban settings and provide direction for further research.
Developing Individualized Care in Nursing Homes
Authors: Walker Leslie , Porter Martha , Gruman Cynthia , Michalski Marion 
Published: May 2014

Integrating the Views of Nurses and Certified Nurse Aides
ABSTRACT
Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.
BLADDER DIARIES and Voiding Patterns Older Adults
Authors: Pfister Susan M 
Published: May 2014

ABSTRACT
Urinary incontinence is one chronic health problem that many older adults experience. Assessment is the first step in approaching a urinary elimination problem and forms the basis for determining potential management modalities. The bladder diary, one type of fluid intake and output record, is helpful in describing an individual's voiding pattern and is an integral component of urinary assessment. Bladder diaries also can be used to evaluate the effectiveness of interventions initiated to manage incontinence. This article describes the procedure for using bladder diaries within the context of a research study conducted with residents of retirement settings.
IS COGNITIVE IMPAIRMENT a Guide to Use of Video Respite™?: Lessons From a Special Care Unit
Authors: Malonebeach Eileen E , Royer Mark , Jenkins Cathleen C 
Published: May 2014

ABSTRACT
The goal of this study was to examine the usefulness of Video Respite™ (VR) in relation to the abilities of cognitively impaired older adults. Three VR videotapes were shown to residents of a special care unit. Older adults were videotaped as they viewed the VR videotapes to observe their levels of involvement. Analyses of the videotapes of the older adults confirmed that participation varies considerably between and within residents and, further, that cognitive status is not a useful guide in predicting levels of participation. Some residents showed no interest in television in general or in VR, while the elimination of distractions resulted in more sustained viewing for those inclined to participate. The authors' observations suggest ways to optimize the usefulness of VR for formal and informal caregivers.
WANDERING: A Dementia-Compromised Behavior
Authors: Algase Donna L 
Published: May 2014

ABSTRACT
The wandering behavior of individuals with dementia is a puzzling behavior, and strategies for responding to it often are poorly grounded. However, advances in the understanding of neurocognitive factors contributing to wandering now may provide important clues for designing nursing approaches, in this article, such advances are summarized, and implications and strategies for practice are delineated.
FAMILY PERSPECTIVES on Dying in Long-Term Care Settings
Authors: Wilson Sarah A , Daley Barbara J 
Published: May 2014

ABSTRACT
Dying is a central experience in the life of a family. Yet there are few studies of dying in longterm care and the role of a family. The dynamic relationships among families, staff, and residents in long-term care facilities related to the process of dying is an area where research is needed. As part of a larger study of death and dying in long-term care settings, 11 family members who recently had experienced the loss of a relative in the long-term care setting were interviewed. The purpose of this study was to describe family perspectives on death and dying in long-term care facilities and to discuss ways staff may be helpful to families in coping with the loss of a family member. Analyzing death and dying from the family perspective offers health care providers an opportunity to expand the understanding of the phenomenon of death in long-term care facilities and to incorporate care activities that families view as helpful. Major themes emerged from this study, including the caring behaviors of staff, participating in the dying process, and providing spiritual support. The themes and practice implications are discussed in this article.
Older Women and the Meaning of Health
Authors: Maddox Margie 
Published: May 2014

ABSTRACT
Health promotion has become an essential component of comprehensive health care, especially considering the growing female population. Older women, in particular, have demonstrated an increasing need for preventive services or health care maintenance and promotion. These needs consist of services provided by health care professionals that can help women meet their own self-care demands. However, before the health care needs of women can be met, they first must be identified.
Using Orem's Self-Care Theory, a three-part qualitative phenomenological study was conducted in an attempt to understand what health actually means to older women and what types of health behaviors they feel are important to maintain or promote health. Three different groups of women age 55 and older with a variety of education, socioeconomic, and racial backgrounds were interviewed. Their responses were analyzed carefully, and each participant was interviewed a second time to validate recurrent themes regarding their statements about health.
Results of the interviews with the three different groups of women were surprisingly similar. Although each participant had a unique application of their definition of health, there were five recurrent themes identified by 75% to 80% of the women. The themes were interactions with a being greater than themselves, acceptance of self, humor, flexibility, and being other-centered. Numerous examples supported the five themes. In addition, several "healthy behaviors" also were identified. Based on the findings of this 3-year study, older women seem to have their own perspectives on what health actually means and how they can best monitor or maintain their health. While the list is slightly different than the traditional one prescribed by health care professionals, perhaps it is time to encourage older adults to become more of a partner in their care. These healthy behaviors could be incorporated easily into the treatment and management plans and thereby reflect both parties' definitions of what it means to be healthy. Health care professionals must continue to ask older adults about their view of health and encourage their partnership in healthrelated issues. All individuals, no matter what age, are being encouraged to assume more responsibility for their own personal health, and by including older adults in the decision-making process, this partnership can be strengthened.
Understanding What MOTIVATES Older Adults to Exercise
Authors: Resnick Barbara , Spellbring Ann Marie 
Published: May 2014

ABSTRACT
The purposes of this study were to explore the factors that influenced adherence to an exercise program for older adults, and compare differences in motivation, efficacy expectations, health status, age, functional performance, and falls between adherers and nonadherers. A combined qualitative and quantitative design was used. Participants included 23 of the 24 members of an existing walking group, with an average age of 81 ± 7.2 years. Fourteen (60%) participants did not adhere to walking, while 9 (40%) adhered. Those that adhered had fewer functional limitations due to their health, (F = 7.7, p < .05), better functional performance (F = 4.0, p < .05), stronger self-efficacy expectations related to exercise (F = A3, p < .05), and fewer falls (F = 4.4, p < .05). Six major themes were identified that impacted adherence: a) beliefs about exercise; b) benefits of exercise; c) past experiences with exercise; d) goals; e) personality; and f) unpleasant sensations associated with exercise. Interventions that focus on teaching older adults about the benefits of exercise, establishing appropriate goals, and decreasing unpleasant and increasing pleasant sensations associated with exercise may be useful to improve adherence to a regular exercise program.