Demographic and Socioenvironmental Characteristics of Black and White Community-Dwelling Caregivers and Care Recipients' Behavioral and Psychological Symptoms of Dementia.

The purpose of the current study was to compare the association between caregiver background characteristics and care recipients' behavioral and psychological symptoms of dementia (BPSD) in Black and White community-dwelling family caregivers. Using logistic regression models, caregiver/care recipient dyad data from the Aging Demographics and Memory Study were used to describe associations between caregiver background characteristics (i.e., demographic and socioenvironmental variables) and care recipients' BPSD (i.e., hallucinations, delusions, agitation, depression) (N = 755). Results showed that Black caregivers were more likely to be female, younger, an adult child, have less education, and live in the South (p ≤ 0.05); they were less likely to be married. Several caregiver background characteristics were associated with care recipients' depression and agitation, but not with other BPSD. Caregiver background characteristics may play a role in the recognition and reporting of BPSD and should be considered when working with families of individuals with dementia.

Nursing opinion leadership: a preliminary model derived from philosophic theories of rational belief.

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent-based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. The purpose of this paper is to describe the work conducted in preparation for the development of an agent-based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation.

Measurement of aggressive behaviors in dementia: comparison of the physical aggression subscales of the Cohen-Mansfield Agitation Inventory and the Ryden Aggression Scale.

One of the central issues in the development of research-based interventions for aggressive behavior (AB) in late-stage dementia is the provision of precise measurement of the major dependent variable, in this case, AB levels. To advance the nursing goal of evidence-based practice, this article presents the characteristics of two research instruments: the Cohen-Mansfield Agitation Inventory (CMAI) aggressive behavior subscale (CMAI-ABS) and the Ryden Aggression Scale (RAS) physically aggressive behavior subscale (RAS-PABS). A total of 282 shower bath events (which are most associated with AB) were observed for 107 nursing home residents with dementia in nine randomly selected nursing homes. Then, we compared the psychometric properties of the CMAI-ABS and the RAS-PABS. Moderate to substantial agreements between the two instruments were identified using Cohen's Kappa. A similar percentage of AB was found on both subscales. Similar items on both subscales, such as hitting and pushing, were moderately correlated. Overall, the study results support that the CMAI-ABS and RAS-PABS measure a single but multifaceted construct-physically aggressive behavior in dementia.

A philosophical analysis of agent-based modelling: a new tool for theory development in nursing.

AIM: In this paper we present a discussion of the nature of agent-based modelling from nursing's philosophical perspectives and truth criteria as a means of evaluating this methodological tool's disciplinary fit. BACKGROUND: Agent-based modelling is a new methodological tool used to study complex systems. Researchers from a multitude of disciplines are using agent-based models to enhance understanding of problems that transcend disciplinary and geographical boundaries. Because of the growing interest in complexity science in the discipline of nursing, this new tool may prove useful for nurses engaged in research and theory development. DATA SOURCES: Electronic indexes and iterative bibliographic searches were used to identify papers, books and abstracts addressing agent-based modelling. In order to trace the emergence of the topic in the literature, date limiting parameters were not used. Selected studies from the international literature were limited to English language reports in the social sciences. The work was completed in 2008. DISCUSSION: Recurrent themes concerning the use of agent-base modelling include heterogeneity, dynamics, adaption, emergence and 'bridging'. The themes were congruent with philosophical views and metanarratives in nursing. IMPLICATIONS FOR NURSING: Agent-based models offer practical advantages in the pursuit of new knowledge, including the ability to pilot research studies using simulation or to visualize potential practice changes prior to implementation. CONCLUSION: The use of agent-based modelling as tool for nursing theory development, should be expanded. As nurses and other researchers become more familiar with the use of these models, methodological critique will contribute to the development of increasingly valid models.

Contributing factors associated with impulsivity-related falls in hospitalized, older adults.

Impulsivity-related falls (IRFs) sustained by hospitalized, older adults can lead to critical adverse events. The purpose of this study was to determine whether 7 common fall risk factors contributed to the occurrence of IRF in hospitalized, older adults. This study found that 31% of falls were classified as IRF. Logistic regression indicated that inattention and mobility were contributors to IRF. Early identification of these 2 risk factors could improve identification of potential IRFs and reduce fall rates.

