Geriatric Nursing Research Papers - Academia.edu (original) (raw)

In 2003, the John A. Hartford Foundation Institute for Geriatric Nursing (Hartford Institute), in collaboration with the American Association of Colleges of Nursing, conducted a survey of baccalaureate schools of nursing in the United States to compare gerontological content to baseline data collected by the Hartford Institute in 1997. Since last surveyed in 1997, baccalaureate nursing programs have been the recipients of substantial new resources and initiatives focused on gerontological curriculum enhancement. While these initiatives are ongoing, and some are in an early stage of development, resurveying baccalaureate programs was seen as a means of taking a midcourse "pulse" as to the effectiveness of these efforts. Data suggest that there has been a fundamental shift in baccalaureate curriculum toward incorporation of a greater amount of gerontological content, integration of gerontological content in a greater number of nursing courses, and more diversity of clinical ...

- by
- •
- Program Evaluation, Nursing, Geriatrics, Gerontology

This article describes posthospitalization visits by 83 nursing students to 57 older patients and their caregivers discharged from two large academic medical centers and one community hospital. Patient and caregiver interviews in the home focused on the areas of geriatric assessments of cognitive and functional status, patient and caregiver satisfaction with recent hospitalization, ongoing health management, patient teaching, and discharge planning. (Geriatr Nurs 2001;22:248-52)

- by Beth Latimer and +1
- •
- Program Evaluation, Nursing, Family, Activities of Daily Living

In June 2001, the John A. Hartford Foundation of New York awarded the American Association of Colleges of Nursing (AACN) a 3.99 million dollar grant to enhance gerontology curriculum development and new clinical experiences in 20 baccalaureate and 10 graduate schools of nursing. Over the 4-year grant implementation period, AACN learned a valuable lesson from the grant's site directors: Faculty development is the single most necessary precursor to the successful implementation and maintenance of geriatric curricular enhancements. Unless faculty members foster positive attitudes toward aging, expand their geriatric nursing knowledge base, and are able to integrate geriatric content into the curricula, progress cannot be made. Enhancing Geriatric Nursing Education project directors recommend that the following steps be taken toward the creation of successful faculty development activities: (1) anoint a champion to mentor and persuade faculty members to embrace gerontology; (2) garner faculty buy-in by engaging the faculty early so that they become active participants in the curricular change process; (3) assess faculty knowledge and comfort level by administering tools developed by the John A. Hartford Foundation Institute for Geriatric Nursing and by conducting surveys based on AACN geriatric core competencies; (4) conduct faculty development workshops that include cutting-edge knowledge and research and provide the faculty with opportunities to discuss feelings and stereotypes about aging; (5) elicit the dean's support to encourage and allow time and opportunities for training; and (6) use the many excellent resources that help the faculty integrate geriatric content into their courses. This article will further elucidate such strategies and will highlight the range of faculty development activities in which grant-funded schools engaged. (Index words: Gerontology curriculum; Faculty development) J Prof Nurs 22: [79][80][81][82][83] 2006. A

- by Deirdre Thornlow
- •
- Nursing, Educational Measurement, Prejudice, Faculty Development
- by Peri Rosenfeld
- •
- Program Evaluation, Nursing, Data Analysis, Faculty Development

Purpose: To test the relationship between nurses' perceptions of the geriatric nurse practice environment (GNPE) and perceptions of geriatric-care delivery, and geriatric nursing knowledge. Design: A secondary analysis of data collected by the New York University Hartford Institute Benchmarking Service staff using a retrospective, cross-sectional, design. Methods: Responses of 9,802 direct-care registered nurses from 75 acute-care hospitals in the US that administered the GIAP (Geriatric Institutional Assessment Profile) from January 1997 to December 2005 were analyzed using linear mixed effects modeling to explore associations between variables while controlling for potential covariates. Findings: Controlling for hospital and nurse characteristics, a positive geriatric nurse practice environment was associated with positive geriatric care delivery (F=4,686, p<.0001) but not geriatric nursing knowledge. The independent contribution of all three dimensions of the geriatric nurse practice environment (resource availability, institutional values, and capacity for collaboration) influences care delivery for hospitalized older-adult patients. Conclusions: Organizational support for geriatric nursing is an important influence upon quality of geriatric care. Clinical Relevance: Hospitals that utilize an organizational approach addressing the multifaceted nature of the GNPE are more likely to improve the hospital experience of older adults. [Key words: acute care, geriatric nursing, nurse practice environment, quality of geriatric care]

