Group Reminiscence Programs for Older Adults Without Cognitive Impairment: A Scoping Review.

Reminiscence interventions have been tested with people with and without cognitive impairment. However, the literature on reminiscence interventions for the latter is less extensive. The purpose of the current scoping review was to list and describe group session reminiscence protocols used with older adults without cognitive impairment and not involving psychotherapy. Arksey and O'Malley's five stages scoping framework was used for this review. Seven databases were searched, and nine articles were included. Results show the heterogeneity of reminiscence programs available for older adults without cognitive impairment and highlight that key elements for replication are often lacking. Well-defined reminiscence programs should be selected for replication and evaluation studies. However, few well-defined reminiscence programs not involving psychotherapy are available for older adults without cognitive impairment. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 15-21.].

Family members' experiences and management of resident-to-resident abuse in long-term residential care.

OBJECTIVES: Resident-to-resident (RRA) abuse is increasingly recognized as a significant problem in long-term residential care.Families have a constant presence in this setting, yet their inclusion in research about RRA is minimal. The purpose of this study was to examine family members' experiences and management of RRA. METHODS: The methodology was critical ethnography.Twelve family members participated in in-depth interviews and 56 hours of participant observation were conducted. Data were analyzed thematically. RESULTS: The main themes illuminate families' experiences of RRA in a context that largely normalizes it.In the absence of formal supports, families developed a range of management strategies, ranging from passive to active intervention.Organizational factors, such as staffing levels and mix, and the physical environment also contributed to RRA. DISCUSSION: Families are actively managing RRA in long-term residential care. Policies and programs, including educational supports, should be developed to validate and support families.

[The best cuff for measuring arterial pressure]. / Le bon brassard pour mesurer la pression artérielle.

Hypertension prevention, detection, follow-up and medication adjustment depend on valid blood pressure measurement. Many factors should be taken into consideration to get accurate blood pressure readings: the blood pressure measurement method, the equipment used and the patient preparation. This column will focus on the importance of the cuff for blood pressure measurement.

Blood Pressure Measurement in Severely Obese Patients: Validation of the Forearm Approach in Different Arm Positions.

BACKGROUND: Blood pressure measurement in severe obesity may be technically challenging as the cuff of the device may not fit adequately around the upper arm. The aim of the study was to assess the agreement between intra-arterial blood pressure values (gold standard) compared with forearm blood pressure measurements in severely obese patients in different arm positions. METHODS: Thirty-three severely obese patients and 21 controls participated in the study. Pairs of intra-arterial blood pressures were compared with simultaneous forearm blood pressure measurement using an oscillometric device in 4 positions: (i) supine, (ii) semi-fowler with the forearm resting at heart level, (iii) semi-fowler with the arm downward, and (iv) semi-fowler with the arm raised overhead. Degree of agreement between measurements was assessed. RESULTS: Overall, correlations of systolic and diastolic blood pressure measurements between the gold standard and forearm blood pressure were 0.95 (n = 722; P < 0.001) and 0.89 (n = 482; P < 0.001), respectively. Systolic blood pressure measured using the forearm approach in the supine and the semi-fowler positions with arm downward showed the best agreement when compared with the gold standard (-4 ± 11 (P < 0.001) and 2 ± 14 mm Hg (P = 0.19), respectively). In the control group, better agreement was found between the supine and semi-fowler positions with the arm resting at heart level (1 ± 9 mm Hg (P = 0.29) and -3 ± 10 mm Hg (P = 0.01), respectively). CONCLUSIONS: Forearm systolic blood pressure consistently agreed with the gold standard in the supine position. This method can be of use in clinical settings when upper-arm measurement is challenging in severe obesity.

Workplace continuing education for nurses caring for hospitalised older people.

