A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes.

Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.

Musical Memories: translating evidence-based gerontological nursing into a children's picture book.

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.

Individualized music for dementia: Evolution and application of evidence-based protocol.

The theory-based intervention of individualized music has been evaluated clinically and empirically leading to advancement and refinement of an evidence-based protocol, currently in its 5th edition. An expanded version of the protocol was written for professional health care providers with a consumer version tailored for family caregivers. The underlying mid-range theory is presented along with a seminal study that was followed by further research in the United States, Canada, Great Britain, France, Sweden, Norway, Japan and Taiwan. Key studies are summarized. Given its efficacy when implemented by research staff, studies have advanced to testing the intervention under real-life conditions when implemented and evaluated by trained nursing assistants in long-term care facilities and visiting family members. In addition, one study evaluated the implementation of music by family members in the home setting. Initial research focused on agitation as the dependent variable with subsequent research indicating a more holistic response such as positive affect, expressed satisfaction, and meaningful interaction with others. The article advances by describing on-line programs designed to train health care professionals in the assessment, implementation and evaluation of individualized music. In addition, Gerdner has written a story for a picture book intended for children and their families (in press). The story models principles of individualized music to elicit positive memories, reduce anxiety and agitation, and promote communication. The article concludes with implications for future research.

Craniosacral still point technique: exploring its effects in individuals with dementia.

A mixed methodology was used to explore the effects of craniosacral still point technique (CSPT) in 9 older adults with dementia. Participants were monitored at baseline (3 weeks), intervention (6 weeks), and postintervention (3 weeks) using the modified Cohen-Mansfield Agitation Inventory (M-CMAI). CSPT was implemented daily for 6 weeks by a certified craniosacral therapist. Findings indicated a statistically significant reduction in M-CMAI total and subscale scores during the intervention period. This reduction continued during postintervention for subscale scores of physical nonaggression and verbal agitation. Staff and family interviews provided convergent validity to the quantitative findings. Participants were also more cooperative during caregiving activities and displayed meaningful interactions.

Hard lives, God's help, and struggling through: caregiving in Arkansas Delta.

The purpose of this ethnographic study was to describe the experience of African American adults providing in-home care for a family member with chronic confusion living in the Arkansas Delta. We conducted this study over fourteen months in two rural Delta counties using participant observation and in-depth interviews. The majority of caregivers were adult daughters. Nearly half attributed chronic confusion to a difficult life and emotional stress or "worry;" a third believed it to be a natural component of "old age." Caregivers tended to view their work as an expression of love and devotion that was accompanied by emotional stress and personal sacrifice. While just under half of the caregivers had no other family members willing or available to assist with the physical care of the elder, the majority were able to turn to family members for emotional support. Further they identified strong religious beliefs as the primary force that sustained them in the caregiving role. The centrality of spirituality, faith/religion was noted in nearly all aspects of life. Faith in God was seen as continuing to be an important aspect of the care recipients' lives as well. Recipients' spiritual needs were addressed by accompanying the care recipient to church services and reading Bible passages to them on a regular basis. Selective community services (i.e., adult day care, home health services) were used that supported efforts at maintaining the family caregiver role. Findings are discussed within the context of historical and sociopolitical factors of the geographic region.

The circle of life: end-of-life care and death rituals for Hmong-American elders.

The Hmong are an ethnic minority from Southeast Asia who constitute a growing U.S. population. Gerontological nurses need to understand the cultural meaning and rituals associated with dying, death, and the bereavement process of Hmong Americans. Critical to this is the structure and role of clan and family as a source of support and their involvement in the decision-making process. In this article, we provide an overview of the traditional spiritual beliefs related to life and death with implications for end-of-life and postmortem care. Information was acquired through invited field experiences. Published literature and consultation with Hmong elders were used to clarify, enhance, and validate this understanding.

Competence in nursing informatics among nursing students and staff at a nursing institute in Sweden.

BACKGROUND: Information technology (IT) has slowly been implemented in many health-care organizations (i.e. hospitals). The use of computers has advanced to home care and long-term facilities. Consequently, it is important that nurses are able to demonstrate competence and feel confident in the use of IT. Yet, research has reported that nursing students have varying degrees of competence and experience with IT. AIMS: The purpose of this study was to ascertain nursing students' and nursing educators' self-reported attitudes, skills and experiences using IT. METHODS: Data were collected through a written survey distributed and completed by 247 nursing students (45 of whom were registered nurses who participated in extension courses) and 52 staff members from the nursing faculty at a university in Sweden. RESULTS: Two-thirds of the students and 92% of the nursing educators had access to the Internet from their homes. Of the students, 71% identified their IT skills as being sufficient for their current or future work as a registered nurse. Nurse educators were less confident in the students' ability, reporting that only 29% of nursing students had sufficient IT skills. Comparatively, 48% of the nursing educators believed that they themselves had sufficient IT skills for their role as a nurse educator. CONCLUSIONS: It is important that nursing students have basic IT skills and are familiar with e-mail, word-processing and various databases on the World Wide Web. Findings indicate that participants had a deficit in these skills, suggesting the need to integrate IT into the nursing curriculum.

