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Online Advanced Release
Articles appearing in this "Online Advanced Release" section have been peer-reviewed and accepted for publication in the Journal of Gerontological Nursing and posted online before print publication. Articles appear on this site after copyediting and author corrections, but before final proofing. The content of the article will usually remain unchanged, and possible further corrections are fairly minor. The final published article will specify the issue and page numbers. Once the final version is available in print, the version posted here will be removed from this site.
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Table of Contents
A Theory-Based Self-Care TALK Intervention for Family Caregiver-Nurse Partnerships
Cherie Parker, MSN, ARNP-BC; Cynthia Teel, PhD, MSN, BSN, RN; Mary Hobbs Leenerts, PhD, MN, RN; Anita Macan, MPA, CCRPReceived: December 18, 2008; Accepted: March 19, 2010; Posted: July 22, 2010
Family caregivers need assistance with information, support, and advice from nurses and other health care professionals to successfully meet the demands of caregiving. Self-Care TALK (SCT) is a theory-based nursing intervention designed to improve the health and well-being of older adult spouse caregivers. The Self-Care for Health Promotion in Aging Model (S-CHPA) provides a framework for development of SCT. Key to implementation of the SCT intervention is partnership building between nurses and caregivers, which is fostered through relational conversations. In this article, the model and intervention are described, and an individual example is provided to show the application of the model in practice. Implications for practice and research are explored.
doi:10.3928/00989134-20100702-01 [get full text]
Communication Between Nurses and Unlicensed Assistive Personnel in Nursing Homes
Elena O. Siegel, PhD, RN; Heather M. Young, PhD, RN, FAAN
Explicit Expectations
Received: May 18, 2009; Accepted: March 4, 2010; Posted: July 22, 2010
Effective communication is at the core of quality improvement efforts. This study identified and explored the written guidelines for what, how, and when nurses and unlicensed assistive personnel (UAP) are expected to communicate regarding residents’ status and care needs. Documents from six nursing homes were analyzed for this descriptive study, from which two primary themes emerged. First, extensive and explicit guidelines were identified for UAP-to-nurse communication, in comparison to few corresponding guidelines for nurses. Second, written guidelines for UAP communication were identified in multiple documents, with variations across sites in the situations requiring communication, the level of detail, and the format for how UAP-to-nurse communication should occur (i.e., verbal, written). This study raises the issue of the extent to which explicit organizational structures and written guidelines support and reinforce nurses’ scope of practice, the translation of UAP role expectations into actual practice, and the effectiveness of communication to promote quality care.
doi:10.3928/00989134-20100702-02 [get full text]
Indicators of a New Depression Diagnosis in Nursing Home Residents
Lorraine J. Phillips, PhD, RN, FNP-BC; Marilyn Rantz, PhD, RN, FAAN; Gregory F. Petroski, PhDReceived: July 27, 2009; Accepted: March 19, 2010; Posted: July 22, 2010
Depression affects approximately 30% to 40% of nursing home residents but frequently goes unrecognized. Using the Missouri Minimum Data Set, we aimed to determine whether changes in clinical status, other than mood changes, were associated with new depression diagnosis in residents 65 and older without a recorded depression diagnosis. Of 127,587 potential participants, 14,371 met inclusion criteria and were not depressed at baseline (Time 0). At the next quarterly assessment (Time 1), 1,342 (9.3%) had acquired a new diagnosis of depression. Residents with new depression were significantly younger and less cognitively impaired. Nearly 30% had a decline in activities of daily living (ADL) performance. The multivariate model predicting depression showed that increased verbal aggression, urinary incontinence, increased pain, weight loss, change in care needs, cognitive decline, and ADL decline significantly increased the likelihood of new depression diagnosis. The pattern of decline identified here may provide additional clues to the presence of underlying depression.
