Experiences of Older Adults During COVID-19: Loss, Boredom, Uncertainty, Worry, and Resilience.

The coronavirus disease 2019 (COVID-19) pandemic and resulting instructions to stay home and social distance enhanced concerns of the impact of social isolation on the physical and mental well-being of older adults. Eighteen community-dwelling older adults participated in interviews describing their experiences early in the COVID-19 pandemic. Participants experienced loss of activities, routines, and social connection, and feelings of worry and uncertainty. Nevertheless, participants were hopeful about the future and demonstrated resilience in overcoming boredom as they became intentional in finding new activities and using technology to maintain connection with others. Older adults may need support in such situations to manage boredom and uncertainty and avoid social isolation. [Journal of Gerontological Nursing, 49(6), 27-32.].

Home Monitoring to Track Activity and Sleep Patterns Among Older Adults: A Feasibility Study.

Measuring changes in activity and sleep over time is important for research and practice. While commercially available home monitoring systems passively track these parameters, the feasibility, acceptability, and usefulness of new products need to be evaluated. We tested a commercially available system for providing long-term data on activity and sleep with 10 single women (mean age, 86.5 years) who were monitored in their homes. Motion detectors, a bed sensor, door sensor, and chair sensor were installed for 3 months to collect data. Other measures, objective actigraphy data from 1 week and self-report, provided data for comparison. Sleep and activity data were similar across measures; the most active participant had the highest scores on all activity measures including sensor data. Participants were generally positive about the monitoring system, but participants varied in their awareness levels of the presence of the equipment. Use of the sensor system was feasible in this pilot study and acceptable to participants. The study also illustrates challenges researchers can encounter when working with a commercial company.

A methodological review of qualitative longitudinal research in nursing.

Qualitative longitudinal research (QLR) provides temporal understanding of the human response to health, illness, and the life course. However, little guidance is available for conducting QLR in the nursing literature. The purpose of this review is to describe the methodological status of QLR in nursing. With the assistance of a medical librarian, we conducted a thorough search circumscribed to qualitative, longitudinal nursing studies of patients' and care-givers' experiences published between 2006 and 2016. The methodological quality of the 74 reviewed studies varied tremendously; many reports lacked sufficient detail in reporting on sampling and attrition, retention strategies, and data collection and analysis, making it difficult for readers to evaluate the credibility and transferability of study findings. Based on the strengths and limitations of the studies reviewed and findings in the literature, we provide recommendations for enhancing the reporting of the research process as a supplement to the standards for qualitative research more broadly. These recommendations are offered in the spirit of encouraging dialogue among colleagues and assisting journal reviewers and editors in their evaluation of QLR.

The Dementia Friendly Hospital Initiative education program for acute care nurses and staff.

Individuals with Alzheimer's disease and other dementias have 3.2 million hospital stays annually, which is significantly more than older individuals without dementia. Hospitalized patients with dementia are at greater risk of delirium, falls, overwhelming functional decline that may extend the hospital stay, and prolonged or complicated rehabilitation. These risks highlight the need for staff education on the special care needs of this vulnerable population. This article describes a one-day education program, the Dementia Friendly Hospital Initiative, designed to teach staff how to provide the specialized care required by patients with dementia. Participants (N = 355) from five different hospitals, including 221 nurses, completed a pretest-posttest evaluation for the program. Changes in participants attitudes and practices, confidence, and knowledge were evaluated. Scores indicated significant improvement on the posttest. The evaluation provides further evidence for recommending dissemination of the Dementia Friendly Hospital Initiative.

The placebo puzzle: examining the discordant space between biomedical science and illness/healing.

The placebo response presents an enigma to biomedical science: how can 'inert' or 'sham' procedures reduce symptoms and produce physiological changes that are comparable to prescribed treatments? In this study, we examine this puzzle by explicating the discordant space between the prevailing biomedical paradigm, which focuses on a technical understanding of diagnosis and treatment, and a broader understanding of illness and healing as relational and embodied. Although biomedical achievements are impressive, the knowledge resulting from this paradigm is limited by its ontological and epistemological assumptions. When the body and world are objectified, illness meanings, therapeutic relationships, and healing practices are dismissed or distorted. In spite of a robust critique of the tenets of biomedicine for guiding practice, the biomedical paradigm retains a tenacious hold on evidence-based medicine and nursing, downplaying our clinical understanding of the sentient body, patients' life-worlds, and illness and healing. In reality, skilled nurses rely on multiple forms of knowledge in providing high-quality care to particular patients. Clinically wise nurses integrate their experience and knowledge of patients' priorities, fears, and illness trajectories along with biomedical findings to make astute judgments and promote health and healing.

Preserving personhood of individuals with advanced dementia: lessons from family caregivers.

