Demandas clínicas e intervenções de enfermagem em consultas gerontológicas: Revisão integrativa / Demandas Clínicas e intervenciones de Enfermería en consultas gerontológicas: Una revisión integrativa / Clinical demands and nursing interventions in gerontological consultations: An integrative review

Resumen Introdução: A criação de guias que unificam as demandas clínicas prevalentes em consultas de enfermagem gerontológica e, das suas respectivas intervenções, se faz presente, devido a heterogeneidade das patologias emergentes no processo de envelhecimento, que irão precisar de cuidados. Objetivo: Identificar as demandas clínicas em consultas de enfermagem gerontológica e, as intervenções implementadas pelos(as) enfermeiros(as). Método: Revisão integrativa de pesquisas originais, publicadas entre 2018 e 2022, em inglês, espanhol e português, disponíveis nas bases de dados Scopus, MEDLINE/PubMed, BIREME/LILACS/BDENF/IBECS/BVS, SciELO e Google Scholar, pelos descritores DeCS/MESH: "Idoso"; "Enfermagem no Consultório"; "Enfermagem Geriátrica" e "Geriatria". O Rating System for the Hierarchy of Evidence for Intervention foi usado para determinar o nível de evidência da amostra final. Foram excluídos editoriais, estudos de revisão e artigos duplicados. A análise dos dados se deu pela leitura analítica e interpretativa, guiadas por um checklist. Resultados: Oito artigos foram selecionados e trouxeram demandas clínica tais como: o déficit no autocuidado para banho; autonegligência; fadiga; risco de integridade da pele prejudicada; desesperança; tristeza e depressão. As intervenções se relacionaram ao incentivo ao autocuidado; otimização dos medicamentos; estímulo a atividade física; cuidados com a pele; aconselhamento; musicoterapia e reabilitação psicossocial. Conclusão: Demandas clínicas atendidas nas consultas de enfermagem gerontológica possuem grande variação, com prevalência no domínio atividade/repouso, tais como intervenções voltadas para o tratamento e prevenção de doenças e ações visando a promoção da saúde, tendo o domínio comportamental mais expressivo.

Resumen Introducción: La creación de guías que unifiquen las demandas clínicas prevalentes en las consultas de enfermería gerontológica y sus respectivas intervenciones es necesaria, debido a la heterogeneidad de patologías emergentes en el proceso de envejecimiento que requerirán cuidados. Objetivo: Identificar las demandas clínicas en las consultas de enfermería gerontológica y las intervenciones implementadas por el personal de enfermería. Método: Revisión integrativa de investigaciones originales, publicadas entre 2018 y 2022, en inglés, español y portugués, en las bases de datos Scopus, MEDLINE/PubMed, BIREME/LILACS/BDENF/IBECS/BVS, SciELO y Google Scholar. Se utilizaron los descriptores DeCS/MESH: "Idoso"; "Enfermagem no Consultório"; "Enfermagem Geriátrica" e "Geriatria". Para determinar el nivel de evidencia de la muestra final, se usó el Rating System for the Hierarchy of Evidence for Intervention. Además, se excluyeron los editoriales, los estudios de revisión y los artículos duplicados. Los datos se analizaron mediante lectura analítica e interpretativa, guiada por una lista de verificación. Resultados: Se seleccionaron ocho artículos que aportaron demandas clínicas como déficit en el autocuidado para el baño, autodescuido, fatiga, riesgo integridad de la piel perjudicada; desesperanza, tristeza y depresión. Las intervenciones estaban orientadas al fomento del autocuidado, la optimización de la medicación, el fomento de la actividad física, el cuidado de la piel, el asesoramiento, la musicoterapia y la rehabilitación psicosocial. Conclusión: Las demandas clínicas atendidas en las consultas de enfermería gerontológica son muy variadas, con predominio en el dominio actividad/reposo, como intervenciones dirigidas al tratamiento y prevención de enfermedades y acciones dirigidas a la promoción de la salud, siendo más expresivo el dominio conductual.