- by Elizabeth Capezuti
- •
- Nursing, Organizational Culture, Quality of Mental Health Care, Social Support

Our country's rapidly growing older adult population represents the core business of health care; however, few nurses are adequately prepared to care for their unique needs. This is caused, in part, by the limited attention paid by nursing educators to incorporating basic gerontological nursing principles into undergraduate programs. During the last 7 years, the American Association of Colleges of Nursing, through the generous support of the John A. Hartford Foundation, has led several initiatives to improve gerontological nursing education in baccalaureate programs. This article describes innovative educational strategies successfully implemented by three nursing programs-New York University, Tuskegee University, and University of Rhode Island-to increase knowledge and improve attitudes of nursing students in caring for older adults. Successful strategies include a long-term care guide, a senior mentor experience, student assignments addressing diversity issues, student debates, critical reflective journalizing, and an evaluation tool for measuring student attitudes. These strategies are readily reproducible and assist faculty to easily integrate gerontological nursing content into the curriculum while simultaneously enhancing student attitudes and knowledge. (Index words: Student attitudes; Health care; Nursing education; Older adults) J Prof Nurs 22: 91-97, 2006.

- by Elizabeth Capezuti
- •
- Program Evaluation, Nursing, Health Promotion, Health Care

RNs make measurable contributions to the health and wellness of individuals living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively affect resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based on eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness...

- by Stacie Salsbury
- •
- Nursing, Leadership, Long Term Care, Evidence Based Nursing

Despite the expansion of Deaf people's use of communication technology little is published about how they use electronic communication in their social and working lives and the implications for their concepts of identity and community. Australia is an ideal research base because the use of a range of technologies is widespread there. To gain access to a wide age range of people who identify as Deaf, members of the national organization, the Australian Association of the Deaf, were surveyed by mail. Results showed that Short Message Service (SMS), telephone typewriters (TTY), voice/TTY relay services, fax, and e-mail were used regularly. Deaf users are discerning of the purposes for which they use each method: SMS for social and personal interactions, TTY for longer communications and (via the relay service) with people and services without TTYs, fax for business and social contact, and computers for personal and business e-mails as well as Web browsing, accessing chat rooms, word processing, games, and study.

- by Louise Horstmanshof
- •
- Nursing, Mental Health, Quality of life, Older people
- by Mary Schumann
- •
- Nursing, Geriatric Nursing, Older Adult
- by Lisa Reider
- •
- Nursing, Evidence Based Nursing, Geriatric Nursing

Pain is an individual experience. This paper presents four phenomenological accounts of pain which describe: the pain at the time of the experience; the meaning the pain had at the time of the experience (reflection in); and the meaning of the experience looking back on it (reflection upon). Specifically, the accounts describe pain that is emotional, cognitive and physical (acute and chronic). By exploring the essence of pain using very personal accounts, we encourage nurses to reflect on how their own understanding of pain and individual responses to pain can impact on how they in turn recognise, assess and manage pain in older people and especially those living with dementia. Paper 1 highlights the under-assessment of pain in older people with dementia. By confronting readers with this paper's phenomenological approach, it is hoped that they will be challenged to address this situation.

- by Rhonda Nay
- •
- Nursing, Dementia, Chronic Pain, Phenomenology

Aim. This study sought to uncover what nurses perceived to have learned, during their participation in video supported counselling, based on Marte Meo principles, in four dementia specific care units.

- by Rigmor Alnes
- •
- Nursing, Dementia, Focus Groups, Counseling
- by Annie T Chen
- •
- Nursing, Geriatric Nursing

relating to nurses' critical thinking and decision-making skills. Unrelieved pain leads to many serious negative health outcomes in people with dementia. The purpose of the study was to examine temporally based relationships between change in behavior, the nurses' level of certainty regarding pain, assessment scope and outcomes of pain and agitation. Relationship between severity of dementia, comorbid burden, ability to verbally self-report symptoms and patient outcomes of pain and agitation was also investigated. A Convenient sample of 78 nursing home residents with dementia was selected from 5 nursing homes in Amman, Jordan. The average age of the participants was 72. 52 years and 56.0% of them were men. Nurses' level of certainty regarding suspected pain was examined with one item Likert Scale. Scope of pain assessment was coded and collected directly from change tracking sheets. Pain was measured by Discomfort Scale for Dementia of Alzheimer's Type. Agitation was measured by Wisconsin Agitation Inventory tool. Severity of dementia was measured by the Mini Mental State Examination. Comorbid burden was measured by