doi:10.3928/00989134-20100702-03 [get full text]
Lawrence H. Plawecki, RN, JD, LLM; David W. Amrhein, MD
Unlicensed Assistive Personnel and the Professional Nurse
Posted: July 22, 2010
As the American population of older adults increases and the nursing shortage widens, professional nurses caring for older adults are often confronted with managing an increased number of patients. To care for more patients safely and cost effectively, many health care facilities and organizations are creating positions for and utilizing a large number of unlicensed assistive personnel (UAP). Although unlicensed, these health care workers have become a fixture in health care facilities, especially those that care for older adults. To provide competent care for a larger population of patients, the professional nurse has had to become proficient in delegation. While delegating tasks to UAP may seem like a quick and easy determination, a great deal of accountability, responsibility, and liability is placed on the health care facility and the individual nurses.
doi:10.3928/00989134-20100712-01 [get full text]
Caring for Older Adults with Dementia when Disaster Strikes
Deborah Adelman, PhD, RN, NE-BC, CNS; Timothy J. Legg, PhD, CRNP, NHA, GNP-BC, CHESPosted: July 22, 2010
Disaster emergencies are occurring with seemingly increased frequency. The likelihood that gerontological nurses will be involved in a disaster scenario, regardless of practice setting, is real. Instead of recoiling from this likelihood, the best approach is preparedness. In this article we examine what constitutes a disaster and how it differs from an emergency, as well as the potential impact of a disaster on older adults in general and those with dementia in particular. Concepts of sheltering in place, caring for older adults with dementia in a temporary shelter, and partnering with nurses in acute care settings are discussed.
doi:10.3928/00989134-20100701-01 [get full text]
Life History Collages: Effects on Nursing Home Staff Caring for Residents with Dementia
Bill Buron, PhD, RNC, GNP/FNP-BCAccepted: March 4, 2010; Received: April 25, 2009; Posted: June 22, 2010
This study evaluated the effects of person-centered life history collages on nursing staff knowledge about individual residents living with dementia and staff perceptions of individualized care practices. Thirty-six nursing staff participants (18 experimental and 18 control) who cared for 5 residents with dementia in two nursing homes were recruited. Intervention staff members were exposed to life history collages for 4 weeks. Pretest and posttest data were analyzed using multivariate analysis of covariance and analysis of covariance. While intervention group members’ knowledge of residents’ family, jobs/careers, and likes/dislikes/interests improved significantly at posttest, F(3, 26) = 6.80, p < 0.01, and at 3 weeks postintervention, F(3, 23) = 9.85, p < 0.001, perceptions of individualized care/person-centered care practices did not. Potential reasons for this lack of improvement are identified and discussed. Directions for future research are also provided.
doi:10.3928/00989134-20100602-01 [get full text]
Donald D. Kautz, PhD, RNReceived: November 9, 2009; Accepted: January 11, 2010; Posted: June 22, 2010
My father Harry died recently at age 89. When he filled out the hospice forms and answered the question “How do you want to be remembered?” he wrote, “That I was a Christian and had a good sense of humor.”
doi:10.3928/00989134-20100527-99 [get full text]
Why Should Older Adults Receive the Shingles Vaccine?
Turna LaNeigh Harkness, MSN, RNReceived: August 31, 2009; Accepted: February 16, 2010; Posted: May 21, 2010
This article seeks to educate health care providers in understanding the need for immunization of older adults with the new herpes zoster vaccine, Zostavax®. Herpes zoster (shingles) is a painful and disabling condition that can result in significant morbidity, loss of productivity, and decrease in quality of life. Herpes zoster is a reactivation of the varicella zoster virus, the same virus that causes chicken pox. Anyone who has had chickenpox can get shingles. Evidence found in the literature demonstrates that the vaccine prevents shingles in approximately half of adults 60 and older.
doi:10.3928/00989134-20100504-06 [get full text]
Pain Management in Nursing Homes: What Do Quality Measure Scores Tell Us?