Abstract Introduction: The creation of guidelines that unify the prevalent clinical demands from gerontological nursing consultations and their corresponding interventions are necessary due to the heterogeneity of emerging pathologies in the aging process that will require nursing care. Objective: To identify clinical demands in gerontological nursing consultations and the interventions implemented by nurses. Method: An integrative review of original research published from 2018 and 2022, in English, Spanish, and Portuguese, in Scopus, MEDLINE/PubMed, BIREME/lilacs/BDENF/IBECS/VHL, SciELO, and Google Scholar databases, using the DeCS/MESH descriptors: "Elderly", "Nursing in the Office", "Geriatric Nursing", and "Geriatrics". The Rating System for the Hierarchy of Evidence for Intervention was used to determine the level of evidence of the final sample. Editorials, review studies, and duplicate articles were excluded. The data were analyzed by analytical and interpretative reading, guided by a checklist. Results: Eight articles were selected that showed clinical demands such as deficits in self-care for bathing, self-negligence, fatigue, risk of damaged skin integrity, hopelessness, sadness, and depression. Interventions were related to encouraging self-care, medication optimization, encouragement of exercise, skin care, counseling, music therapy, and psychosocial rehabilitation. Conclusion: There are many different clinical demands in gerontological nursing consultations, especially associated with the domain of activity/rest. These include interventions to treat and prevent diseases, and actions aimed at health promotion, in most cases associated with the behavioral domain.

A Simple Framework of Smart Geriatric Nursing considering Health Big Data and User Profile.

The National Bureau of Statistics of China shows that the population over 65 years old in China exceeds 166 million accounting for 11.93% of the total population by the end of 2018. The importance and severity of taking care of the elderly are becoming increasingly prominent. High-quality and meticulous care for the daily life of the elderly needs helpful and advanced sciences and technologies. Smart geriatric nursing is a must. Basing on the professional knowledge of geriatric nursing, this paper proposes a framework of smart geriatric nursing which consists of three aspects of smart nursing: smart geriatric nursing in physical health using biosensor and advanced devices, smart geriatric nursing in mental health based on user profile, and smart geriatric nursing for daily life based on big data in health. The deployment of the proposed method relies on the technologies of the Internet of Things (IoT), user profile system, big data, and many other advanced information technologies. The framework of methods can provide a useful reference for the systematic technical scheme of smart geriatric nursing in an aging society.

Political and pedagogical projects of nursing residency to the elderly from Paulo Freire's perspective.

OBJECTIVE: to analyze political and pedagogical projects of nursing residency to the elderly from Paulo Freire's perspective. METHOD: a descriptive, exploratory study, qualitative approach using documentary analysis. Data source was pedagogical political projects of nursing residency programs in the health of the elderly. The data were collected between March and May 2017. Data analysis was based on Bardin's Thematic Analysis. It had as analytical categories specific dimensions of the proposed theoretical framework. RESULTS: twelve pedagogical political projects showed that learning dimensions appear in an incipient, fragmented way, demonstrating the reproduction of banking education, disregarding the importance of bringing the student as a subject of learning. CONCLUSION: there is a gap in pedagogical political projects from Paulo Freire's perspective. It is necessary that regulatory institutions can systematize and encourage so that pedagogical projects of these programs are based on Paulo Freire's epistemological bases, enabling the so desired holistic training.

The community-based integrated care system in Japan: Health care and nursing care challenges posed by super-aged society.

Japan is experiencing unprecedented aging of its population. People age 65 years or older accounted for 28.1% of the total population in 2018, and that proportion is expected to reach 33.3% in 2036 and 38.4% in 2065. In 2017, the average life expectancy in Japan was 81.09 years for men and 87.26 years for women. By 2065, it is expected to reach 84.95 years for men and 91.35 years for women. Population aging affects health and long-term care systems. The government proposed the establishment of "a community-based integrated care system" by 2025 with the purpose of comprehensively ensuring the provision of health care, nursing care, preventive care, housing, and livelihood support. This will require health care and nursing care professionals who are capable of fully understanding the physical and mental characteristics of elderly people and the fostering of organic collaboration with others professionals in the community-based integrated care system. A department of gerontology or geriatric medicine is desired to be established in each medical school to teach students medicine and efficient medical care, to conduct research, and to develop personnel to facilitate this paradigm shift. In 2018, there were 263 colleges of nursing with an admissions capacity of 23,667. In Japan, Certified Nurse Specialists can specialize in 13 areas as of December 2016. The number of Certified Nurse Specialists increased to 2,279 as of December 2018. One hundred and forty-four of those specialists specialized in Gerontological Nursing while 53 specialized in Home Care Nursing. The number of nurses specializing in Gerontological Nursing and Home Care Nursing is desired to be increased in order to implement and improve community-based comprehensive care.

