The role of nurse prescribers in memory services and their continuing professional development: A review of the literature.

BACKGROUND: Nurse prescribers (NPs) in memory services have a potentially important role in alleviating the burden of dementia on health care, but they require continuing professional development (CPD) specific to their scope of practice. AIMS: To inform development of CPD workshops for mental health NPs working in memory services, a review of the literature was undertaken regarding role and CPD issues of this professional group. DESIGN AND METHODS: Healthcare databases were searched using defined search terms alongside lateral searches. Study characteristics were extracted systematically, with results grouped thematically in the style of a narrative review. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, adapted for current methods (see Supporting Information File S1). RESULTS AND DISCUSSION: Nine articles specifically addressing nurse prescribing in memory services were found. Studies from broader areas were drawn upon. Considerable variation was found for how the role of memory service NPs might be defined, due in part to variation in characteristics of memory services. NPs, other clinical staff and patients have provided positive feedback to the introduction of the role in memory services and elsewhere. However, concerns around prescribing cautiousness of NPs were apparent. Little clinical or economic outcome data were found to compare opinions and experiences to, with none for NPs in memory services. Literature addressing CPD issues for NPs in memory services was nonexistent. Studies from surrounding areas suggest a problem with availability of CPD opportunities for nurse prescribers. CONCLUSION: This review highlights the paucity of literature for this area of inquiry, particularly for clinical, economic and other patient outcome data. RELEVANCE TO CLINICAL PRACTICE: Variation in the little existing evidence suggests development of CPD opportunities should spend time understanding issues at the local level. The gap in the literature in this area may impact policy decisions in the UK and elsewhere.

Developing the advanced nurse practitioner role in a memory service.

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.

Developing the advanced nurse practitioner role in a memory service.

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.

Psychometric Properties of the Problem Solving Inventory in Caregivers of Individuals With Memory Loss.

Limited research exists assessing problem-solving capabilities among caregivers of individuals with memory loss using a validated instrument. To address this gap, the current study evaluated the psychometric properties of the Problem Solving Inventory (PSI) using data at baseline and 8 weeks from a randomized controlled trial among caregivers (N = 78) of community-dwelling individuals with memory loss. Participants were mainly White (85.9%), female (71.8%), and on average age 66.5. Cronbach's alphas ranged from 0.84 to 0.92 for the subscales and overall PSI. Test-retest reliability over 8 weeks ranged from 0.44 to 0.56. Five factors were retained through exploratory factor analysis. Spearman's correlations showed convergent validity and discriminant validity between scores on the PSI and Beck Depression Inventory®-II (r = 0.32, p < 0.01), the Self-Efficacy for Managing Chronic Disease Scale (r = -0.44, p < 0.001), and the Newest Vital Sign questionnaire (r = -0.07, p > 0.05). Findings show that the PSI is reliable and valid in assessing problem-solving capabilities among caregivers of individuals with memory loss. [Journal of Gerontological Nursing, 44(6), 25-32.].

Short-term exposure to enriched environment rescues chronic stress-induced impaired hippocampal synaptic plasticity, anxiety, and memory deficits.

Exposure to prolonged stress results in structural and functional alterations in the hippocampus including reduced long-term potentiation (LTP), neurogenesis, spatial learning and working memory impairments, and enhanced anxiety-like behavior. On the other hand, enriched environment (EE) has beneficial effects on hippocampal structure and function, such as improved memory, increased hippocampal neurogenesis, and progressive synaptic plasticity. It is unclear whether exposure to short-term EE for 10 days can overcome restraint stress-induced cognitive deficits and impaired hippocampal plasticity. Consequently, the present study explored the beneficial effects of short-term EE on chronic stress-induced impaired LTP, working memory, and anxiety-like behavior. Male Wistar rats were subjected to chronic restraint stress (6 hr/day) over a period of 21 days, and then they were exposed to EE (6 hr/day) for 10 days. Restraint stress reduced hippocampal CA1-LTP, increased anxiety-like symptoms in elevated plus maze, and impaired working memory in T-maze task. Remarkably, EE facilitated hippocampal LTP, improved working memory performance, and completely overcame the effect of chronic stress on anxiety behavior. In conclusion, exposure to EE can bring out positive effects on synaptic plasticity in the hippocampus and thereby elicit its beneficial effects on cognitive functions. © 2016 Wiley Periodicals, Inc.