This article reports on a phenomenological study of 15 family caregivers who admitted their spouse or parent with probable Alzheimer's disease to long-term care. The caregivers were attuned to the needs, desires, moods and concerns of their family members with dementia; thus, they were attuned to personhood. Caregivers also reported observations of care by nurses and nursing staff. Observations were of individualized care and actions that promoted personhood and impoverished care delivered with minimal or no communication. These family caregivers' perspectives can inform the care of individuals with advanced dementia by nurses and nursing staff.

Development of an online orientation course for preceptors in a dedicated education unit program.

The dedicated education unit (DEU) is an emerging model of nursing education. Instead of an instructor-led clinical group, students are partnered with a unit staff nurse for precepted learning. These experiences in learning typically begin with early clinical courses. Precepting nursing students in a DEU is different from precepting newly hired staff nurses and traditional clinical students. This article describes the DEU model implemented at one university, the challenges associated with preparing staff nurses to precept nursing students, the development of a face-to-face DEU preceptor orientation, and progression to an innovative online orientation course.

Listening to and learning from older adult Hurricane Katrina survivors.

OBJECTIVE: The objective of this pilot study was to explore how Hurricane Katrina affected older adult disaster survivors. DESIGN AND SAMPLE: Participants for this descriptive exploratory pilot study were recruited from churches and senior centers on the Gulf Coast of Mississippi. Of the 224 participants, one hundred provided additional comments at the end of a forced-response questionnaire. MEASURES: Manifest content analysis was used to examine the participants' comments by identifying, coding, and categorizing their responses to the open-ended question. The codes were based on conditions and behaviors that might be exhibited by disaster victims. RESULTS: Themed categories were losses and needs, giving advice, justification for continuing to live in this disaster-prone region, deterrents and facilitators of home evacuation, spirituality and faith, manageability, bereavement, grief, anger, and natural debriefing. CONCLUSION: The strongest message of these survivors was the need to be heard by public health nurses, other public health officials preparing for disasters, and those in positions to render aid.

Caregivers' desired patterns of communication with nursing home staff- just TALKKK!

Individuals with cognitive impairment often represent a significant percentage of the residents in a nursing home nurse's care. With years of experience caring for their placed family members, caregivers of these residents are often experts in knowing the resident's needs, habits, behaviors, and moods. Caregivers often wish to convey this insider knowledge to nursing home staff. Furthermore, communication with caregivers promotes trust that personalized, safe, and effective care occurs when they are not there. Based on an interpretive study of the experiences of caregivers who place a family member with Alzheimer's disease in the nursing home, six preferred patterns of communication are presented in this article. The six patterns are represented by the acronym TALKKK (tell them; ask them; listen to them; know their family member by relating and communicating; be knowledgeable about dementia, its progression, dementia-specific care, and commonly used medications; and share that knowledge with them).

Unified Parkinson's Disease Rating Scale-Motor Exam: inter-rater reliability of advanced practice nurse and neurologist assessments.

AIM: This paper is a report of a study to establish the inter-rater reliability of advanced practice nurse and neurologist neurological assessments which included ratings with the Unified Parkinson's Disease Rating Scale-Motor Exam. BACKGROUND: Around the world, advanced practice nurses are performing tasks once completed only by physicians. To promote consumer and provider confidence, it is important to establish that nurse and physician ratings using assessment tools are similar. In addition in research settings, when different raters are used, establishment of inter-rater reliability for study assessments is needed. METHOD: Advanced practice nurses and neurologists independently recorded findings on neurological examinations of 46 participants in a study conducted between August 2007 and January 2008. An intraclass correlation coefficient was calculated to estimate overall agreement between the nurse and neurologist ratings. Agreement for individual items measured on a dichotomous scale was assessed by calculating Cohen's kappa. RESULTS: There was substantial agreement between advanced practice nurses and neurologists on the mean Unified Parkinson's Disease Rating Scale-Motor Exam ratings (intraclass correlation coefficient = 0.65) and the U.S. National Alzheimer's Coordinating Center Uniform Data Set neurological examination ratings of unremarkable findings (kappa = 0.74) and of gait disorder (kappa = 0.73). Moderate agreement (kappa = 0.53) was reached for the rating of whether all Unified Parkinson's Disease Rating Scale-Motor Exam items were normal. CONCLUSION: These findings are consistent with studies of the inter-rater agreement of the Unified Parkinson's Disease Rating Scale-Motor Exam and support the conduct of neurological assessments by advanced practice nurses.

A guide to web-based resources on care of older adults for nursing educators, students, and clinicians.

Numerous web-based resources are available to improve the knowledge of undergraduate students in assessing and providing care to older adults. These resources can be helpful to nurse educators regardless of the learning environment and to students and nurses who are working with older adults. This article describes some of the widely available online resources for teaching geriatric content to students and how to use them. The purpose of this article is to promote use of websites as teaching tools for nurse educators and as a resource to students and nurse clinicians.