Political and pedagogical projects of nursing residency to the elderly from Paulo Freire's perspective / Proyectos políticos y pedagógicos de residencia de enfermería al anciano en la perspectiva de Paulo Freire / Projetos políticos e pedagógicos de residência de enfermagem ao idoso na perspectiva freiriana

ABSTRACT Objective: to analyze political and pedagogical projects of nursing residency to the elderly from Paulo Freire's perspective. Method: a descriptive, exploratory study, qualitative approach using documentary analysis. Data source was pedagogical political projects of nursing residency programs in the health of the elderly. The data were collected between March and May 2017. Data analysis was based on Bardin's Thematic Analysis. It had as analytical categories specific dimensions of the proposed theoretical framework. Results: twelve pedagogical political projects showed that learning dimensions appear in an incipient, fragmented way, demonstrating the reproduction of banking education, disregarding the importance of bringing the student as a subject of learning. Conclusion: there is a gap in pedagogical political projects from Paulo Freire's perspective. It is necessary that regulatory institutions can systematize and encourage so that pedagogical projects of these programs are based on Paulo Freire's epistemological bases, enabling the so desired holistic training.

RESUMEN Objetivo: analizar los proyectos políticos y pedagógicos de residencia de enfermería en el anciano en la perspectiva de Paulo Freire. Método: estudio descriptivo, exploratorio, enfoque cualitativo utilizando el análisis documental. La fuente de datos fueron los proyectos políticos pedagógicos de programas de residencia de enfermería en salud del anciano. Los datos fueron recolectados entre marzo y mayo de 2017. El análisis de los datos fue a partir del Análisis Temático de Bardin, teniendo como categorías analíticas dimensiones propias del referencial teórico propuesto. Resultados: doce proyectos políticos pedagógicos mostraron que las dimensiones de aprendizaje aparecen de manera insípida, fragmentada, demostrando la reproducción de la educación bancaria, desconsiderando la importancia de traer al educando como sujeto del aprendizaje. Conclusión: hay una laguna en los proyectos políticos pedagógicos en la perspectiva de Paulo Freire. Es necesario que las instituciones reguladoras puedan sistematizar y estimular para que los proyectos pedagógicos de estos programas sean pautados en las bases epistemológicas de Paulo Freire, posibilitando la tan deseada formación holística.

RESUMO Objetivos: analisar os projetos políticos e pedagógicos de residência de enfermagem ao idoso, na perspectiva Freiriana. Método: estudo descritivo, exploratório, abordagem qualitativa utilizando a análise documental. A fonte de dados foram os projetos políticos pedagógicos de programas de residência de enfermagem em saúde do idoso. Os dados foram coletados entre março e maio de 2017. A análise dos dados foi a partir da Análise Temática de Bardin, tendo como categorias analíticas dimensões próprias do referencial teórico proposto. Resultados: doze projetos políticos pedagógicos mostraram que as dimensões de aprendizagem aparecem de maneira insipiente, fragmentada, demonstrando a reprodução da educação bancária, desconsiderando a importância de trazer o educando como sujeito do aprendizado. Conclusão: há uma lacuna nos projetos políticos pedagógicos na perspectiva Freiriana. É necessário que as instituições reguladoras possam sistematizar e estimular para que os projetos pedagógicos destes programas sejam pautados nas bases epistemológicas Freirianas, possibilitando a tão desejada formação holística.

Implementation of Individualized Music in Long-Term Care: Application of the PARiHS Framework.

The need to provide evidence-based, person-centered care for long-term care (LTC) residents, which often include individuals with dementia, has led to a surge of interest in the implementation of individualized music (IM) programs. An exploratory study was conducted over a 6-month period using the Promoting Action on Research in Health Systems (PARiHS) framework to examine the implementation of an IM program with 19 residents in a LTC facility. All residents using IM had the device available at the end of the program, and 53% received IM at least two times per week. Qualitative analysis of stakeholder interviews with six staff members and three residents after using the PARiHS framework as an implementation guide revealed two themes: Overcoming Resistance to Innovation and Person-Centered Care Through IM. Identification of barriers and facilitators through the PARiHS elements of evidence, context, and facilitation supported the IM implementation process and should enable its replication in other facilities. [Journal of Gerontological Nursing, 44(8), 29-38.].

Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach.

BACKGROUND: Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice. METHODS: A convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Participants were 20 interdisciplinary staff nominating as CoP members between Nov 2013-Nov 2015 representing 13 facilities (approximately 780 beds) of a RAC organisation. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i.), the RAC facility (level ii.) and RAC organisation (level iii.). RESULTS: Staff participating as CoP members gained knowledge and awareness in falls prevention (p < 0.001) through connecting and sharing. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management. CONCLUSIONS: Interdisciplinary staff participating in a falls prevention CoP gained connectivity and knowledge and were able to facilitate the translation of falls prevention evidence into practice in the context of their RAC facility and RAC organisation. Support from RAC organisational and facility management to make the necessary investment in staff time to enable change in falls prevention practice is essential for success.