[The nursing consultation in a CMRR]. / La consultation infirmière en CMRR.

Resource and research memory centres (CMRRs) cater for patients with a cognitive disorder, usually with memory loss. Their aim is to establish if there is an underlying neurodegenerative pathology, Alzheimer's disease or related syndrome.

Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles.

BACKGROUND: Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed. METHODS: Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011-2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively. RESULTS: One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia. CONCLUSIONS: An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.

Manifestation of respect in the care of older patients in long-term care settings.

BACKGROUND: Respect is fundamental to ethical nursing practice. However, respect in the care of older people is seldom investigated from the perspective of patients and their next of kin. AIM: To describe the manifestation of respect in the care of older patients in long-term care settings from the perspective of older patients with memory disorders and their next of kin. DESIGN AND METHODS: A narrative inquiry on research methodology using open interviews was employed. Transcribed interviews were analysed using inductive content analysis, and from this analysis a typology was produced. SETTINGS: The study settings were patients' own homes supported by professional home care, and nursing homes in three cities in southern Finland. PARTICIPANTS: A purposeful sample (N = 40) of participants (older patient, n = 20 and their next of kin, n = 20) was recruited. Half of the older patient lived at home where they received professional care and the other half lived in nursing homes. RESULTS: Respect in long-term care settings is manifested in patient care through the being and doing of the nurse. A typology of nurses' being and doing described three ways nurses manifested respect: 'I'm here for you', 'I'm here for work' and 'I'm not here for you'. Patient's responses to the typology were as follows: sharing, exploring and withdrawing, respectively. CONCLUSIONS: The analysis and typology of nurses' being and doing increases the understanding of respect in patient care in long-term care settings. Furthermore, this knowledge of respect will make it possible to develop measureable respect indices for use in the evaluation of care.

Memory performance and affect: are there gender differences in community-residing older adults?

After age 65, the incidence of episodic memory decline in males is greater than in females. We explored the influence of anxiety and depression on objective and subjective memory performance in a diverse sample of community-residing older adults. The study was a secondary analysis of data on three samples of adults from two states, Ohio and Texas: a community sample (n = 177); a retirement community sample (n = 97); and the SeniorWISE Study (n = 265). The sample of 529 adults was 74% female, the average age was 76.58 years (range = 59-100 years), and educational attainment was 13.12 years (±3.68); 68% were Caucasian, and 17% had depressive symptoms. We found no memory performance differences by gender. Males and females were similarly classified into the four memory performance groups, with almost half of each gender in the poor memory category. Even though males had greater years of education, they used fewer compensatory memory strategies. The observed gender differences in memory were subjective evaluations, specifically metamemory. Age was not a significant predictor of cognition or memory performance, nor did males have greater memory impairment than females.

Memory loss following coronary artery bypass graft surgery: a discussion of the implications for nursing.

AIM: The aim of this discursive paper is to present nursing interventions that address memory loss following heart surgery and that can be incorporated into patients' overall plan of care. BACKGROUND: Coronary artery bypass graft (CABG) is the most frequent surgical treatment for cardiovascular disease. Despite the advantages, reports indicate CABG procedures significantly increase the risk of cerebral impairment and/or injury, which can present itself in the form of memory loss. Older individuals tend to be at higher risk for memory loss than other age groups. Age combined with the effects of the surgical procedure increases the likelihood that individuals over the age of 65 years will experience some form of memory loss following surgery. In this paper, the author presents a discussion of the relevance and implications of memory loss to clinical nursing practice with particular attention to strategies nurses should use when caring for patients experiencing this symptom. RELEVANCE TO CLINICAL PRACTICE: Memory loss is a common symptom present in at least 25% of all patients following CABG. Screening for memory loss following CABG using reliable and valid instruments, revisions to current patient education initiatives to include calling patients following hospital discharge to review education and delivering education over multiple sessions, creating supportive reality-oriented relationships, and engaging in memory oriented training are suggested as nursing strategies that should be incorporated into existing nursing care for patients following CABG. CONCLUSION: Currently, nursing practice does not routinely incorporate assessment and management of memory loss into the overall plan of care for patients following heart surgery. Specific nursing strategies that centre on the assessment and management of memory loss need to be implemented into the standard of nursing practice.