Chronic confusion and memory impairment in Hmong elders: Honoring differing cultural beliefs in America.

The Hmong began arriving to the United States as refugees in the mid 1970s and constitute a growing number of the population. Little is known about the prevalence and care of dementia in Hmong elderly individuals. The purpose of this article is to discuss the traditional beliefs and treatment of tem toob (memory impairment) within the Hmong culture. This includes a discussion of the authors' encounters with Hmong herbalists in open-air markets during a journey in Laos and Thailand. A story cloth is then featured to discuss a shamanic healing ceremony for an elderly woman with tem toob. Nursing implications are discussed.

Application of the Progressively Lowered Stress Threshold Model across the continuum of care.

Over the last two decades, increasing attention has been paid to the nature of behavioral symptoms in dementia. Early notions that all behaviors were an inevitable component of cognitive impairment have all but disappeared in the face of evidence that diverse personal, social, and environmental factors regularly act as antecedents to behavioral and psychologic symptoms of dementia (BPSD). The quality of care provided to persons with dementia has been advanced through nursing care conceptual models that explain antecedents to BPSD and, in turn, offer specific interventions to promote comfort and optimal function.

Use of individualized music by trained staff and family: translating research into practice.

This pilot study used a mixed methodology to evaluate the effectiveness of individualized music for the management of agitation when implemented by trained staff and family. Music was administered daily and as needed to eight elderly individuals with dementia who resided in a long-term care facility. A statistically significant reduction in agitation was found during the presentation of music and an overall reduction in agitation was found on day shift during weeks 1 to 8 and on evening shift during weeks 5 to 8. Staff and family interviews provided convergent validity of findings. Music also promoted meaningful interaction between the resident and others.

History, development, and future of the progressively lowered stress threshold: a conceptual model for dementia care.

Behavioral symptoms associated with dementia are a major concern for the person who experiences them and for caregivers who supervise, support, and assist them. The knowledge and skill of formal and informal caregivers affects the quality of care they can provide and their ability to cope with the challenges of caregiving. Nurses are in an excellent position to provide training to empower caregivers with the knowledge and skills necessary to reduce and better manage behaviors. This article reviews advances in geriatric nursing theory, practice, and research based on the Progressively Lowered Stress Threshold (PLST) model that are designed to promote more adaptive and functional behavior in older adults with advancing dementia. For more than 17 years, the model has been used to train caregivers in homes, adult day programs, nursing homes, and acute care hospitals and has served as the theoretical basis for in-home and institutional studies. Care planning principles and key elements of interventions that flow from the model are set forth, and outcomes from numerous research projects using the PLST model are presented.

Impact of a psychoeducational intervention on caregiver response to behavioral problems.

BACKGROUND: Eighty percent of persons with Alzheimer's disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job. OBJECTIVE: To evaluate the efficacy of a longitudinal, multisite, community-based intervention designed to teach home caregivers to manage behavioral problems in persons with Alzheimer's disease. METHODS: Usable data were analyzed from 237 caregiver/care recipient dyads (n = 132 Experimental; n = 105 Comparison). The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987). The comparison group received routine information and referrals for case management, community-based services, and support groups. Although a variety of psychosocial outcomes were compared between caregivers in the two groups, this article focuses on frequency and response to behavioral problems and functional decline. RESULTS: The Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems (p <.01) for all caregivers and on response to activities of daily living problems (p <.01) for spousal caregivers. In addition, nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems (p <.01). No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses. CONCLUSIONS: This Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers.

Elder Mistreatment Among Rural Family Caregivers of Persons With Alzheimer's Disease and Related Disorders.

This article presents four case studies of elder abuse from the files of a multisite training project designed to teach rural caregivers of persons with Alzheimer's disease and related disorders how to better manage behavioral problems associated with dementia. The cases are used to illustrate characteristics of victims, perpetrators, and family systems that are vulnerable to abuse. The examples presented reflect a variety of factors associated with abuse in caregiving situations, including denial and maladaptive personality characteristics in the caregiver, and anxiety and lack of knowledge. The role of health care professionals and researchers who uncover abuse or neglect situations is also discussed.