Teresa L. Russell, MSN, RN; Richard W. Madsen, PhD; Marcia Flesner, PhD, RN; Marilyn J. Rantz, PhD, RN, FAANReceived: September 26, 2009; Accepted: February 15, 2010; Posted: May 21, 2010
Pain management for older adults residing in nursing homes continues to present multifaceted challenges to health care practitioners and researchers. This study, which focuses on improvement in pain assessment and management, is a secondary analysis of data from a larger study, which used an intervention simultaneously directed at all levels of staff with change in quality measure (QM)/quality indicator (QI) scores to determine improvement in resident outcomes. We anticipated that focused improvement efforts in resident care regarding pain management would be reflected by correspondingly lower QM/QI scores over time. Findings of increased QM/QI scores may be positive in that they may point to increased attention by staff regarding pain management for residents.
doi:10.3928/00989134-20100504-07 [get full text]
Factors Affecting Health-Promoting Behaviors of Community-Dwelling Korean Older Women
Young Mi Lim, PhD; Mi Hae Sung, PhD; Kyung Sook Joo, MSNReceived: September 8, 2009; Accepted: February 15, 2010; Posted: May 21, 2010
The purpose of the study was to examine a staged theoretical causal model on health-promoting behavior of community-dwelling Korean older women (N = 438). Sixty-two percent of the variance in the health-promoting behaviors of the sample was explained by the direct effect of social support (β = 0.53), self-efficacy (β = 0.18), perceived health status (β = 0.16), education (β = 0.12), and presence of a spouse (β = 0.10). Twenty-nine percent of the variance in social support was explained by the direct effect of self-efficacy (β = 0.31), personal control (β = 0.10), perceived health status (β = 0.16), age (β = –0.31), and religion (β = 0.15). The results indicate that self-efficacy, personal control, and perceived health status had an indirect influence on health-promoting behavior through social support. The findings of this study suggest that social support is a mediating variable on health-promoting behavior of community-dwelling older women, and further refinement of the underlying model is warranted.
doi:10.3928/00989134-20100504-05 [get full text]
Rediscovering: The Lived Experience of Women Journeying Toward Aging
Carol M. Wiggs, PhD; Anne Young, EdD; Beth Mastel-Smith, PhD; Peggy Mancuso, PhDReceived: November 4, 2009; Accepted: January 26, 2010; Posted: May 21, 2010
The aim of this hermeneutic phenomenological inquiry was to explore the lived experience of aging for late-midlife women via reflective journaling and a photo elicitation interview, and to demonstrate how the creation of a collage allows women to make meaning of the aging experience. Using van Manen’s philosophical framework, four themes were discovered: Invisibility, Conflicted Self, Freedom, and Relationality. Invisibility was expressed by the women as disregard, not being seen by others, or overlooked in daily activities. Conflicted Self involved the conflict between the inner being and the outer physical body. Freedom related to the ability to let go of others’ expectations and allow themselves to be the people they were in their own reality. Relationality was the interconnectedness the women felt with family, friends, and colleagues, and the changes in these relationships. The women’s narratives and collages portrayed a holistic picture of aging, not confined to decline but rather a life of anticipation.
doi:10.3928/00989134-20100504-04 [get full text]
Family Caregiving to Hospitalized End-Of-Life and Acutely Ill Geriatric Patients
Chaim J. Cohen, PhD, MSW; Gail Auslander, PhD, MPH; Yifat Chen, PhDReceived: May 16, 2009; Accepted: November 5, 2009; Posted: April 22, 2010
The article examines family caregiving to hospitalized older adults at the end of life (EOL). The stress process model was used to compare family caregiving in an EOL patient population (n = 50) with family caregiving in an acutely ill elderly population (n = 50) in a single Israeli hospital. A convenience sample of family caregivers was interviewed in the hospital using a structured questionnaire. Differences between the two groups were examined using contingency tables, t tests, and discriminant multivariate analysis. Findings show that family caregivers of EOL patients carry out fewer caregiving tasks and report a greater sense of overload and captivity. On the other hand, they attend to the patient for more days, mobilize more social network support, and report a comparable sense of reward and growth. These findings are discussed in the context of active versus passive caregiving and the significance of nursing support for family caregivers of EOL patients.
