Elder Abuse: A Global Challenge and Canada's Response.

Elder abuse is a global call to action. Nurses have a primary role to play in its detection and prevention. Globally, demographic change is creating an increasing number of older adults. Consequently, this increased number of people will be affected by age discrimination and ageism, both of which contribute to elder abuse. Despite the existence of the Universal Declaration of Human Rights, older adults are not recognized explicitly under the international human rights laws that legally oblige governments to address the rights of all people. Drawing initially on global conversations specific to elder abuse and the role of nurses, the current article explores the challenges of recognizing and combating elder abuse. To provide specific gerontological nursing strategies, recognition is given to actions implemented in Canada to address this major health challenge. The desired outcome is an advocacy framework for gerontological nurses to use in working toward the recognition and prevention of elder abuse. [Journal of Gerontological Nursing, 48(4), 21-25.].

The implementation of correctional nursing practice-Caring behind bars: A grounded theory study.

AIM: To understand how registered nurses implement their nursing practice in correctional institutions with healthcare governance by a health authority (e.g. Ministry of Health). DESIGN: Straussian grounded theory. METHODS: Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison and memo writing. Thirteen registered nurses engaged in semi-structured telephone interviews about implementing their correctional nursing practice including, providing direct care to adult offenders. Data were collected (December 2018 to October 2019) until saturation occurred. Analytic coding (open, axial and final theoretical integration) was performed to identify the core category and subcategories around which the substantive theory was developed. RESULTS: The theory of Caring Behind Bars refers to the process of how registered nurses implemented their correctional nursing practice to care for offenders. The core category of Caring Behind Bars is comprised of five subcategories: tension between custody and caring, adaptability and advocacy, offender population, provision of care, and challenging and positive elements. CONCLUSION: Caring Behind Bars required registered nurses to address tension between custody and caring by adapting and advocating to access offenders. The provision of care required registered nurses to use assessment skills and numerous resources to provide a variety of patient focused care to offenders. The consequences of Caring Behind Bars had challenging and positive elements. IMPACT: The tension provides purposeful space to continue improving teamwork among correctional officers and registered nurses. More research is required about the impact of correctional healthcare governance models on professional practice and health outcomes. Frontline registered nurses can use the theory to make informed choices when providing care. Registered nurses practising in other domains of correctional nursing (i.e. administration, education and research) can also use this theory to advance and inform practice with the goal of promoting offender health.

Delirium in Emergency Departments: Is it Recognized?

BACKGROUND: Delirium is a complex neurocognitive manifestation of an underlying medical or surgical abnormality such as substance abuse, infection, sepsis, or organ failure. A recognized risk factor for delirium is advanced age (age >65 years). The projected demographic changes over the next 2 decades suggest that the number of aging adults will grow dramatically, and emergency nurses will see an increasing number of older patients manifesting the wide range of neuropsychiatric symptoms associated with delirium. METHOD: An examination of 5 commonly used delirium assessment tools was undertaken specific to clinical features, use, scoring, findings, advantages, and disadvantages. FINDINGS: Numerous factors contribute to the lack of effective delirium recognition. However, emergency nurses, with educational support, can successfully use the delirium assessment tools to recognize delirium. CONCLUSION: Emergency nurses face challenges in recognizing delirium. One key challenge for many of these nurses is the appropriate use of assessment tools suitable for the ED setting.

Effectiveness of a community program for older adults with type 2 diabetes and multimorbidity: a pragmatic randomized controlled trial.

