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This article provides a brief overview of the early development of geropsychiatric nursing (GPN) as background for examining its advancement subsequent to the 2010 Future of Nursing (FON) Report. The FON's education, practice and leadership recommendations form the three pillars that have supported geropsychiatric nursing's continuing evolution, framed within a practice and policy perspective. Lessons learned are relevant to developing the next phase of FON recommendations. The importance of overcoming challenges faced by the field of GPN is supported by the aging global population, the directions of nursing as a discipline, and the clear necessity of an intra- and inter-professional approach to mental health and aging.
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Educação em Enfermagem , Geriatria , Liderança , Pesquisa em Educação em Enfermagem , Enfermagem Psiquiátrica/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , HumanosRESUMO
Nursing home culture change (NHCC) aims to change the way care is provided in nursing homes. Valid and reliable measures are needed to evaluate the impact of NHCC on outcomes. The current systematic review provides an overview of instruments designed to measure NHCC and criteria for others to evaluate and choose instruments according to their own purpose. Ten instruments were identified that measure NHCC on an organizational level. Lack of development description hindered their assessment, and studies examining the relationship between NHCC and outcomes are rare. A common limitation of the instruments reviewed was the lack of psychometric testing; thus, their validity and reliability need further exploration. [Res Gerontol Nurs. 2018; 11(2):103-112.].
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Serviços de Saúde para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Difusão de Inovações , Guias como Assunto , Humanos , Cultura OrganizacionalRESUMO
PURPOSE: This study evaluated the longitudinal influence of an individualized evidence-based psychoeducational intervention for caregivers on frequency of behavioral symptoms in persons with dementia (PWD) and caregiver reaction to these symptoms. The intervention included information about the disease process using Progressively Lowered Stress Threshold (PLST) content and a family meeting based on Mittelman's New York University Intervention. METHOD: A quasi-experimental study design was implemented. The Revised Memory and Behavior Problems Checklist was administered to N = 127 caregiver/care recipient dyads at baseline, 6, 12, and 18 months follow-up. All caregivers were enrolled in the intervention at baseline and followed over 18 months. Linear mixed models were developed to evaluate effects on frequency of behavioral symptoms in PWD and caregiver response. RESULTS: The most frequently occurring behavior was memory problems, although depressive behaviors produced the most negative caregiver responses. Between baseline and 6-month follow-up, there was a significant decrease in frequency of behavioral symptoms. Overall, there was a significant decrease in caregiver's reaction to behavioral symptoms from baseline to 18-month follow-up.
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Sintomas Comportamentais/prevenção & controle , Cuidadores/educação , Cuidadores/psicologia , Demência/psicologia , Educação não Profissionalizante , Estresse Psicológico/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Sintomas Comportamentais/diagnóstico , Lista de Checagem , Demência/enfermagem , Família , Feminino , Amigos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistemas de Apoio Psicossocial , Avaliação de SintomasRESUMO
BACKGROUND: The Iowa Model is a widely used framework for the implementation of evidence-based practice (EBP). Changes in health care (e.g., emergence of implementation science, emphasis on patient engagement) prompted the re-evaluation, revision, and validation of the model. METHODS: A systematic multi-step process was used capturing information from the literature and user feedback via an electronic survey and live work groups. The Iowa Model Collaborative critically assessed and synthesized information and recommendations before revising the model. RESULTS: Survey participants (n = 431) had requested access to the Model between years 2001 and 2013. Eighty-eight percent (n = 379) of participants reported using the Iowa Model and identified the most problematic steps as: topic priority, critique, pilot, and institute change. Users provided 587 comments with rich contextual rationale and insightful suggestions. The revised model was then evaluated by participants (n = 299) of the 22nd National EBP Conference in 2015. They validated the model as a practical tool for the EBP process across diverse settings. Specific changes in the model are discussed. CONCLUSION: This user driven revision differs from other frameworks in that it links practice changes within the system. Major model changes are expansion of piloting, implementation, patient engagement, and sustaining change. LINKING EVIDENCE TO ACTION: The Iowa Model-Revised remains an application-oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care.
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Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Objetivos Organizacionais , Atenção à Saúde/normas , Humanos , Iowa , Inquéritos e QuestionáriosRESUMO
Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place. Prominent among these are the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States. In an AFC, older adults are actively involved, valued, and supported with necessary infrastructure and services. Specific criteria include affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and community leadership, and accessible health and wellness services. Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria, narrates case studies of AFCs in various stages of development, and suggests solutions to common challenges to becoming age-friendly. Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care.