doi:10.3928/00989134-20100330-03 [get full text]
Susan B. del Bene, PhD, RN, CNSReceived: August 31, 2009; Accepted: November 16, 2009; Posted: April 22, 2010
More African American grandmothers are becoming caregivers for their grandchildren when the parents are unable or unwilling to provide care. This qualitative study used hermeneutic phenomenology based on in-depth interviews with 15 African American women who have assumed the role of caregiver. The following themes, with subthemes, emerged regarding this new role for the grandmothers: Finding a Voice to Match Medical Needs, The Role of the Confidante: The Power of the Group, The Relationship with the Biological Parents, and Legal Issues. These findings provide rich understanding of the African American women and the challenges they face related to culture, race, lack of political voice and power, and limited resources—in essence, the impact of marginalization in society. The underlying point is the potential impact on this population and the degree to which the health care profession can draw on an interdisciplinary model to frame, analyze, and address future health care problems in marginalized African American women.
doi:10.3928/00989134-20100330-01 [get full text]
Agreeableness and Activity Engagement in Nursing Home Residents with Dementia: A Pilot Study
Nikki L. Hill, MS, RN; Ann Kolanowski, PhD, RN, FAAN; Esra Kürüm, MSReceived: July 17, 2009; Accepted: December 9, 2009; Posted: April 22, 2010
Residents with dementia are the least likely to be engaged in the nursing home and often spend most of their time doing nothing at all. However, resident participation in meaningful activities is important to promote both physical and psychological health. Tailoring activities to individual functional abilities and personality preferences improves both the time and level of participation. This pilot study used an analysis of covariance procedure to test the relationship between the personality trait of agreeableness and engagement when activities are ideally tailored to ability and interest. No significant difference was found between the high and low agreeableness groups, indicating that residents were more engaged when activities were individually tailored, regardless of their agreeableness level. Although low agreeableness may pose a challenge when implementing activities for people with dementia, the results of this study suggest that tailoring activities to functional ability and interest may overcome the effects.
doi:10.3928/00989134-20100330-10 [get full text]
Maria Justine, PT, MSc; Tengku Aizan Hamid, PhDSubmitted: July 19, 2009; Accepted: January 26, 2010; Posted: April 22, 2010
This study examined the effects of a multicomponent exercise program on depression and quality of life in institutionalized older adults. A quasi-experimental pretest-posttest design was used. Participants were recruited from a publicly funded shelter home in Seremban, Negeri Sembilan Malaysia. The experimental group consisted of 23 volunteers 60 or older who performed 60 minutes of supervised exercise three times per week for 12 weeks. The control group consisted of 20 volunteers who continued with a sedentary lifestyle. At 12 weeks, the exercise group demonstrated an improvement in quality of life by 10.74% (p > 0.05) but not depression (–1.6%, p > 0.05). The control group demonstrated a decrease in both quality of life by 11.26% (p > 0.05) and level of depression by 17.7% (p > 0.05). This study suggests a multicomponent exercise program is a feasible intervention to improve quality of life in institutionalized older adults.
doi:10.3928/00989134-20100330-09 [get full text]
Chun-Ja Kim, PhD, RN; Dong-soo Shin, PhD, RNSubmitted: June 27, 2009; Accepted: January 11, 2010; Posted: April 22, 2010
The purpose of this descriptive, cross-sectional study was to identify the optimal cut-off point of estimated glomerular filtration rate (eGFR) using the area under the receiver operating characteristic curve to screen for renal impairment among rural Korean older adults taking medications (N = 100). Renal function was assessed by eGFR using the Cockcroft-Gault formula. Nearly half of participants took five or more prescription drugs, and 46% took nephrotoxic medications. Participants’ optimal eGFR cut-off points in screening for renal impairment with and without polypharmacy were 54.3 mL/min (area under curve [AUC] = 0.824, p < 0.001) and 61.4 mL/min (AUC = 0.768, p < 0.001), respectively. The incidence of renal impairment was 61.2% and 56.9%, respectively, using 54.3 mL/min and 61.4 mL/min as the new optimal cut-offs of eGFR with and without polypharmacy. More than half of the rural older adults require a reduction in medication dosage or a change to non-nephrotoxic medications. These new optimal cut-off points using eGFR according to polypharmacy may be helpful in screening for renal impairment among rural older adults taking medications.