- by Mohammad Rababa
- •
- Nursing, Geriatric Nursing

Self-transcendence changes how older adults perceive themselves, their relationships with others, the material world, and the metaphysical or spiritual dimension. It is associated with multiple indicators of well-being. The purpose of this pilot study (N = 20) was to examine the feasibility and effectiveness of a psychoeducational intervention to increase self-transcendence and wellbeing of older adults. Data were analyzed using generalized estimating equations. All variables trended in the directions hypothesized. Self-transcendence increased in the intervention group and decreased in the control group but not significantly. The group × time interaction for life satisfaction was significant (z = 2.89, p = .004). This feasibility study supports further investigation to assess the effectiveness of the intervention in a larger sample.

- by Lynne Hall
- •
- Nursing, Health Promotion, Quality of life, Independent Living

Function-focused care (FFC) is an approach to care in which nurses help patients engage in activities of daily living (ADL) and physical activity, with the goal of preventing avoidable functional decline. This prospective, observational study, conducted with hospitalized older adults (N 5 93) examined: 1) the demographic and clinical characteristics of patients who were provided FFC activity, and 2) the relationship between change in physical activity and FFC activities. Patients who received FFC were more likely: to be younger (P 5 .028); had one or more falls during the hospitalization (P 5 .048); had demonstrated better functional performance at admission (P 5 .004) and better physical capability, measured by the Tinetti gait and balance scale (P 5 .004). FFC was associated with less decrement in ADL function, admission to discharge, while considering patient characteristics (t 5 7.6; P \ .008). Results suggest that hospitalized older persons can benefit from FFC. (Geriatr Nurs 2012;33:272-279) O lder adults are admitted to acute care hospitals at rates as high as 3 times those of younger individuals. 1 It is estimated that up to 50% lose the ability to conduct activities of daily living (ADLs) while hospitalized, 2 with profound implications for their health. The consequences of functional decline include decreased functional recovery 3 and increased morbidity and mortality. 4 The immobility associated with functional decline results in iatrogenic infections, pressure ulcers, falls, and nonelective rehospitalizations. 5,6 Moreover, lack of attention to functional health predisposes the older adult to prolonged, costly rehabilitative care with limited guarantee of return to prehospitalization function. 7 This shortfall in care delivery is inconsistent with the basic tenet of gerontological nursing that emphasizes preservation of function and with the older person's expectation that the hospitalization improve not worsen health and functioning. 8 This study begins to address this gap by examining the interaction between nurses and hospitalized older adults during ADL performance and the relationship with functional outcomes.

- by Marie Boltz
- •
- Nursing, Activities of Daily Living, Geriatric Nursing, Hospitalization

The aim of this study was to illuminate the meaning of older people's dependence on caregivers' help, and of their opportunity to make independent decisions. Throughout the world, the older population is growing, and in Sweden, the system of care for older people is currently undergoing change. Older people in the need of care are expected to live at home for as long as possible. A qualitative and life world approach was used. Audio-taped interviews were conducted with twelve older persons living at home, dependent on daily municipal home help service. A phenomenological hermeneutic method was utilised to disclose the meanings of lived experiences. The findings revealed three themes: being facilitated to make one's own decisions, being hindered from making one's own decisions, struggling for vs. resigning oneself to losing the opportunity to make one's own decisions. The comprehensive understanding revealed that as older people become more dependent on caregivers...