Evaluating the relationship between inattention and impulsivity-related falls in hospitalized older adults.

Impulsivity in older adults is poorly understood and there is limited literature on the relationship between impulsivity and falls. This retrospective study evaluated the relationship between of inattention and impulsivity related falls (IRF) in hospitalized older adults. The sample (N = 192) included patients 65 years and older with a documented in-patient fall in 2007. "Impaired judgment" was identified as the critical attribute of IRF. The Confusion Assessment Method item for inattention was extracted as the variable for inattention. Twenty-eight percent (28%) of falls were classified as IRF. A significant relationship was found between inattention on the shift prior to a fall and the fall being an IRF (Chi-square = 45.5, df = 1, p = .00, Phi = .54, p = .00). Early identification of older adults with impaired attention has potential to reduce IRF when nursing uses this assessment to implement additional safety interventions for hospitalized older adults.

Factors associated with aggressive behavior among nursing home residents with dementia.

PURPOSE: In an attempt to more thoroughly describe aggressive behavior in nursing home residents with dementia, we examined background and proximal factors as guided by the Need-Driven Dementia-Compromised Behavior model. DESIGN AND METHODS: We used a multivariate cross-sectional survey with repeated measures; participants resided in nine randomly selected nursing homes within four midwestern counties. The Minimum Data Set (with verification by caregivers) identified participants. We used a disproportionate probability sample of 107 participants (51% with a history of aggressive behavior) to ensure variability. Videotaped care events included four of direct care (shower baths, meals, dressing, and undressing) and two of nondirect care (two randomly selected 20-minute time periods in the afternoon and evening). The majority of participants (75%) received three shower baths, for a total of 282 videotaped baths. RESULTS: Because the shower bath was the only care event significantly related to aggressive behavior (F = 6.9, p < .001), only those data are presented. Multilevel statistical modeling identified background factors (gender, mental status score, and lifelong history of less agreeableness) and a proximal factor (amount of nighttime sleep) as significant predictors (p < .05) of aggressive behavior during the shower bath. We found significant correlations between aggressive behavior and negative subject affect (r = .27) during the bath, and aggressive behavior and lifetime agreeableness level (r = -.192). We also found significant correlations between mental status and the amount of education (r = .212), and between negative caregiver affect and negative participant affect (r = .321). IMPLICATIONS: We identified three background and one proximal factor as significant risk factors for aggressive behavior in dementia. Data identify not only those persons most at risk for aggressive behavior during care, but also the care event most associated with aggressive behavior. Together these data inform both caregiving for persons with dementia as well as the design of intervention studies for aggressive behavior in dementia.

Preserved implicit memory in dementia: a potential model for care.

A growing body of evidence supports the presence of a preserved implicit memory (PIM) system for persons with Alzheimer's disease (AD). This article describes a new approach to dementia care, the PIM model, which translates evidence from implicit memory research into a practice model of dementia care. The PIM model predicts that function can be sustained longer for persons with AD through interventions and environments that activate an individual's PIM. Activation of PIM can occur with perceptual priming of familiar objects and reinforcement of learned motor skill memories within tasks. This practice model provides a new framework for planning and implementing dementia care that may preserve function for persons with Alzheimer's dementia.

Factors associated with psychotropic drug usage among nursing home residents with dementia.