Client-centred home modifications improve daily activity performance of older adults.

BACKGROUND: Remaining at home is a high priority for many older adults, but the capacity to "age in place" often is threatened by environmental barriers. PURPOSE: To describe a client-centred occupational therapy home modification intervention program and examine the impact of the intervention on daily activity performance over time. METHODS: Using a competence-environmental press framework, a client-centred home modification program for older adults was implemented. In this quasiexperimental, single group prospective study, participants'subjective ratings of daily activity performance were evaluated before and after the intervention (baseline/post/post). FINDINGS: After home modification, participants'perception of their daily activity performance at home improved significantly and was maintained 2 years post-modification. IMPLICATIONS: Home modification may benefit older adults attempting to age in place.

Preventing aspiration in older adults with dysphagia.

Dysphagia, the impairment of any part of the swallowing process, increases the risk of aspiration. Dysphagia and aspiration are associated with the development of aspiration pneumonia. While some changes in swallowing may be a natural result of aging, dysphagia is especially prevalent among older adults with neurologic impairment or dementia, leading to an increased risk of aspiration and aspiration pneumonia. This article discusses best practices for assessment and prevention of aspiration among older adults who are being hand-fed or fed by tube. To view an accompanying online video, go to http://links.lww.com/A226.

Crossing the "line": College students and academic integrity in nursing.

BACKGROUND: Researchers have shown a relationship between academic integrity in the classroom and acts of dishonest behavior in the clinical setting which is concerning for nursing faculty and the health care field. OBJECTIVES: The purpose of this study was to compare the attitudes toward academic integrity and the frequency of behaviors related to academic dishonesty in nursing and non-nursing students at a religiously affiliated institution. DESIGN: A cross-sectional, descriptive design was used to collect data regarding the knowledge, behavior, perceptions, and attitudes related to academic integrity via an online survey. SETTINGS AND PARTICIPANTS: Nursing students and non-nursing students who attended a religiously affiliated (Jesuit) University in the United States were surveyed for this study. RESULTS: Results of the study suggest upper division and second degree nursing students are less tolerant and more condemnatory of cheating than younger students. Frequent dishonest classroom behaviors include asking and telling other students what was on the exam while the most frequent dishonest clinical behaviors included documenting findings that were not assessed or findings that were false. CONCLUSION: Recommendations for nursing faculty include frequent and timely discussion of expected behaviors and values of nurses in order to support students' development of honesty and integrity beyond the classroom and into the clinical setting.

Nursing Examinations: Promotion of Integrity and Prevention of Cheating.

Academic integrity is a concern in higher education. The authors describe the findings of a nursing faculty task force developed with the goal of reducing incidents of cheating on classroom examinations in a school of nursing. Following a review of the literature, a modified Delphi technique was used to prioritize the suggested strategies into recommendations for faculty to follow. The findings and recommendations from the task force are presented and serve as a guide for nursing faculty in implementing measures to promote academic integrity during classroom examinations.

Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders.

PURPOSE: Although driving by persons with Alzheimer's disease (AD) is an important public health concern, we know little about the attitudes and perceptions of key stakeholders regarding driving safety in these individuals or the factors that precipitate and influence driving assessment and cessation decisions. DESIGN AND METHODS: We convened 10 focus groups composed of persons intimately involved in driving decisions for older adults to identify and compare beliefs and perceptions concerning AD and driving and to identify effective strategies to limit or cease unsafe driving. The 68 focus-group participants included health professionals, transportation and law-enforcement professionals, current and former drivers with AD, and family caregivers of current and former drivers with the disease. RESULTS: With few exceptions, participants said that a diagnosis of very mild AD alone did not preclude driving. Most regarded family members as pivotal in monitoring and managing unsafe driving and recognized their need for institutional and medical support, especially support from physicians in counseling and evaluation of health-related fitness of older drivers. Members of each group acknowledged their own roles and responsibilities in driving decisions and described difficulties they experienced in making assessments and implementing decisions to limit or stop the driving of given individuals with AD. IMPLICATIONS: Education of families, professionals, and transportation specialists is needed to understand the influence of AD severity on driving abilities, identify problem driving behaviors, make appropriate referrals of unsafe drivers, and access available resources for drivers with AD and those most responsible for their safety.

An academic-service partnership to promote and support RNs' return to school.

This article describes an academic-service partnership that promotes the educational progression of RNs in response to the Institute of Medicine's recommendation that 80% of RNs hold a baccalaureate degree or higher by 2020. Using the logic model as a framework, this article describes a sustainable, replicable, and mutually beneficial partnership that supports the national movement toward baccalaureate education for RNs.

A model of risk reduction for older adults vulnerable to nursing home placement.

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.