- by Ingegerd Fagerberg
- •
- Nursing, Decision Making, Aging, Self Care
- by Vanessa Burholt and +2
- •
- Nursing, Activities of Daily Living, Life Satisfaction, Geriatric Nursing

acute and residential care settings Objectives. The objective of this review was to investigate physical restraint minimization in acute and residential care settings. The first aim was to determine the effectiveness of attempts to minimize the use of physical restraint, and the second was to generate a description of the characteristics of restraint minimization programmes. Method. A comprehensive search was undertaken involving all major databases and the reference lists of all relevant papers. To be included in the review studies had to be an evaluation of restraint minimization in an acute or residential care setting. As only a single randomized controlled trial (RCT) was identified, it was not possible statistically to pool the findings of different studies on the effectiveness of restraint minimization. To generate a description of the characteristics of restraint minimization programmes, the reported components of these programmes were identified and categorized. Results. A total of 16 studies evaluating restraint minimization were identified: three in acute care and 13 in residential care. Of these, only one was an RCT, with the most common approach being the before and after study design. Based on the findings of the single RCT, education supported by expert consultation effectively reduced the use of restraint in residential care. There has been little evaluation of restraint minimization in acute care settings. The common approach to restraint minimization has involved a programme of multiple activities, with restraint education being the characteristic common to most programmes. Discussion. Evidence suggests that physical restraint can be safely reduced in residential care settings through a combination of education and expert clinical consultation. There is little information on restraint minimization in acute care settings. The major finding of this review is the need for further investigation into all aspects of restraint minimization.

- by Leonnie Lambert
- •
- Program Evaluation, Nursing, Health Services Research, Critical Care

Assisted living, by its very definition, provides assistance in living. One area where this is increasingly needed for AL residents involves fall prevention. Unfortunately, this same concern has also been an increasing focus of malpractice liability to AL communities. As a result of this need and focus, ALs would be well served to develop an aggressive plan of action in managing resident fall risks. This process starts with careful assessment of each residents fall risk, development of a well-thought-out care plan to address these risks, followed by implementation of the plan of care to ensure that residents receive the assistance they require.

- by richard stefanacci
- •
- Nursing, Risk assessment, Geriatric Nursing, Assisted living facilities

Nurses' perceptions of barriers preventing optimal pain management in older adults on acute medical units and the extent to which they perceived they had adopted four evidence-based practices related to pain assessment and management were often incongruent with actual practice. Eliciting reports of pain, offering pro re nata pain relief regularly, utilizing pain assessment tools in patients with cognitive impairment, redesigning documentation tools and processes, making nonpharmacological alternatives accessible, and helping patients and families manage side effects would target the 12 barriers having the biggest impact.

- by Irene Turpie
- •
- Nursing, Pain, Evidence Based Practice, Evidence Based Nursing
- by Lois Miller and +1
- •
- Nursing, Leadership, Long Term Care, Quality of Mental Health Care
- by David Jones
- •
- Dentistry, Long Term Care, Needs Assessment, Geriatric Nursing

As in acute care, use of health information technology in long-term care holds promise for increased efficiency, better accuracy, reduced costs, and improved outcomes. A comprehensive electronic health record (EHR), which encompasses all health care measures that clinicians want to useboth standard health care assessments and those acquired through emerging technology-is the key to improved, efficient clinical decision making.

- by Marjorie Skubic and +2
- •
- Nursing, Electronic Health Records, Computer Security, Systems Integration

In this study we examined how nursing home staff experienced assisting patients with oral health care. The results of a previous questionnaire indicated that oral health care is a low priority in nursing. The 22 in-depth interviews administered in this study showed that the quality of the oral health care received by the patients depended on several factors. It was found that often there were no specific routines for assisting oral health care in the nursing homes and that other activities were given higher priority. Assisting oral health care was described as passing a barrier, where the main problem was to gain access to the oral cavity. It was concluded that nursing staff working with geriatric patients need to be better educated in oral health care and should be seen by themselves and others as part of a team, where oral health care is clearly defined and included among other daily nursing activities.

- by Lars Andersson
- •
- Nursing, Geriatric Nursing, Oral health, Aged

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time...

- by Ragnhildur Bjarnadottir
- •
- Nursing, Geriatric Nursing, Nursing Homes, Nursing staff

Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Services and is characterized by an inability to meet one's own basic needs. The Kohlman Evaluation of Living Skills (KELS) has been validated in geriatric populations to assess performance with both instrumental (IADL) and basic activities of daily living (ADL), and as an assessment tool for the capacity to live independently, therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders. Methods-This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from Adult Protective Services (APS) as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics. Control participants were matched for age, race, gender and zip code. A geriatric nurse practitioner-led team administered a comprehensive geriatric assessment in homes of all study participants. The assessment included the KELS and Mini-Mental State Examination (MMSE) tests. Chi-square analyses were used to determine if cases of self-neglect were significantly more likely to fail the KELS test than matched controls. Summary of Results-The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (50% vs. 30%, p=0.025). When stratified by MMSE scores, self-neglectors with intact cognitive function remained significantly more likely to fail the KELS compared to matched, cognitively intact controls (45% vs. 17%, p=0.013). Conclusion-Abnormal results using an in-home KELS test was significantly associated with substantiated cases of self-neglect. These findings suggest that the KELS test has significant utility as part of a comprehensive geriatric assessment to aid clinicians in suspected cases of self-neglect. Implications for Practice-There is currently no gold standard measure for identifying capacity with self-care behaviors among cases of self-neglect. As a result, self-neglect may remain unidentified in many clinical settings. The KELS provides clinicians with an objective measure of an individual's capacity and performance with everyday life supporting tasks and thus, provides information that can help nurse practitioners identify elders at risk for self-neglect.

- by Sabrina Pickens
- •
- Nursing, Risk assessment, Activities of Daily Living, Geriatric Nursing

Individualized nursing care, a form of personcentered care delivery, is accepted as best practice, yet its implementation into actual care is far from complete. Appropriate measures of this elusive concept are needed to better understand barriers to implementation. This study explored and tested the convergent validity and the reliability of 2 individualized nursing care measures. A cross-sectional survey design was used to collect data using the Individualized Care Scale and the Individualized Care Instrument (ICI) from a sample of nurses (n 5 263, response rate 71%) working in older peoples' care settings in Finland, and the data were analyzed statistically. Cronbach's alpha coefficients for the ICI scales (.63e.80) and ICS-A and B subscales (both a 5 .91) demonstrated only moderate correlation between the 2 instruments (r 5 e.39 to .50) and possibly the complexity of measuring "individualized care." The study acknowledges the latent influence of culture and care approach to the conceptualization of individuality. It concludes that the concept may best be measured at this point with the use of other factors in addition to instruments to capture its multiple domains. (Geriatr Nurs 2012;33:17-27)

- by Andreas Charalambous
- •
- Nursing, Geriatric Nursing, Nurses, Aged

Pain is a common problem for many older adults, with up to 50% of community-dwelling and 70% to 80% of nursing home residents experiencing pain regularly. Effective pain management requires thorough assessment, appropriate intervention, and systematic reassessment. Pain assessment, however, is complicated by dementia, which impairs memory, reasoning, recognition, and communication, and affects elders' ability to verbally report pain. As such, observational measures are needed to assess pain in this vulnerable population. The Noncommunicative Patient's Pain Assessment Instrument (NOPPAIN) was developed for this purpose, but more validation of this measure is needed. Thus, the purpose of this study was to (1) evaluate reliability of the NOPPAIN tool when used by nurses and to (2) compare NOPPAIN ratings with self-report and other well-established behavioral rating procedures. Forty participants (20 cognitively intact and 20 impaired) were randomly selected for this study from a larger sample. In the parent study, participants were asked to perform everyday activities (i.e., sit, stand, walk in place, transfer in and out of bed) while being videotaped. The tapes, all previously scored using microanalytic observational coding, were rated again by naïve raters using the NOPPAIN measure. Results indicated (1) high inter-and intrarater reliability of the NOPPAIN and (2) significant correlations of the NOPPAIN with self-reported pain and detailed behavioral coding. Findings support the reliability and validity of the NOPPAIN measure-

- by Ann Horgas
- •
- Psychology, Nursing, Pain, Dementia
- by Leslie Neal-Boylan
- •
- Nursing, Medicine, Retirement, Geriatric Nursing

The development of an identity and pattern of practice in the health care professions is based on a process of socialization into the roles and norms of a particular discipline and has important implications for clinical practice with elderly persons. Presented is a model for understanding the socialization process of physicians, nurses, and social workers as the development of professional meaning ("voice") based on the acquisition of value orientations or themes intrinsic to their education and training. The implications of these patterns for the abilities of different professions to work together collaboratively in the care of older persons are highlighted as a framework for developing new interdisciplinary curricular models in gerontological and geriatric education.