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Promoção da Saúde/métodos , Vida Independente , Características de Residência , Idoso , Planejamento Ambiental , Habitação para Idosos , Humanos , Meio Social , Apoio Social , Meios de TransporteRESUMO
The Progressively Lowered Stress Threshold (PLST) is a conceptual model for reducing behavioral symptoms in individuals with dementia. The aim of the current study was to evaluate the effectiveness of the PLST-based intervention on burden, symptoms of depression, and quality of life (QOL) of caregivers, as well as neuropsychiatric symptoms and QOL of individuals with dementia. A randomized controlled trial was used. Sixty-five participants completed the study. Although variables examined in caregivers in the intervention group showed statistically significant improvement throughout follow up, there was no statistically significant difference between the intervention and comparison groups. In addition, no statistically significant difference was noted between groups for patient variables. Care based on the PLST model was clinically effective in decreasing caregiver burden and depression of family members, and in increasing their QOL, but no more effective than routine care. [Journal of Gerontological Nursing, 42(7), 44-54.].
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Cuidadores/psicologia , Modelos Psicológicos , Estresse Psicológico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Under the U.S. national Alzheimer's plan, the National Institutes of Health identified milestones required to meet the plan's biomedical research goal (Goal 1). However, similar milestones have not been created for the goals on care (Goal 2) and support (Goal 3). METHODS: The Alzheimer's Association convened a workgroup with expertise in clinical care, long-term services and supports, dementia care and support research, and public policy. The workgroup reviewed the literature on Alzheimer's care and support; reviewed how other countries are addressing the issue; and identified public policies needed over the next 10 years to achieve a more ideal care and support system. RESULTS: The workgroup developed and recommended 73 milestones for Goal 2 and 56 milestones for Goal 3. DISCUSSION: To advance the implementation of the U.S. national Alzheimer's plan, the U.S. government should adopt these recommended milestones, or develop similar milestones, to be incorporated into the national plan.
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Doença de Alzheimer/epidemiologia , Doença de Alzheimer/terapia , Assistência de Longa Duração/métodos , Pesquisa Biomédica , Humanos , National Institutes of Health (U.S.)/normas , National Institutes of Health (U.S.)/tendências , Política Pública , Estados Unidos/epidemiologiaAssuntos
Prática Avançada de Enfermagem/educação , Educação de Pós-Graduação em Enfermagem/métodos , Enfermagem Geriátrica/educação , Enfermagem Psiquiátrica/educação , Currículo/estatística & dados numéricos , Educação de Pós-Graduação em Enfermagem/estatística & dados numéricos , Humanos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa em Educação em Enfermagem/métodos , Recursos HumanosRESUMO
Functional magnetic resonance imaging (fMRI), a noninvasive technique that measures brain activation, has been increasingly used in the past decade, particularly among older adults. Use of fMRI in research with stroke survivors in recent years has substantially contributed to researchers' understanding of the pathophysiology of stroke sequelae. However, despite the increasing popularity and use of fMRI, little is known about the patient experience of fMRI under research circumstances. The current research brief reports the findings of a pilot study undertaken to understand stroke survivors' experiences with fMRI under research circumstances. Nine ischemic stroke patients underwent two MRI sessions, each of which lasted 1.5 hours and included several fMRI tasks. Patients were asked about their experiences and to share any advice. All participants reported that they did not feel claustrophobic; in addition, the importance of educating participants about fMRI was a universal theme that emerged. Knowledge of participant experiences may help with enrollment strategies for fMRI studies and improve research outcomes related to the fMRI experience.
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Terapia Cognitivo-Comportamental/métodos , Imageamento por Ressonância Magnética/psicologia , Resolução de Problemas/fisiologia , Acidente Vascular Cerebral , Sobreviventes/psicologia , Idoso , Emoções/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Resultado do TratamentoRESUMO
The number of Americans with dementia is expected to increase as the population ages. Developing dementia is feared by many older adults and may result in anxiety in persons with dementia. This article focuses on anxiety, one of the least understood symptoms associated with dementia in community-dwelling older adults, the stigma of dementia, and the relationship between anxiety and stigma in dementia. When undetected and untreated, anxiety and associated stigma can adversely affect quality of life and the ability to age in place.