Electronic reminding technology for cognitive impairment.

Demographic changes highlight the need to address disabilities associated with the costly morbidities of old age, such as dementia. Memory impairment associated with dementia represents a significant challenge for many older people. Difficulties occur in carrying out activities in their entirety or in commencing them at all. Technology has the potential to help individuals overcome the barriers created by cognitive disability in terms of performing activities of daily living and therefore help to maintain independence and enhance quality of life (Czaja, 2005). This literature review examines the current reported research, which employs electronic reminding technology to support individuals with cognitive impairment. These devices range from everyday technologies, such as phones, to sophisticated interactive devices with specifically designed software. A summary of the current evidence base is presented and recommendations for future practice are made.

Memory matters in assisted living.

Memory loss often signifies loss of independence, which is a growing concern for residents in assisted living (AL) facilities. The purpose of this exploratory study was to characterize the memory experiences and concerns of AL residents. Six residents voluntarily participated in 1-hour recorded interviews focusing on memory and guided by eight open-ended questions. Interviews were transcribed and analyzed using qualitative content analysis. Subjects reported varying degrees of memory loss they found frightening and frustrating, but also accepted the loss as a natural part of the aging process. Concerns focused primarily on inability to recall staff and resident names and activities, schedules, and appointments. Understanding memory experiences and concerns is important for nursing staff members who care for AL residents. Memory challenges identified by these residents were used to develop a memory intervention for older adults residents of this and other AL facilities. Improving cognitive skills may help AL residents maintain their functional abilities, enabling them to "age in place" in AL.

Targeting memory improvement in assisted living: a pilot study.

This pilot study tested an intervention designed to improve memory for assisted-living (AL) residents. Seven residents in one Midwestern AL facility participated in a six-session memory program based on qualitative research that identified typical memory challenges of residents (e.g., remembering names, schedules, and appointments). Scores on memory self-efficacy (the Memory Complaint in Age-Associated Impairment) and performance (Rivermead Behavioral Memory Test) measures were compared before and after the intervention. Self-efficacy improved significantly after the program (z = 2.37, p = .018) for remembering names, phone numbers, lists of items, and facts. Increases in actual memory performance were not statistically significant. However, three out of seven participants (43%) improved in recalling first and last names. Ongoing testing on larger samples with a control group design is needed to verify effects and determine any effects on daily functioning. This study suggests that cognitive interventions targeting frail elder populations are feasible to provide to older adults in AL.

[An advanced practice nurse in a memory clinic]. / Une infirmière en pratique avancée en consultation mémoire.

Le Mans general hospital has created an advanced practice nurse position in memory clinics in geriatrics. The activity began in September 2019. During the first year, 189 consultations with the nurse were carried out, despite the difficult health context. Most of the activity has focused on consultations. However, the nurse's other skills have also been deployed. An analysis of the activity enables the areas to improve to be identified in order to continue creating advanced practice nursing positions within the hospital and across the country.

Anticholinergic medications: use among older adults with memory problems.

The purpose of this study was to determine the frequency with which over-the-counter and prescription medications with potential anticholinergic side effects were used by a sample of 193 older adults with memory problems. Medications with anticholinergic side effects are contraindicated in this population because they can worsen memory impairment and increase confusion. A retrospective chart review of clients seen between October 1999 and April 2004 was completed, with a secondary analysis of the medications older adults (older than 50 years) were taking at their initial clinic visit. Findings revealed that 10.3% of these older adults were consuming one or more medications with anticholinergic side effects. These findings demonstrate an ongoing opportunity for nurses to educate health care providers, as well as consumers, regarding the dangers of these medications.

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.