- by Phillip Clark
- •
- Geriatrics, Communication, Social Work, Higher Education

Much of contemporary research in Artificial Immune Systems (AIS) has partitioned into either algorithmic machine learning and optimisation, or modelling biologically plausible dynamical systems, with little overlap between. Although the... more

- by Ben Paechter
- •
- Nursing, Health Promotion, Machine Learning, Artificial Immune Systems

BACKGROUND: The Prevention and Reactivation Care Program (PReCaP) entails an innovative multidisciplinary, integrated and goal oriented approach aimed at reducing hospital related functional decline among elderly patients. Despite calls for process evaluation as an essential component of clinical trials in the geriatric care field, studies assessing fidelity lag behind the number of effect studies. The threefold purpose of this study was (1) to systematically assess intervention fidelity of the hospital phase of the PReCaP in the first year of the intervention delivery; (2) to improve our understanding of the moderating factors and modifications affecting intervention fidelity; and (3) to explore the feasibility of the PReCaP fidelity assessment in view of the modifications. METHODS: Based on the PReCaP description we developed a fidelity instrument incorporating nineteen (n=19) intervention components. A combination of data collection methods was utilized, i.e. data collection from...

Objectives: Moral distress (MD) occurs when the health care provider feels certain of the ethical course of action but is constrained from taking that action. The purpose was to examine MD in geriatric nursing care and to identify factors... more

- by Nele Van Den Noortgate and +1
- •
- Linear models, Belgium, Geriatric Nursing, End of life care

In recent years, there has been an increased emphasis on violence and abuse within society. It therefore seems appropriate to consider the role of education in promoting a greater understanding of the linked phenomena of elder abuse and neglect, and of the quality of life of older people. The rationale behind the educational process covering the area of elder abuse and neglect has not, until now, been discussed in any structured or open way. Education concerning these social problems has tended to develop in an ad hoc manner, with numerous organizations, professionals and academics developing their own ideas about what might be considered to be an appropriate curriculum. This paper aims to address some of the fundamental questions which need to be explored, including: who is to be educated; what knowledge is to be taught; and how is it to be taught?

- by Bridget Penhale
- •
- Nursing, Academic Development, Social Problems, Quality of life

2 0 0 6 ) Journal of Clinical Nursing 15, 581-587 Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting? Background. The common use of physical restraints in older people in hospitals and nursing homes has been associated with injurious falls, decreased mobility and disorientation. By offering access to bed-chair pressure sensors in hospitalized patients with perceived fall risk, nurses may be less inclined to resort to physical restraints, thereby improving clinical outcomes. Aims and objectives. To investigate whether the access of bed-chair pressure sensors reduces physical restraint use in geriatric rehabilitation wards. Design. Randomized controlled trial. Methods. Consecutively, patients admitted to two geriatric wards specialized in stroke rehabilitation in a convalescent hospital in Hong Kong, and who were perceived by nurses to be at risk of falls were randomly assigned to intervention and control groups. For the intervention group subjects, nurses were given access to bedchair pressure sensors. These sensors were not available to control group subjects, as in usual practice. The trial continued until discharge. The primary outcomes were the proportion of subjects restrained by trunk restraint, bedrails or chair-board and the proportion of trial days in which each type of physical restraint was applied. The secondary outcomes were the proportions of those who improved in the mobility and transfer domains of modified Barthel index on discharge and of those who fell. Results. One hundred and eighty subjects were randomized. Fifty (55AE6%) out of the 90 intervention group subjects received the intervention. There was no significant difference between the intervention and control groups in the proportions and duration of having the three types of physical restraints. There was also no group difference in the chance of improving in mobility and transfer ability, and of having a fall. Ó 2006 Blackwell Publishing Ltd 581

- by Eric Tam and +1
- •
- Psychology, Nursing, Risk assessment, Hong Kong

The multifactorial model of delirium was developed to explain the interrelationship between predisposing and precipitating factors for delirium. Although validated among hospitalized patients, this model has never been tested among long-term care residents with dementia. We undertook this secondary data analysis to investigate the combined effect of predisposing and precipitating factors on the likelihood of having delirium among this population. Delirium was defined as meeting the Confusion Assessment Method criteria for definite or probable delirium. Risk factors considered in the study were those found significantly associated with delirium in the original study. Participants (N = 155) were classified into risk groups. Prevalence of delirium for the low, moderate, and high predisposing risk groups were 32%, 78.4%, and 98.1%, respectively, and 37.9%, 67.2%, and 86.8% for the precipitating factors risk groups. When both variables were included in the same model, only predisposing factors remained statistically associated with delirium. Predisposing factors play a key role in the likelihood of having delirium among this population. Increased awareness of these factors among nurses could improve the care of these residents by targeting modifiable risk factors.