Supporting spirituality in the care of older people living with dementia: a hermeneutic phenomenological inquiry into nurses' experiences.

BACKGROUND: Spirituality is defined as a search for answers to existential questions about the meaning of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve affiliation with a specific religion. Studies on spirituality have focused on palliative care, and there are limited studies into the spirituality in the care of older people with dementia. AIM: To describe the experiences of nurses supporting spirituality in the care of older people living with dementia. METHOD: This study, informed by Heideggerian hermeneutic phenomenology, was conducted in 2014/15. Data were collected by interviewing a purposive sample of 17 nurses. RESULTS: Supporting the spirituality of older people with dementia was seen as understanding their spirituality within a framework of person-centeredness and individuality. The participants came to understand the spiritual needs of older people with dementia through both verbal and nonverbal expression and by learning about older people's individual spiritual backgrounds. Meeting spiritual needs meant approaching the person with dementia as a valuable human as well as paying attention, to and supporting, his/her personal philosophy of life within nursing care. CONCLUSION: Learning and developing an understanding of the spiritual needs of older people with dementia is challenging. The nurses offered person-centred, spiritual care, to people with dementia from a variety of perspectives, which is important in the provision of comprehensive care. There is a need to find usable tools to help nurses to learn and understand the individual spiritual needs of older people with dementia and to explore how these older adults experience having their spirituality supported within their nursing care.

Prompted Voiding Offers Long-Term Benefits to Nursing Home Residents.

According to this study.

The Influence of Skill Development Training Program for Spiritual Care of Elderly Individual on Elderly Care Technician Students' Perception of Spiritual Support.

Spiritual care means helping an individual protect, maintain and gain all the dimensions of his/her existence. Elderly care technicians face numerous cases or crisis situations in which elderly individuals from different backgrounds question the meaning and value of life. Elderly care technicians must acknowledge that the spirituality is an important element in the way an elderly individual receives healthcare and they must be equipped for this matter. This study was conducted in order to examine the influence of "Skill Development Training Program for Spiritual Care of Elderly Individual," which was carried out with students from elderly care program, on the perception of spirituality support in a pretest-posttest quasi-experimental study design with control group. As the data collection form, "Spiritual Support Perception" (SSP) scale was used. The mean scores of the intervention group after the training and after one month are 50.39 ± 5.34 and 51.13 ± 4.98, respectively, and those of the control group are 43.16 ± 4.83 and 42.72 ± 4.48. A statistically significant difference was found between the mean scores of the intervention group from the pretest and the posttests immediately after the training and one month after the training (f = 94.247, p = 0.001). In the control group, however, there was no significant change in the SSP mean scores (f = 0.269, p = 0.77). As a result, this study pointed out the necessity of such training programs for healthcare professionals to make a distinction between their professional duties and their own personalities in order to offer spiritual care to the elderly individual.

Ethnocultural Gerontological Nursing: An Integrative Literature Review.

The aging population is growing increasingly more diverse, with one in four older adults from an ethnic minority group by 2050, while the nursing force will largely remain members of a single race White population. The purpose of this review is to appraise the state of nursing knowledge in relationship to meeting the needs of elders in unique racial/ethnic groups using two approaches: evaluating the efficacy of current knowledge and evaluating the state of nursing knowledge about ethnocultural gerontological nursing based on an integrative review of nursing literature. Thirty-four articles were reviewed. Most articles used qualitative methodology focused on a single ethnic group, with several articles focused on health promotion/prevention. Cultural perspectives were better addressed than aging concepts and few articles integrated ethnocultural and gerontological nursing concepts. This evaluation indicates many gaps in the knowledge base about ethnocultural gerontological nursing. Specific areas for future knowledge development are identified.