BACKGROUND: Although federal regulations hold nursing homes responsible for monitoring psychotropic drug (PD) usage, there is a high prevalence of PD usage and significant variation in use across nursing homes. OBJECTIVES: The aims of study were to (a) describe current PD usage in nursing homes and (b) examine resident and nursing home factors associated with PD usage in nursing home residents with dementia. METHODS: A multivariate, multisite, cross-sectional descriptive study was used on data from 107 dementia patients residing in nine randomly selected nursing homes in southeastern Michigan. The PD usage of interest included antipsychotics, antidepressants, anxiolytics or sedatives, and mood stabilizers. Regression analysis tested resident factors, including cognitive ability, functional ability, presence of depressive symptoms, and demographic characteristics, and three facility factors (nursing home size, type of ownership, and level of registered nurse [RN] staffing) in comparison with PD usage. RESULTS: In this study, 67.3% of the participants received at least one PD. The most frequently prescribed PDs were antidepressants (41.1%) and antipsychotics (37.4%). Newly developed antipsychotics such as risperidone were given more frequently to residents than were conventional drugs such as haloperidol. Regression analysis suggests that the presence of depressive symptoms (odds ratio [OR]= 3.5, p < .01) and low levels of RN staffing (OR = 1.0, p < .01) were associated with the use of PD. DISCUSSION: Psychotropic drugs are prescribed frequently for nursing home residents, although such usage is variable. Behavioral symptoms were not an independent predictive factor for PD use. Rather, combined resident and facility characteristics best predicted the use of PDs in nursing home residents. The evaluation of nursing home systems for these characteristics as predictive factors for PD usage in nursing home patients with dementia is suggested by the results. Likewise, attention to new drugs such as selective serotonin reuptake inhibitors and their appropriate use is recommended.

Expert nurses' use of implicit memory in the care of patients with Alzheimer's disease.

AIM: This paper reports a study exploring expert nurses' use of implicit memory in the care of people with Alzheimer's disease. BACKGROUND: Although research has shown the benefits of preserving and using implicit memory in patients with Alzheimer's disease, the literature shows little evidence of how nurses, in particular expert ones, make use of implicit memory with this client group in clinical practice. METHOD: Semi-structured interviews were carried out with a purposive sample of eight nurses (four from Michigan, United States of America and four from Northern Ireland) in 2004. The interviews focused on specific issues, but were deliberately flexible to allow participants to tell their stories as well. A nine-step data analysis process was developed based on a synthesis of methods used by other researchers. FINDINGS: According to the expert nurses interviewed, the effective and meaningful use of the implicit memory of patients with Alzheimer's disease in achieving positive outcomes depended on 'knowing the patient', 'working within the patient's worldview' and 'using sensitive and patient-centred interactional skills'. They explained how their use of implicit memory (drawing from a range of knowledge sources) was underpinned by reflective practice. CONCLUSION: The findings provide a positive profile of expert nurses' use of implicit memory of patients with Alzheimer's disease; however, their use of theoretical and research knowledge could be improved. There is also a need to test interventions based on the use of implicit memories.

Teaching interdisciplinary geriatrics ambulatory care: a case study.

Interdisciplinary health care training is advocated by numerous government and philanthropic organizations. Educators in the health professions are increasingly offering training in interdisciplinary health care in a variety of contexts, including ambulatory settings. This paper describes a three-year program to teach skills in interdisciplinary care to learners from internal medicine, social work, pharmacy, and nursing in a geriatrics clinic at a major academic institution in the United States. Framed in a critical review of existing evidence for the effectiveness of interdisciplinary training and health care and expert recommendations, specific recommendations are made to educators interested in interdisciplinary training in ambulatory settings.

An ontological view of advanced practice nursing.

Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.

Deriving interventions from the NDB model. Using natural environment and implicit memory theories.

By drawing on theoretical propositions developed outside nursing, and by modifying and synthesizing these with nursing experiential data, useful statements for practice may be developed for further examination. Because practice theory for the care of patients with dementia is not well-developed or well-examined yet, the process described here to develop meaningful interventions for practice should be further explored and evaluated.

The unrecognized paradigm shift in nursing: implications, problems, and possibilities.

An important paradigm (or worldview) shift is occurring in science that affects the nature of nursing education, practice, and research. The shift from positivism to postmodernism and now to neomodernism has received little attention in US nursing and as such may forestall many opportunities related to such change. The nature of this paradigm shift and its effects on selected aspects of nursing education, practice, and research are described, and related implications, problems, and possibilities are explored. Neomodernism is discussed as one future for nursing that encompasses aspects of both positivism and postmodernism but yet goes beyond these to include important metanarratives as traditional values and beliefs of nursing. The work of Laudan and Lakatos are explored as supportive of this neomodernist approach.