- by Pierre-Hugues Carmichael
- •
- Nursing, Psychometrics, Long Term Care, Dementia

The purpose of this study was to examine the relationship between the certified nurse aides' (CNAs) perception that “training is always available when needed” and the CNAs' performance, turnover, attitudes, burnout, and empowerment. The data came from a larger study where a self-administered survey instrument was completed by 359 CNAs working in 11 nursing homes in the North Texas region. The data analyses largely support previous research. Perceived training availability was most highly associated with participation in decision making, information exchange, the procedures used, and satisfaction/commitment. The data suggest that the CNAs surveyed may not have received substantial training related to the depersonalization of residents, self-esteem, and direct decision making. Further, the findings suggest an opportunity to improve training by including a component to help CNAs transfer the skills and knowledge learned during the training to the actual provision of resident care.

- by Cynthia Cready
- •
- Perception, Decision Making, Job Satisfaction, Performance

Background and Purpose: To evaluate the quality of care provided to older people, the competence of the nursing staff must be measured. This study evaluates a new instrument called Nursing Older People-Competence Evaluation Tool (NOP-CET). Methods: A 65-item questionnaire was completed by 1,016 community-based nursing staff and evaluated for validity, reliability, precision, interpretability, acceptability, and feasibility. Results: The survey demonstrated good content validity; conceptually coherent factor structure explaining 54.98% (knowledge items), 65.03% (skills items), and 52.83% (personal attribute items) of the total variance; and internal consistency (.77-.93). Conclusions: The NOP-CET showed good validity and reliability as a measure of community-based nursing staff competence and may be used in further investigations of competence in older people nursing.

- by christina foss
- •
- Nursing, Psychometrics, Geriatric Nursing, Questionnaires

Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health. J Am Geriatr Soc 2014.

- by Barbara McKenzie-Green and +2
- •
- Program Evaluation, Long Term Care, Quality Improvement, Geriatric Nursing
- by Sharon Kaasalainen
- •
- Psychology, Nursing, Psychometrics, Pain

The aim of this paper is to report the findings of a case study that explored the phenomenon of advanced care planning and advance care directives in residential care settings in Australia. In particular, this paper focuses on the experiences of Registered Nurses with advanced care planning and advance care directives. Nurses need to know how to engage with residents and families when they invest time and effort on advanced care planning and documentation of advance care directives. A case-study design involving participant observation, field note recording, semi structured interviews and document analysis was used. Data were collected over 7 months. Data analysis involved thematic content analysis. The factors that enhanced and inhibited the experiences of the Registered Nurses with advanced care planning were identified. The enhancing factors include; &amp;amp;amp;amp;amp;amp;amp;#39;it is their essence of who they are&amp;amp;amp;amp;amp;amp;amp;#39;, and &amp;amp;amp;amp;amp;amp;amp;#39;back-up from family members and other nursing staff’. The inhibiting factors are &amp;amp;amp;amp;amp;amp;amp;#39;lack of time&amp;amp;amp;amp;amp;amp;amp;#39;, &amp;amp;amp;amp;amp;amp;amp;#39;a culture of do everything and don&amp;amp;amp;amp;amp;amp;amp;#39;t go there&amp;amp;amp;amp;amp;amp;amp;#39;, and &amp;amp;amp;amp;amp;amp;amp;#39;lack of family involvement&amp;amp;amp;amp;amp;amp;amp;#39;. The findings of the current study provided nurses with evidence of the positive nature of experiences of older people, family members, and nurses themselves with advanced care planning in an attempt to better implement and practise advanced care planning.