BACKGROUND: Type II diabetes mellitus (T2DM) affects upwards of 25% of Canadian older adults and is associated with high comorbidity and burden. Studies show that lifestyle factors and self-management are associated with improved health outcomes, but many studies lack rigour or exclude older adults, particularly those with multimorbidity. More evidence is needed on the effectiveness of community-based self-management programs in older adults with T2DM and multimorbidity. The study purpose is to evaluate the effect of a community-based intervention versus usual care on physical functioning, mental health, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with T2DM and 2 or more comorbidities. METHODS: Community-living older adults with T2DM and two or more chronic conditions were recruited from three Primary Care Networks (PCNs) in Alberta, Canada. Participants were randomly allocated to the intervention or control group in this pragmatic randomized controlled trial comparing the intervention to usual care. The intervention involved up to three in-home visits, a monthly group wellness program, monthly case conferencing, and care coordination. The primary outcome was physical functioning. Secondary outcomes included mental functioning, anxiety, depressive symptoms, self-efficacy, self-management, and the cost of healthcare service use. Intention-to-treat analysis was performed using ANCOVA modeling. RESULTS: Of 132 enrolled participants (70-Intervention, 62-Control), 42% were 75 years or older, 55% were female, and over 75% had at least six chronic conditions (in addition to T2DM). No significant group differences were seen for the baseline to six-month change in physical functioning (mean difference: -0.74; 95% CI: - 3.22, 1.74; p-value: 0.56), mental functioning (mean difference: 1.24; 95% CI: - 1.12, 3.60; p-value: 0.30), or other secondary outcomes.. CONCLUSION: No significant group differences were seen for the primary outcome, physical functioning (PCS). Program implementation, baseline differences between study arms and chronic disease management services that are part of usual care may have contributed to the modest study results. Fruitful areas for future research include capturing clinical outcome measures and exploring the impact of varying the type and intensity of key intervention components such as exercise and diet. TRIAL REGISTRATION: NCT02158741 Date of registration: June 9, 2014.

Nursing and music: Considerations of Nightingale's environmental philosophy and phenomenology.

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the use of music within a holistic, caring-healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music-based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well-being of this vulnerable group of older persons.

What Do Family Members Really Want When Older Adults Transition to a Nursing Home?

The purpose of the current study was to explore family members' perceptions of supports received during the transition experience of their older adult family member into a nursing home. In this exploratory, descriptive, qualitative study, interviews were conducted with six family members during the initial 6-month period following admission of the older adult family members. One overarching theme was found: importance of recognizing and supporting the personhood of older adult family members. Implications for how older adults' personhood can be supported are described. [Journal of Gerontological Nursing, 43(11), 9-14.].

Chasing the Mirage: a grounded theory of the clinical reasoning processes that Registered Nurses use to recognize delirium.

AIM: The aim of this study was to construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognize delirium in older adults in acute care hospitals. BACKGROUND: Delirium is under-recognized in acute hospital settings, this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' (RNs) clinical reasoning processes in complex situations such as delirium recognition. DESIGN: A grounded theory approach was used to analyse interview data about the clinical reasoning processes of RNs in acute hospital settings. METHOD: Seventeen RNs were recruited. Concurrent data collection and comparative analysis and theoretical sampling were conducted in 2013-2014. FINDINGS: The core category to emerge from the data was 'chasing the mirage', which describes RNs' clinical reasoning processes to recognize delirium during their interaction with older adults. CONCLUSION: Understanding the reasoning that contributes to delirium under-recognition provides a strategy by which, this problem can be brought to the forefront of RNs' awareness and intervention. Delirium recognition will contribute to quality care for older adults.

Tracking the footsteps: a constructivist grounded theory of the clinical reasoning processes that registered nurses use to recognise delirium.

AIMS AND OBJECTIVES: To construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognise delirium while caring for older adults in acute care settings. BACKGROUND: Delirium is often under-recognised in acute care settings; this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' clinical reasoning processes in complex situations such as delirium recognition. DESIGN: Seventeen registered nurses working in acute care settings were interviewed. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2013-2014. METHODS: A grounded theory approach was used to analyse interview data about the clinical reasoning processes of registered nurse in acute hospital settings. RESULTS: The core category that emerged from data was 'Tracking the footsteps'. This refers to the common clinical reasoning processes that registered nurses in this study used to recognise delirium in older adults in acute care settings. It depicted the process of continuously trying to catch the state of delirium in older adults. CONCLUSIONS: Understanding the clinical reasoning processes that contribute to delirium under-recognition provides a strategy by which this problem can be brought to the forefront of awareness and intervention by registered nurses. RELEVANCE TO CLINICAL PRACTICE: Registered nurses could draw from the various processes identified in this research to develop their clinical reasoning practice to enhance their effective assessment strategies. Delirium recognition by registered nurses will contribute to quality care to older adults.

Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon.

AIMS AND OBJECTIVES: In order to obtain more information regarding this phenomenon, a scoping review of the literature was undertaken to analyse current research on the recognition of delirium by registered nurses in acute care settings. BACKGROUND: Delirium is often manifested as a sign of an underlying undiagnosed condition that requires immediate intervention and is frequently manifested in acute care settings. Unfortunately, registered nurses often do not recognise delirium and its occurrence goes under-reported. DESIGN/METHODS: Based on six inclusion criteria, a search in numerous databases using terms such as delirium detection, recognition and diagnosis by registered nurses was undertaken. Eight quantitative studies were deemed relevant and analysed for this scoping review. RESULTS: Seven major categories emerged: the fluctuating nature of delirium, the impact of delirium education on its recognition, communication barriers, inadequate use of delirium assessment tools, lack of conceptual understanding of delirium, delirium as a burden and the likeness of delirium and dementia. A brief summary of the findings in each category is reported here. CONCLUSIONS: The scoping review revealed that delirium remains underrecognised by registered nurses, which potentially contributes to reduced quality of nursing care for clients experiencing this condition. Further research on delirium and the processes that registered nurses use to recognise it is timely and will facilitate the development of evidence-based interventions to manage it. RELEVANCE TO CLINICAL PRACTICE: While acute care registered nurses have historically reported dramatic changes in cognitive and neuro-biological functions in ill older adults, the literature highlighted in this scoping review revealed the following: (1) the need for further research to validate delirium assessment tools and, (2) the need for education and training for registered nurses on the use of these assessment tools to promote early recognition and thereby decrease the incidence of delirium in older adults.

Institutionalizing Clinical Reasoning: A Grounded Theory of the Clinical Reasoning Processes RNs Use to Recognize Delirium.

Delirium is a common disorder among hospitalized older adults often leading to prolonged hospitalization, increased health care costs, and sometimes death. The goal of the current study was to construct a grounded theory that explains the clinical reasoning processes that RNs use to recognize delirium in older adults in acute care settings. Seventeen participants in three hospitals were interviewed. The core category that emerged from the data was institutionalizing clinical reasoning. Findings from the current study can be a starting point for RNs to bring self-awareness to variables that influence their reasoning processes.

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference.

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

Placement of undergraduate students in nursing homes: careful consideration versus convenience.

Several decades ago, concerns were raised about using nursing homes as clinical placement sites for undergraduate nursing students. As a result, some nursing programs moved away from using these clinical sites. However, within the past 15 years, a shift back toward reconsidering nursing homes as viable placement options has begun. What has brought about this shift, and what must happen to ensure that nursing homes provide positive learning experiences for students? This article reviews the literature on placing students in nursing home environments and presents a model that is designed to enhance gerontological competence in undergraduate nursing students, as well as to enhance students' learning in nursing home placements. If programs use nursing homes for student placements, a carefully constructed plan that encompasses gerontological education throughout the nursing degree program is recommended.

Are gerontological nurses apathetic about apathy in older adults.

Despite its serious health consequences, apathy in older adults is often underrecognized by gerontological nurses and other health care professionals. Within this article, we discuss what apathy is and present a review of the literature and research. Two frameworks emerging from the literature search-one regarding rehabilitation and the other illness-are introduced as ways in which apathy may be conceptualized and addressed. Using these frameworks, implications for gerontological nurses are outlined.

Institutional abuse of older adults: what we know, what we need to know.

Although Canadian policies support "aging in place," there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.

Conversations with Holocaust survivor residents.

Traumatic events in one's younger years can have an impact on how an individual copes with later life. One traumatic experience for Jewish individuals was the Holocaust. Some of these people are moving into long-term care facilities. It was within this context that the research question emerged: What are Holocaust survivor residents' perceptions of a life lived as they move into a long-term care facility? For this qualitative study, Holocaust survivors were individually interviewed. Findings emphasize that nursing care needs to ensure that Holocaust survivor residents participate in activities, receive timely health care, and receive recognition of their life experiences.