doi:10.3928/00989134-20100330-07 [get full text]
Frail Older Adults’ Experiences of Receiving Health Care and Social Services
Jimmie Kristensson, PhD, RN; Ingalill Rahm Hallberg, PhD, RNT; Anna Kristensson Ekwall, PhD, RNReceived: June 3, 2009; Accepted: December 9, 2009; Posted: April 22, 2010
This study explored frail older adults’ overall experience of receiving health care and/or social services. Frail older adults with unstable health are dependent on the health care system because of the frequency of their contacts with it. More knowledge is needed about how they experience the health care and social services they receive. Interviews with 14 older adults (mean age = 81) revealed one main category, Having Power or Being Powerless, that incorporated three categories: Autonomous or Without Control in Relation to the Health Care and/or Social Services System, Being Confirmed or Violated in Relation to Caregivers, and Paradoxes in Health Care or Social Services. Each category comprised subcategories reflecting aspects of having power or being powerless. The findings indicate it is important for health care and social services to ensure a high level of interpersonal continuity to empower frail older adults. This may contribute to more relationship-based care and help older adults remain in control of their life situations.
doi:10.3928/00989134-20100330-08 [get full text]
Developing a Statewide Medication Technician Pilot Program in Nursing Homes
Pamela K. Randolph, MS, RN; Jill Scott-Cawiezell, PhD, RN, FAANReceived: July 7, 2009; Accepted: November 5, 2009; Posted: April 22, 2010
In times of fiscal constraints, nursing homes are seeking to maximize use of licensed staff through delegation of low-risk tasks to unlicensed personnel. Between 2004 and 2008, the Arizona State Board of Nursing developed and conducted a pilot program to determine the impact on patient health and safety of licensed nurses delegating medication administration to trained certified nursing assistants. There were no differences in patterns of medication errors before and after the introduction of medication technicians, and structured interviews revealed that participants viewed the role favorably, with reported increased role satisfaction on the part of delegating nurses. Efforts are underway to extend the program statewide.
doi:10.3928/00989134-20100330-06 [get full text]
Feasibility of Family Participation in a Delirium Prevention Program for Hospitalized Older Adults
Deborah A. Rosenbloom-Brunton, PhD, ACNP-BC; Elizabeth A. Henneman, PhD, RN; Sharon K. Inouye, MD, MPHSubmitted: August 12, 2009; Accepted: October 29, 2009; Posted: April 22, 2010
Delirium is the leading complication of hospitalization for older adults. The role family caregivers could play in delirium prevention and how nurses could facilitate family participation has been largely unexplored. This study examined the feasibility of family participation in a multicomponent intervention program for delirium prevention in hospitalized older adults called Family-HELP, as an adaptation and extension of the Hospital Elder Life Program (HELP). Family-HELP demonstrates that active engagement of family caregivers in preventive interventions for delirium is feasible. Intervention completion occurred at least 55% of the time. Three themes emerged on barriers and facilitators for family participation: therapeutic relationships, partnership, and environment. Key to successful implementation of the program is attention to the identified barriers and facilitators. These findings have implications for clinicians committed to delivering quality inpatient care to older adults and their families, with the benefits of HELP being extended to include family caregivers with an important role in delirium prevention efforts.
doi:10.3928/00989134-20100330-02 [get full text]
Practical Implications of Procedural and Emotional Religious Activity Therapy for Nursing
David E. Vance, PhD, MGS; Yvonne D. Eaves, PhD, RN; Norman L. Keltner, EdD, RN; Thomas S. Struzick, MEd, MSW/ACSW, LCSWReceived: April 16, 2009; Accepted: October 29, 2009; Posted: March 22, 2010
Procedural and Emotional Religious Activity Therapy encapsulates an approach to engaging older adults with Alzheimer’s disease in meaningful activities that can be performed within the parameters of their cognitive functioning. Alzheimer’s disease disrupts some brain structures more than others, resulting in a disproportionate loss of certain cognitive abilities. Explicit (conscious) memory skills are disrupted first, followed by implicit (unconscious) memory skills, and lastly emotional memory. Activities relying more on implicit and emotional memory, such as specially selected religious activities, are more likely to be used by patients. Steps and caveats of using this approach are provided.
doi:10.3928/00989134-20100303-04 [get full text]
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