- by Margaret McMillan and +1
- •
- Nursing, Australia, Social Support, Geriatric Nursing

Physical restraint use among hospitalized older adults remains an important issue. Despite evidence indicating that restraints can be harmful and strict regulatory rules restricting the use of restraints, healthcare practitioners continue to utilize physical restraints, often in the name of safety. The purpose of this study was to examine the perceptions regarding physical restraint use among registered nurses (RNs) and nursing assistants (NAs). The Perceptions of Restraint Use Questionnaire (PRUQ) was used to evaluate nursing staff perceptions. The overall mean score for the PRUQ was 2.8 out of a possible 5, indicating a neutral perception. Both RNs and NAs identified treatment interference as the most important reason for restraining a patient and substituting of restraints for staff as the least important reason. This study revealed an overall less favorable perception of restraints than previous studies. NAs favored physical restraint for fall prevention more than RNs. It was also noted that protection from physical abuse and patient combativeness was the most salient reason cited by the emergency department staff. (Geriatr Nurs 2011;32:39-45)

- by Joyce Fitzpatrick
- •
- Nursing, Perception, Geriatric Nursing, Registered Nurse

Title. Multi-faceted palliative care intervention: aged care nurses' and care assistants' perceptions and experiences. Aim. This paper is a report of a study to describe residential aged care nurses' and care assistants' perceptions of a multi-faceted palliative care intervention to identify potential areas to be addressed during subsequent action research phases. Background. Action research was used to enhance the delivery of a palliative approach in residential aged care. The chronic care model guided the development of a multi-faceted intervention. This involved the: (1) establishment of a 'link nurse' role; (2) learning and development strategies for nurses, care assistants and general practitioners; (3) use of multi-disciplinary team meetings; and (4) access to specialist consultation. Method. A purposive sample (n = 28) of aged care nurses and care assistants participated in a series of four focus groups conducted in July 2005. Thematic content analysis of the transcripts was performed. Findings. Four themes emerged: (1) targeted education can make a difference;

- by Debra Jackson
- •
- Nursing, Action Research, Gerontology, Focus Groups
- by Souraya Sidani and +1
- •
- Nursing, Aphasia, Stroke, Geriatric Nursing

This study described experiences of caregivers of persons with Alzheimer's disease and other dementias (ADRD) and caregivers of persons with other chronic conditions on self-reported health, type of assistance they provide, perceptions of how caregiving interferes with their lives, and perceived level of support. A secondary analysis was conducted of the 2013 Porter Novelli SummerStyles survey data. Of the 4,033 respondents, 650 adults self-identified as caregivers with 11.6% caring for people with ADRD. Over half of all caregivers reported that caregiving interfered with their lives to some extent. The greater the perceived support caregivers reported, the less they thought that caregiving interfered with their lives (p<.001). No significant differences were found between ADRD and non-ADRD caregivers regarding general health, types of assistance they provided, and perceived level of support. These findings have the potential to inform future research and practice in the development of supportive services for caregivers.

- by Weizhou Tang
- •
- Nursing, Geriatric Nursing
- by Mary Hickson
- •
- Nutrition and Dietetics, Nutrition, Aging, Quality of Mental Health Care

Aim. The aim of this paper is to explore whether nurses working in elderly medicine and in acute medical settings promote urinary continence in older people or in reality use containment strategies.Background. Untreated urinary incontinence in older adults can result in prolonged hospital admission and increased risk of admission to long-term care. Urinary incontinence can also have severe psychosocial effects on older people. Most studies relating to this topic have relied on quantitative approaches to data collection with a seeming lack of qualitative investigation into how nursing staff promote urinary continence in hospitalized older people.Method. Focus groups and one-to-one semi-structured interviews were carried out in two NHS regions in Scotland. Registered and non-Registered Nurses were invited to participate. Five focus groups (n = 17) and four single interviews (n = 4) were conducted. Data generated were analysed thematically using QSR N-VIVO 2.Findings. Some nurses believe that older people accept urinary incontinence as a consequence of ageing. Lack of assessment results in older people being labelled as incontinent of urine. Assessment strategies in medicine for the elderly tend to focus on product identification and management of incontinence. Although nurses from all clinical areas identify the importance of promoting continence, the problem continues to be contained rather than treated. Conflicting clinical priorities, varying staff approaches to urinary continence and deficits in education are cited among the barriers to promoting continence.Conclusions. The results suggest that nurses continue to contain urinary incontinence rather than promoting continence in older people.Relevance to clinical practice. Nursing staff need to be aware of the impact of untreated urinary incontinence on older people. Practitioners should promote continence rather than employing containment strategies. A validated assessment tool for older people needs to be developed. Views of older people should be sought regarding their attitudes towards urinary incontinence.

- by Lindsay Dingwall
- •
- Psychology, Nursing, Health Promotion, Focus Groups