Análisis del concepto de Autotrascendencia. Importancia en el cuidado de enfermería al adulto mayor / Análise do conceito de Autotranscendência. Importância no cuidado de enfermagem para os idosos / Self transcendence concept analysis. Importance in nursing care for the elderly

Introducción: La autotrascendencia es una conexión con el ser, un avance en la optimización de la realización humana, en contextos profundos: el espiritual. Objetivo: Analizar el concepto 'autotrascendencia' y proponer su uso en el cuidado de enfermería al adulto mayor. Material y métodos: Se analizó el concepto 'autotrascendencia' (método de Walker & Avant). Identificación de elementos conceptuales, revisión de literatura y propuesta conceptual; descriptores: 'autotrascendencia' 'enfermería' (español, inglés, portugués). Resultados: Elementos conceptuales: Capacidad del ser humano, Ir más allá de sí mismo, Ampliar límites personales, Camino espiritual, Dar sentido a la vida, Conexión con el yo, los demás, el entorno, Conexión con el espíritu del universo, Encontrar significado de la propia existencia. Propuesta conceptual: 'Es la capacidad del ser humano para ir más allá del propio yo y como consecuencia ampliar los límites personales mediante un camino espiritual para dar sentido a la vida y que se enlaza con una conexión con el yo, los demás, el entorno y con el espíritu del universo; como un significado de la propia existencia'. Conclusiones: La autotrascendencia es un fenómeno complejo que varía desde situaciones concretas, como entrar en proceso de superación y aspiraciones personales; y complejas como el duelo o muerte (AU)

Introduction: The Self-Transcendence is a connection with the being, an advance in optimizing of the human realization, on deeper contexts: the spiritual. Objective: Analyze the concept of 'selftranscendence' and propose their use in nursing care for the elderly. Material and methods: It was analyzed the concept of 'Self-transcendence' (method from Walker & Avant). Identification of conceptual elements, review of literature and conceptual proposal; Descriptors: 'Self-transcendence' 'Nursing' (Spanish, English, Portuguese). Results: Conceptual elements: Capacity of human being, Go beyond self, Expand personal bounds, Spiritual path, Giving meaning to life, connection with self, others, the environment, connection with the spirit of the universe, Find meanings of own existence. Conceptual proposal: 'It is the ability of the human being to go beyond the self and consequently expand the personal bounds by a spiritual path to give meaning to life and that links to a connection with self, others, the environment and the spirit of the universe; as a meaning of existence itself'. Conclusions: Self-Transcendence is a complex phenomenon that varies from specific situations, like entering in process of improvement and personal aspirations; and complex as mourning or death (AU)

Introdução: A Auto transcendência é uma conexão com o ser, um avanço na otimização do desempenho humano, em contextos mais profunda: a espiritual. Objetivo: Analisar o conceito de 'Auto transcendência' e propor a sua utilização em cuidados de enfermagem para os idosos. Material e métodos: Foi analisado o conceito de 'Auto transcendência' (método do Walker & Avant). Identificação de elementos conceituais, revisão de literatura e proposta conceitual; Descritores: 'autotranscendência' 'enfermagem' (Espanhol, Inglês, Português). Resultados: Elementos conceituais: Capacidade do homem, vai além de si mesmo, os limites pessoais maiores, caminho espiritual, dar sentido à vida, conexão com o eu, os outros, o ambiente, a conexão com o espírito do universo, descobrir significados de própria existência. Proposta conceitual: 'É a capacidade do ser humano de ir além de si mesmo e o efeito de alargar os limites pessoais por um caminho espiritual para dar sentido à vida e que a ligação a uma conexão com o eu, os outros, o ambiente e o espírito do universo; como um sentido da própria existência'. Conclusões: Autotranscendência é um fenômeno complexo que varia de situações específicas, como entrar melhoria de processos e aspirações pessoais; e complexo como o sofrimento ou a morte (AU)

Diagnosis and management of patients with hypercalcaemia.

Hypercalcaemia is a common biochemical abnormality in the blood that can be caused by malignancy, hyperparathyroidism, medications or underlying medical conditions. Initial signs and symptoms are often vague, however, if someone has severe hypercalcaemia it is treated as an emergency, requiring prompt management to prevent life-threatening complications such as dehydration, cardiac arrhythmias or coma. Understanding the pathophysiology, signs and symptoms of hypercalcaemia enables effective diagnosis and holistic management of the patient with complex health needs.

Diversional and physical nonpharmacological interventions for behavioral and psychological symptoms of dementia.

This article is the last of a four-part series addressing the use of non-pharmacological interventions for older adults with behavioral and psychological symptoms of dementia (BPSD). These types of interventions are used to prevent, lessen, or eliminate BPSD, thereby reducing patient reliance on psychoactive medications. These interventions are easy to use, cost-effective, and simple to implement. The Centers for Medicare & Medicaid Services' psychoactive medication reduction initiative encourages all staff to use nonpharmacological interventions to manage BPSD. As with any attempt to handle BPSD, health care professionals and staff need a tool-box of interventions, as what works one day may not work the next and what works with one older adult may not work with another. This article describes the categories of diversional and physical nonpharmalogical interventions, presents the evidence supporting their use, and provides information on effective implementation.