AIMS AND OBJECTIVES: To develop, implement and evaluate a workplace continuing education programme about nursing care of hospitalised older people. BACKGROUND: The healthcare system cannot rely solely upon nurses' prelicensure education to prepare them to meet the evolving needs of hospitalised older patients. Over the past decade, there has been a dramatic rise in the proportion of older people in hospitals, yet many nurses do not have specialised knowledge about the unique care needs of this population. DESIGN: A multimethod pre-to post-design was employed. METHODS: Between September 2013 and April 2014, data were collected via surveys, focus groups and interviews. Thirty-two Registered Nurses initially enrolled in the programme of which 22 completed all data points. Three managers also participated in interviews. One-way repeated-measures ANOVAs were conducted to evaluate the effect of the programme and change over time. Qualitative data were analysed using thematic analysis. RESULTS: Survey results indicated improvements in perceptions about nursing care of older people but no changes in knowledge. Themes generated from the qualitative data focused on participants' experiences of taking part in the programme and included: (i) relevance of content and delivery mode, (ii) value of participating in the programme and (iii) continuing education in the context of acute care. CONCLUSIONS: This study illustrated the potential role of workplace continuing education in improving care for hospitalised older people, particularly the potential to change nurses' perceptions about this population. Nurses prefer learning opportunities that are varied in delivery of educational elder-focused content and accessible at work. Organisational leaders need to consider strategies that minimise potential barriers to workplace continuing education. IMPLICATIONS FOR PRACTICE: Workplace continuing education can play a key role in improving quality of care for hospitalized older adults and ought to be a priority for employers planning education for nurses.

Factors influencing nurses' readiness to care for hospitalised older people.

AIMS AND OBJECTIVES: To gain a better understanding of nurses' perspectives on factors that influence their readiness to provide appropriate care for hospitalised older people. BACKGROUND: Hospitals have consistently been criticised for failing to address the unique, complex needs of older people. Research suggests that multiple issues have led to this situation, including a lack of educational preparation for nurses, limited attention to environmental factors, and an absence of organisational preparedness that ensures hospitals are adapted to meet the needs of older people. DESIGN: An exploratory, qualitative approach was used. METHODS: Forty-one Registered Nurses participated (24 point-of-care nurses; 17 organisational leaders). Six focus groups and one individual interview were conducted. Thematic data analysis was employed to generate the main study findings. RESULTS: An overarching theme of 'Poor Fit' emerged. While participants identified the shifting needs of patients towards more complex and relational care, the broader organisational and societal contexts were, largely, unchanging. This resulted in nurses recognising the factors needed to be ready to care for older patients and their families, but working in hospitals that were not suited to these needs. CONCLUSIONS: The findings identify factors at the point-of-care, the organisational level, and in broader societal attitudes that shape nurses' readiness to care for hospitalised older people. However, many of these factors are modifiable and care for older people could be improved through quality improvement initiatives and nursing leadership. This study offers insight into ways to re-imagine nursing care that can be responsive to older people's complex needs in hospitals. IMPLICATIONS FOR PRACTICE: With a growing contingent of hospitalised older people, it is imperative that nurses, who comprise the largest workforce in this setting, be included in the planning and delivery of healthcare services to ensure readiness to meet the needs of this population.

Sensitivity, specificity, and predictive values of a forearm blood pressure measurement method in severe obesity.

For blood pressure assessment, it has been reported that forearm blood pressure measurement appears to be as valid as an upper-arm blood pressure measurement method in individuals with severe obesity when correlated to the intra-arterial method, considered as the gold standard. Sensitivity, specificity, and predictive values for the presence of systemic hypertension in 25 severely obese patients from 352 blood pressure measurements were calculated. The sensitivity (0.98) and the positive predictive value (0.93) for hypertension on forearm blood pressure measurements are excellent, indicating that the forearm approach is a promising alternative to systemic hypertension diagnosis in severe obesity.

If not dieting, how to lose weight? Tips and tricks for a better global and cardiovascular health.

Weight loss is a popular topic and may be of serious concern for many patients. Even with the abundant literature on obesity and cardiometabolic risk, it is always challenging to demystify and reinforce the determinants of safe approaches to lose weight. Measures of central obesity are essential to characterize the patient's adiposity distribution and should be part of the routine medical examination. Beyond this, screening for fasting lipids and glucose are important for the assessment of the cardiometabolic risk which may lead to increased cardiovascular morbidity and mortality. Differences in adiposity as well as in weight loss exist between sexes and should be taken into consideration. Rather than avoiding some food or following certain type of diet, any planned weight loss interventions should promote lifestyle and environmental modifications with healthy eating and appropriate physical activity. With clear objectives, this appears to be the best way in order to achieve weight loss goals permanently.

Blood pressure assessment in severe obesity: validation of a forearm approach.

