Living with constipation and communication taboos surrounding constipation among older adults: An interpretive phenomenology analysis study.

Chronic constipation is a prevalent problem that significantly impacts older adults' well-being. This study aimed to explore how older adults describe constipation symptoms and impacts and understand the perceived taboo surrounding discussions on related issues. Twenty older adults with constipation were interviewed using a semi-structured format in Taiwan. The Interpretive Phenomenology Analysis approach was utilized for data analysis. Five techniques recommended by Lincoln and Guba (1985) were implemented to ensure the study's trustworthiness. The primary themes encompassed comprehensive portrayals of fecal characteristics, the discomfort symphony of constipation, emotional turbulence in the struggle against constipation, daily activities shadowed by constipation, and underlying factors contributing to communication taboos. Most participants considered the discussion of constipation taboo due to its association with an embarrassing secret, an unacceptable social norm and stigma, and apprehensions of potential gossip. Geriatric caregivers need to consider individual perspectives, communication taboos, and sociocultural contexts when addressing older adults' constipation.

Exploring dementia care competence of nurses working in acute care settings.

AIMS AND OBJECTIVES: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. BACKGROUND: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. DESIGN: The study used a one-sample descriptive-correlation design. METHODS: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product-moment correlation were performed for data analysis (See STROBE). RESULTS: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. CONCLUSIONS: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person-centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. RELEVANCE TO CLINICAL PRACTICE: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs.

Development and psychometric testing of a dementia care competence scale for nurses working in acute care setting.

BACKGROUND: Nurses often have difficulty to deal with dementia-related problematic behaviours, resulting in the prolonged hospitalisation of patients, which further waste medical resources and affect care quality, patient safety and nurses' job satisfaction. It is imperative to improve the dementia care competence of nurses working in acute care. Prior to educational interventions to promote dementia care, using an instrument to evaluate dementia care competence of nurses is needed. PURPOSE: The purpose of this study was to develop and test the psychometric properties of a scale suitable for the investigation of dementia care competence of nurses working in acute care setting. METHODS: The instrumental development design adapted Iceberg Theory as the theoretical foundation was used to develop a scale through three stages: Item development, Content validity and Psychometric testing of the scale. Stratified random sampling was used to enrol subjects from two medical centres in southern Taiwan. The Content Validity Index (CVI), categorical principal components analysis (CATPCA), Cronbach's α coefficient test and the intra-class correlation coefficient test were used to analyse the data. RESULTS: This study enrolled a total of 308 subjects. The CVI of the entire scale reached .97. Through the CATPCA, resulting 33 items in total with the Knowledge subscale consists of 13 items (range = 0-13), the Attitude subscale consists of 11 items (range = 11-55) and the Skills subscale consists of 9 items (range = 0-9). The final Cronbach's alpha coefficient for the Knowledge subscale was .88; for the Attitude subscale was .94; and for the Skills subscale was .85. The test-retest reliability after 2 weeks reached .818. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This scale has good reliability, validity and theoretical support. It can be used to understand the current status and predicaments of dementia care faced by healthcare personnel working in acute care setting, as well as the educational training intervention required to be implemented. Hopefully, nurses' ability to deal with problematic behaviours of dementia can be improved.

[Holistic Healthcare for the Aged: Concepts and Strategies].

Advancing medical technology continues to extend the average human life span, resulting in population aging globally as well as in Taiwan. The challenges posed by aging society increase not only medical and care costs but also the burden on pension funds and the social welfare system. In addition, there is currently a desperate need for many well-trained health providers as well as a friendly and comprehensive long-term care system. However, attention should not simply focus on medical payments and long-term care, as this may prolong the length of unhealthy living years for the aged and further strain national finances. Holistic healthcare for the aged should be introduced as early as possible in order to respond effectively to global aging by assisting the aged to maintain their health, to live independently, and to extend their social functions. The purposes of this report are to: 1. analyze the demographic characteristics of Taiwanese older adults; 2. introduce the concept of holistic healthcare as advocated by the World Health Organization (WHO); 3. discuss the promotion of physical-psychological health and the development of age-friendly environments; 4. strengthen the framework of long-term care policies; and 5. recommend the development of a holistic healthcare model for the aged based on the WHO Global Strategy and Action Plan on Aging and Health, announced in 2016. We hope to facilitate active aging, successful aging, self-esteem, and a high quality of life for the elderly in Taiwan.

[Exploring relocation stress and diabetes control in the elderly residents of long-term care facilities].

BACKGROUND: Stress and glycemic control have a significant and positive relationship. However, elderly diabetic patients who are relocated involuntarily to an institution often exhibit poor control of blood sugar. Few studies have addressed the relationship between relocation stress and diabetes control. PURPOSE: This study explores the relationship between relocation stress and glycemic control in seniors with diabetes in nursing homes. METHOD: This study used a cross-sectional descriptive correlation design with a convenience sampling method to recruit 88 elderly diabetes patients who had relocated to a nursing home within the past 1 year. The structural questionnaires used in this study adopted a personal and disease characteristics datasheet and the modified Chinese-version Relocation Appraisal Scale (RAS). SPSS (Window 18.0 version) was used for statistical analyses. RESULT: Those participants with diabetes who relocated involuntary, had low functional independence, lived with their family prior to admission, had poor health, or were diagnosed with depression faced a significantly higher risk of poor diabetes control. The significant predictors for diabetes control were: low functional independence and relocation stress, which accounted for 45.7% of the total variance for diabetes control. CONCLUSIONS: The result of this study may be referenced to help reduce relocation stress and help improve glycemic control in recently institutionalized seniors with diabetes.

A Feasibility Evaluation of the Need-Centered Watch-Assess-Need Intervention-Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia.

BACKGROUND: Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. PURPOSE: This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. METHODS: A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. RESULTS: Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.

[Concept analysis of feelings of loss among elderly nursing home residents].

Loss is a phenomenon common to the human experience. Feelings of loss represent an emotional response to separation from subjectively important person(s) or things. Loss often leaves nursing home elderly residents feeling abandoned, insecure, lonely, and hopeless and may affect their perception of the meaning of life. Those who are unable to adjust may slip into a depressed mood, which may lead to suicidal ideations. No systematic analysis of loss has been conducted. The purpose of this paper is to expand understanding of the concept of loss. The authors intend to clarify the defining attributes of loss, identify the antecedents that influence the perception of loss and discuss the possible consequences of loss using Walker and Avant's (2005) concept analysis. A model case is used to demonstrate how loss is tied to these critical attributes. Borderline and contradictory cases are presented to differentiate between the concept of loss and other concepts. It is believed that this analysis will help nursing staff to gain a better understanding of the concept of loss and help them apply this knowledge in clinical practice.