"Tipping point" concept analysis in the family caregiving context.

AIM: Analyze the concept "tipping point" in the older adult family caregiving context to further knowledge about caregiving families, enhancing transdisciplinary theory, research, and practice. BACKGROUND: While used commonly in some disciplines, how "tipping point" has been used in health care, generally, and in relation to caregiving families, specifically, is less clear. This project was conducted to offer conceptual clarity to tipping point. DESIGN: Walker and Avant's framework. DATA SOURCE: Searches of scholarly literature in PsycINFO, CINAHL, and PubMed using the search term "tipping point" in either title or abstract. REVIEW METHODS: Definitions used were extracted; instances when the concept was implied but the actual term "tipping point" was not used and contexts where the term was used or implied were identified. RESULTS: The composite definition of a caregiving tipping point is a seemingly abrupt, severe, and absolute change event involving either the older adult or caregiver(s), or both that indicates a breakdown in the status quo of the caregiving system. CONCLUSIONS: Transdisciplinary research, care, and policy should treat caregiving families as complex systems, use longitudinal assessments, and include colloquial communication. Early detection of impending tipping points will provide family-centered decisional support and enhance families' quality of life and safety.

Family Caregivers' Experiences of Within-Hospital Handoffs for Older Adults in Acute Care.

Family caregivers' experiences during within-hospital handoffs between acute care units are not well understood. Qualitative description methodology was employed to describe family caregivers' experiences during their loved ones' handoffs. Semistructured interviews were conducted with 10 caregivers of hospitalized older adults. Three themes emerged: Lack of care coordination, Muddling through handoffs alone, and Wariness toward the care delivery system. Findings can help clinicians shape their interactions with caregivers to maximize their involvement in post-hospital care.

Polypharmacy and symptom management in older adults.

The following is an excerpt from Chapter 1 of the 2010 Oncology Nursing Society book, A Guide to Oncology Symptom Management (pp. 1-14), edited by Carlton Brown, RN, PhD, AOCN®.

Use of iPod™ technology in medical-surgical nursing courses: effect on grades.

Advances in computer technology, such as the portable and affordable iPod™, allow students to view lectures anywhere at any time. iPods™ are of special interest for nurse educators who strive to meet demands posed by a critical nursing shortage. A mixed-methods pilot study was conducted to assess whether iPod™ could be an effective teaching tool for medical-surgical nursing lectures. In a randomized study with 35 participants, together with eight students having their own iPods™, grades of students given pre-recorded class lectures on iPods™ were compared with grades of those who attended lectures without iPods™. Learning styles, amount and use of students devoted to iPod™ lectures were considered as well as grades. Most results were not significant, but there was some evidence that the control groups who attended classroom lectures received better grades than iPod™ users, and individuals who used iPod™ more frequently before the final exam received lower grades. These somewhat surprising results suggest the need for further research in the use of this technology as a resource for nursing education delivery.

Clinical assessment of symptom clusters.

OBJECTIVES: To review the principles of symptom cluster assessment, choosing appropriate symptom measures, and methods to identify symptom clusters. DATA SOURCES: Review articles, research articles, and specialty texts. CONCLUSION: Identification of symptom clusters is clinically challenging and includes the use of reliable symptom assessment tools and clinical judgment. Evidence to guide assessment of symptom clusters is based on limited clinical research and expert practice. Additional research is needed to guide the accurate assessment of symptom clusters and the patient's symptom experience. IMPLICATIONS FOR NURSING PRACTICE: Comprehensive assessment of symptom clusters in individuals with cancer will lead to tailored, comprehensive symptom management strategies that may have a profound impact on cancer-related quality of life.

Symptom correlates in the gero-oncology population.

OBJECTIVES: To review recently published studies that describe the presence of selected cancer-related symptoms and relationships between them in the gero-oncology population. DATA SOURCES: Research studies, review articles, and government documents. CONCLUSION: Cancer-related symptoms have been studied for over two decades, yet little is known about the functional effects of age on the disease experience. IMPLICATIONS FOR NURSING PRACTICE: Nurses are encouraged to consider symptoms related to other chronic illnesses that contribute to an older person's daily living when planning oncology nursing care.