OBJECTIVE: Obesity is frequently associated with systemic hypertension. Blood pressure measure is inaccurate in severely obese patients because of poor cuff size fitting. The aim of the study is to assess the degree of agreement between the intra-arterial method as the gold standard vs. noninvasive methods, i.e., forearm blood pressure and upper-arm blood pressure measures. DESIGN AND METHODS: A total of 1285 measures of intra-arterial and forearm blood pressure were taken in 51 severely obese patients in a supine position in the operating and the recovery room. A subset of 352 upper-arm measures were taken in the recovery room and compared to the intra-arterial and the forearm methods. RESULTS: Correlation between the intra-arterial and the forearm measures was 0.90 (P < 0.001) for the 2570 data (systolic and diastolic). Compared to intra-arterial, the forearm method overestimated systolic (6 ± 16 mm Hg, P < 0.001) and underestimated diastolic blood pressure (2 ± 11 mm Hg, P = 0.03). Compared to intra-arterial, upper-arm underestimated systolic (8 ± 16 mm Hg, P < 0.01) and overestimated diastolic blood pressure (9 ± 7 mm Hg, P < 0.001). CONCLUSION: The magnitude of differences between the intra-arterial and forearm method was less than differences between the intra-arterial and upper-arm method. Our results suggest that forearm method may be a more accurate alternative to upper-arm measurement to assess blood pressure in severely obese patients.

Adiposity assessment: explaining the association between obesity, hypertension and stroke.

Obesity is associated with a greater prevalence of cardiovascular risk factors and a higher risk of cardiovascular events, and contributes to the rise in cardiovascular morbidity and mortality worldwide. Increased BMI is established as an independent risk factor for cardiovascular disease (CVD). Attention has recently been drawn to alternate measures of adiposity/obesity, such as waist circumference, waist-to-hip ratio and waist-to-height ratio, that provide information regarding body fat distribution. Although BMI is the established clinical measurement to estimate CVD risk associated with excess bodyweight, there is evidence suggesting that abdominal obesity could represent a better marker of CVD risk than BMI. It is now recognized that abdominally obese individuals tend to have higher blood pressure. A major cardiovascular risk factor associated with stroke is systemic hypertension followed closely by obesity. Clinical adiposity indices used to describe obesity linked with systemic hypertension and stroke incidence are reviewed in this article. In summary, BMI, waist circumference, waist-to-hip ratio and waist-to-height ratio measurements are all useful tools for assessing adiposity/obesity in clinical practice, and should be evaluated with other cardiometabolic risk factors to refine cardiovascular risk stratification.

Knowledge and practice outcomes after home blood pressure measurement education programs.

OBJECTIVES: We investigated the outcomes of three home blood pressure measurement (HBPM) education programs on adult knowledge and practice. METHODS: We chose a pretest/post-test design and randomly divided 95 adults into three groups: individual training (group A), group training (group B), and self-learning (group C), for education regarding HBPM in accordance with the Canadian Hypertension Education Program. Participants involved in groups A and B received interactive education led by a nurse. Participants in group C learned by themselves using an instruction booklet and a HBPM device lent to them for 7 days. Knowledge was assessed pretest and post-test by questionnaire. Skills were evaluated postintervention by direct observation. RESULTS: Analysis of the 60 participants indicated significant knowledge improvement. Pretest scores of 38 (group A), 54 (group B), and 45% (group C) rose significantly to 97, 99, and 90%, respectively (pretest vs. post-test; P<0.0001). Individual and group training sessions were significantly more effective compared with the self-learning program, which was confirmed by differences between groups in post-test practice. Assessment scores: 74 (group A), 79 (group B), and 53% (group C; group A vs. group C; P=0.001, group B vs. group C; P=0.001). CONCLUSION: Our findings indicate that adults attending an individual or group training program for HBPM retained its theoretical and practical principles better than those engaged in self-learning. Their success may be attributed to interaction with the nurse.

[Conditions linked to the integration of the ecologic approach to the programming of prevention-promotion offered to elderly clients by the CSSS of Quebec: a case study]. / Les conditions liées à l'intégration de l'approche écologique dans la programmation de prévention-promotion offerte à la clientèle aînée par les CSSS du Québec: une étude de cas.

This multiple case study investigates conditions influencing the integration of the ecological approach in disease prevention and health promotion (DPHP) programs offered to older adults by local health organizations in Quebec. Scheirer's (1981) implementation model guided the study of five Centres de Santé et Services Sociaux chosen in line with the ecological dimension of their DPHP programs. Documentary analyses were conducted along with thirty-eight semi-structured interviews among professionals and managers. Three categories of factors were explored: professional, organizational and environmental factors. Results indicate the ecological dimension of programs is influenced by organizational norms, competing priorities, team structure, external partnerships, preconceived ideas regarding DPHP for older adults, along with professional interest and training. These results provide levers for action toward optimizing services offered to the older population through disease prevention and health promotion programs.