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Envelhecimento/psicologia , Ansiedade , Demência/psicologia , Estereotipagem , Humanos , Estados UnidosRESUMO
This study described and contrasted family caregivers and explored the effect of gender and family relationship on the caregiver's role perception, workload, burden, and family help. Home care agencies and community organizations assisted with the recruitment of 533 multicultural, predominantly Latino caregivers who were interviewed at home. The Caregiver Identity Theory guided the study. Survey instruments were standardized tools or were constructed and pretested for this study. Descriptive statistics and t-test analyses assisted in describing the sample, and multivariate analyses were used to contrast the caregiver groups. Findings suggested a gendered approach to self-appraisal and coping. Men in this predominantly Latino and Caribbean sample felt less burden and depression than women who believed caregiving is a female duty. Family nurses should pay attention to the most vulnerable groups-older spouses resistant to using family and community resources and hard-working female adult children-and assess each family situation individually.
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AIMS: The aim of this study was to predict South Florida family caregivers' need for and use of informal help or formal services, specifically, to explore the predictive power of variables suggested by the Caregiver Identity Theory and the literature and develop and test a structural model. BACKGROUND: In the USA, most of the care to older adults is given by family members. Caregivers make economic and social sacrifices that endanger their health. They feel burdened, if they receive no assistance with their tasks; however, services available are not sufficiently used. DESIGN: This cross-sectional correlational study was a survey of family caregivers in their home, using standardized and/or pre-tested scales and a cognitive status test of their patients. METHODS: A random sample of 613 multiethnic caregivers of frail elders were recruited in home care and community agencies. The interviews were held between 2006-2009. Analyses involved correlation and regression analyses and structural equation modelling. Outcome measures were need and use of family help and formal services. RESULTS/FINDINGS: The model yielded excellent fit indices replicated on three random samples of 370. The patients' functional limitations yielded the strongest predictive coefficients followed by caregiver stress. Cultural indicators played a minor role. CONCLUSION: The lack of a link between resource need and use suggested access barriers. Important for policy makers and service providers are the delivery of high-quality services and the use of a personal and individualized approach with all ethnicities. Quality service includes understanding the caregiving situations and requires a trusting relationship with family caregivers.
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Cuidadores , Etnicidade , Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Idoso Fragilizado , Humanos , Masculino , Estados UnidosRESUMO
Caregivers in Miami, Florida (185 Cubans, 108 other Hispanics, 229 non-Hispanic Whites, and 73 Caribbean Blacks) were described and compared along demographic and health variables, cultural attitudes, and caregiving behaviors. Participants were recruited at random through Home Health Services (61 %) and convenience sampling in the community (39 %), and interviewed at their home. Standardized instruments and measures constructed for this study were pretested. Multivariate analyses showed that the ethnic groups differed in age, education, income, and number of persons giving care, while caregiver health and patient functioning were similar. Controlling for demographics, differences in cultural variables were small. The sense of obligation, emotional attachment, openness about who should give care, spirituality, use of family help or community services were comparable in all groups. Commitment to caregiving was high, driven mainly by patient needs. Cubans had the greatest family stability, and worked the hardest, with the lowest sense of burden. Caribbean Black caregivers lived in bigger families, were youngest, and their patients had the lowest cognitive status. Burden was felt most by White caregivers who were older than the others. Professionals need to understand complex belief systems and behavior patterns to assist caregivers in mobilizing appropriate resources.
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População Negra/psicologia , Cuidadores/psicologia , Família/etnologia , Família/psicologia , Hispânico ou Latino/psicologia , População Branca/psicologia , Adulto , Idoso , População Negra/estatística & dados numéricos , Região do Caribe/etnologia , Cuba/etnologia , Diversidade Cultural , Feminino , Florida , Necessidades e Demandas de Serviços de Saúde , Hispânico ou Latino/estatística & dados numéricos , Assistência Domiciliar/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Análise Multivariada , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
Individuals with Alzheimer's disease (AD) are often cared for within multigenerational families. More specifically, 26% of family caregivers have children younger than 18 living with them. This article describes an innovative model for translation of an evidence-based intervention into an engaging, realistic picture book that serves as a teaching tool for children and their families. The book, Musical Memories, focuses on the relationship between a granddaughter and her grandmother who has AD. The story applies basic principles of the Progressively Lowered Stress Threshold model to explain the underlying cause of grandmother's behaviors and models the evidence-based guideline "Individualized Music for Elders with Dementia" to empower the granddaughter in maintaining a relationship with her grandmother. Musical Memories is intended to serve as a valuable resource for families and the gerontological nurses who serve them.