Successful aging in the United States and China: a theoretical basis to guide nursing research, practice, and policy.

Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy.

Depression in older women with metastatic breast cancer.

Depressive symptoms are common in older women with late-stage breast cancer, and some of these patients meet criteria for major depressive disorder. Significant overlap exists among many of the most prevalent physical signs and symptoms of depression in older adults (e.g., weight loss, fatigue) and the physical signs and symptoms of malignancy or treatment for malignancy, which may contribute to ongoing underdiagnosis and undertreatment of depression in this population. The National Comprehensive Cancer Network and evidence-based geriatric nursing guidelines call for routine screening for depression with valid and reliable screening instruments among high-risk groups at every encounter. Geriatrics, oncology, and palliative care nurses are encouraged to regularly screen older women with metastatic breast cancer for depressive symptoms and maintain a low threshold for initiation of behavioral and/or psychopharmacological interventions.

Sensory and nurturing nonpharmacological interventions for behavioral and psychological symptoms of dementia.

This article is part three of a four-part series addressing the use of nonpharmacological interventions in place of or in conjunction with psychotropic medications in older adults with cognitive impairment. Acquiring a better understanding of the mechanics for how each intervention works makes selection of an intervention easier at the time it is needed. Selection of the appropriate nonpharmacological intervention is based on person-centered care and how to adapt and implement it for each individual. Selection also depends on target behavior, behavior triggers, and the physical and cognitive functioning of the individual with the behavioral and psychological symptoms of dementia. Nonpharmacological interventions can be implemented by all staff members, not just recreational and activity personnel. The Centers for Medicare & Medicaid Services initiative would like to see all staff involved with these interventions, which can be implemented on the spot, as they are needed, to prevent, reduce, or stop a particular behavior. The current article will describe sensory and nurturing interventions, present the evidence supporting their use, and provide information on effective implementation.

Spiritual coping of older people in Malta and Australia (part 1).

This descriptive sequential explanatory study, which forms part of a larger study, investigated the use of spiritual coping strategies by three cohort groups of Maltese older residents in three phases. The theoretical model of causal pathway for mental health based on monotheistic religions (Christianity, Judaism, and Islam) guided the study. Participants were recruited from four private homes: two in Australia (n=30), two in Malta (n=43) and two state residences also in Malta (n=64). The residents (n=137; men n=103, women n=34), mean (M) age 72.8 years, were all Roman Catholics, mobile and with a minimum residence of 6 months. The quantitative data (phase I) were collected by the Maltese version of the Spiritual Coping Strategies scale ( Baldacchino and Buhagiar, 2003 ). The qualitative findings in phase II derived from the face-to-face interviews and focus groups explain the use of spiritual coping strategies and how they contributed toward coping with institutionalisation. Significant differences were found in spiritual coping (F=11.434; p=0.001; degree of freedom (df)=2) whereby the cohort in Australia scored the highest scores in the total spiritual coping (M=48.60; standard deviation (SD)=6.251), religious coping (M=23.47; SD=2.145) and existential coping (M=25.13; SD=6.033). No significant differences were found in the total spiritual coping between subgroups of mobility and demographic characteristics except by gender (Student's t-test (t)=2.455; p=0.015) whereby women (M=22.09; SD=4.325) scored higher than the men (M=19.67; SD=4.508). Australian private homes reported the highest (significant) mean scores in total spiritual coping, religious coping and existential coping. Recommendations were set for clinical practice and management, nursing education, and further research.

Attending to the spiritual in dementia care nursing.

Spirituality is a complex and subjective concept. However, spiritual wellness is an important component in a person's overall well-being and the spiritual support of patients is central to nursing care. People with dementia may not be well-supported in this aspect of care; this may lead to spiritual distress. Spiritual needs may be identified by taking the person's spiritual history or, in the case of advanced dementia, by asking a person's significant others about the important spiritual aspects of the person's life. Spiritual care for people with dementia involves reflective practice and meaningful engagement with the person with dementia, so as to facilitate shared understanding. Furthermore, the support of the spiritual and religious beliefs of the person need to be facilitated within an individualised or person centred approach to care and delivered within a multi-disciplinary collaborative context.