Building therapeutic nurse-patient relationships is pivotal to the provision of optimum nurse car... more Building therapeutic nurse-patient relationships is pivotal to the provision of optimum nurse care management for geriatric home health care (HHC) patients. However, little is known about which strategies most effectively treat older adult HHC patients with concomitant depression and disability. This qualitative descriptive study was conducted in two parts to explore the issue further. The first part involved interviews regarding HHC nurse perceptions of geriatric depression and disability care management. The second part, which is the focus of the current analysis, describes HHC nurses' use of care management and therapeutic during home visits. Observation of nurse-patient interactions involved 25 nurses home visits to HHC patients 60 and older who had depression and disability. Drawing on clinical knowledge and interpersonal skills, nurses built relationships and fostered trust. However, despite their disabilities to make these connections, multiple missed opportunities occurred for nurses to engage in more productive interactions. Four training components to support improvement of nurse-patient therapeutic relationships are described and recommended.
ABSTRACT The presence of refractory dyspnea is often associated with illness progression to advan... more ABSTRACT The presence of refractory dyspnea is often associated with illness progression to advanced stages. Opioid medications are the first-line pharmacological treatment for the palliation of refractory dyspnea, and indication for this intervention could signal the need for palliative care or hospice. The aims of this study were to describe opioid use and enrollment in hospice care among Medicare beneficiaries with heart failure, chronic obstructive pulmonary disease, or lung cancer during their last year of life. Using Medicare data, we conducted a retrospective cohort study of beneficiaries with heart failure, chronic obstructive pulmonary disease, or lung cancer who died in 2009. Slightly more than one-third of the 110 218 decedents used an opioid medication during the last year of life. Beneficiaries with lung cancer had the most opioid and hospice use. Hospice was initiated in the last month of life, whereas opioids were first prescribed 9 to 12 months before death. Findings suggest that the symptoms experienced by this population in the last year of life may not be well managed. The introduction of an opioid medication to manage refractory dyspnea could be used as an indicator to begin discussions about palliative care or hospice among patients with advanced illnesses.
Since the vast majority of older adults experiencing and recovering from disability prefer to liv... more Since the vast majority of older adults experiencing and recovering from disability prefer to live in the community nurse home visiting offers an effective method to deliver targeted geriatric strategies to improve measures of disability and promote health. The nurse intervention of the recently concluded Medicare Primary and Consumer-Directed Care Demonstration is one of only seven nurse home visiting studies that have reported positive disability outcomes for community dwelling elders with disability. A process evaluation of this intervention was completed in order to determine which components of the nurse intervention were most related to maintenance of function (ADL status). Outcomes were assessed using data from the nurse notes, case studies, and Demonstration databases. Results showed high levels of participation, dose, and fidelity for the intervention components. The results of the logistic regression (predict the change in ADL disability; maintenance/improvement vs. worsen...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 27, 2014
Research is scarce on how depression is identified and treated among Medicare home healthcare (HH... more Research is scarce on how depression is identified and treated among Medicare home healthcare (HHC) patients age 65+ with disability. The Centers for Medicare & Medicaid Services (CMS) recently incorporated depression screening into the OASIS-C HHC assessment. Our study objectives were to evaluate and characterize depression care management (DCM) in an HHC agency after CMS increased its depression requirements and to determine if there was an association of DCM with disability (activities of daily living [ADLs]) outcomes. The authors conducted a retrospective chart review of 100 new Medicare HHC admissions patients age 65+ (mean age: 81.7) who screened positive for depression and had disability and multimorbidity. Clinical and administrative records were examined and descriptive analyses used. Multivariate regression analyses investigated the association of six DCM components with ADLs improvement. Depression was recognized in care plans of 60% of patients. Documentation of only one...
Psychosocial interventions alone or combined with antidepressant medication can effectively treat... more Psychosocial interventions alone or combined with antidepressant medication can effectively treat mild to moderate geriatric depression. However, most home health care patients with depression and disability do not receive these interventions. Moreover, relatively little is known about home health care nurse views about depression management. Therefore, our research purpose was to provide a deeper understanding about how home health care nurses perceive and experience depression detection and evaluation within the context of caring for geriatric patients with disabilities. Design and Methods: This qualitative descriptive study involved 2 focus groups and 16 semistructured interviews with nurses providing care to geriatric home health care patients followed by observation during 25 nurse home visits to geriatric patients who had depression and disability. Findings: Nurses demonstrated confidence in caring for elderly patients with disabilities. However, they expressed different views about the nature of depression and the integration of depression and disability care in daily practice. Evidence points to a need for advanced training that supports an enhanced role for generalist homecare nurses in providing depression care management for this vulnerable geriatric population. Implications: Policy challenges are associated with ways in which home health care is fiscally organized primarily to address patients' physical and acute skilled care needs and not depression.
Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (... more Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses.
In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Crea... more In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Creating Avenues for Relative Empowerment) for improving outcomes of hospitalized older adults and their family caregivers (FCGs). FCG-patient dyads (n = 407) were randomized into two groups. The CARE group received a two-session empowerment-educational program 1-2 days post-admission and 1-3 days pre-discharge. The attention control group received a generic information program during the same timeframe. Follow-up was at 2 weeks and 2 months post-discharge. There were no statistically significant differences in patient or FCG outcomes. However, inconsistent evidence of role outcome differences suggests that CARE may benefit certain FCG subgroups instead of being a one-size-fits-all intervention strategy. Closer examination of CARE's mechanisms and effects is needed.
Core clinical questions for nursing practice include the nature of human responses to health situ... more Core clinical questions for nursing practice include the nature of human responses to health situations. Nurses need to recognize human responses to health situations in order to provide individualized, holistic care. Evidence derived from qualitative studies has great utility to address these needs. The human response question domain involves clinical questions about the ways people process and manage health issues in their everyday lives.
Context. Despite rapid proliferation of hospital-based palliative care consultation services (PCC... more Context. Despite rapid proliferation of hospital-based palliative care consultation services (PCCSs) across the country, there is little description of the dynamic processes that the PCCS and the non-PCCS hospital cultures experience during the institutionalization of a successful PCCS.
Undergraduate nursing students in one university conduct quality assurance studies in the clinica... more Undergraduate nursing students in one university conduct quality assurance studies in the clinical setting as part of the requirements for a fonnal research course. The joint guidance of student projects by the nursing practice quality assurance coordinator and the research course instructor constitutes a type of collegial relationship that unijies practice and educational goals. There are mutual advantages to the nursing quality assurance program and to nursing students.
The purpose of this narrative literature review was to describe the state of the science on the e... more The purpose of this narrative literature review was to describe the state of the science on the effectiveness of opioid medications to palliate dyspnea in older adults with advanced disease. A three-stage critical appraisal process was used to evaluate articles published between 2000-2011 that were retrieved from the CINAHL, Ovid MEDLINE, and PsycINFO databases. Low-dose opioid medication use was associated with statistically significant reductions in dyspnea intensity scores in the majority of studies included in the analysis. Many recent articles on this topic shed light on the importance but underuse of opioid agents to palliate dyspnea, particularly in older adults with advanced chronic illnesses, such as heart failure and chronic obstructive pulmonary disease. ADRA (Assess, Document, Re-assess, Advocate) is a proposed framework that gerontological nurses can use to ensure patients receive adequate symptom management for refractory dyspnea.
A process evaluation of a primary care affiliated home visiting nurse intervention was performed ... more A process evaluation of a primary care affiliated home visiting nurse intervention was performed to determine which intervention components were associated with disability maintenance/improvement. This secondary analysis (N = 238) used data recorded in intervention databases and patient interviews among community-dwelling elders with disability. Intervention components were examined in descriptive, correlational, bivariate, and logistic regression analyses. Results demonstrated that two structure components--physician-patient-family-nurse conference visits and intervention (education) materials--and three process components--disease management activities, goal setting, and medication management activities--were linked to maintaining/improving activities of daily living disability status. Confirmation of these findings may help home care nurses to delay disability worsening.
ABSTRACT This mixed method study examined nursing home resident, family and staff views regarding... more ABSTRACT This mixed method study examined nursing home resident, family and staff views regarding spiritual nurturance and support for persons with dementia and analyzed institutional resources/approaches for meeting residents’ spiritual needs. For residents able to communicate in words (n = 47/83 or 57%), this topic evoked a range of emotional content, brought back memories, and yielded information about what mattered to them spiritually/religiously. Some observations and reported behaviors of residents unable to be interviewed directly (n = 36/83 or 43%) suggested emotional awareness of spiritual activities. Family member/staff perspectives revealed beliefs, concerns, and needs for support/training in the provision of spiritual care. Quantitative findings were consistent and identified differences between surveyed nursing homes (n = 48) with and without religious affiliations. Discussion of personhood, spiritual/ religious coping, and meeting spiritual care needs led to conclusions about the role of professional chaplaincy in educating and modeling for staff and others appropriate behaviors for providing spiritual support as well as the importance of accommodating diversity and maximizing resources.
Background: Home visiting nurses (HVNs) have long been part of home and community-based care inte... more Background: Home visiting nurses (HVNs) have long been part of home and community-based care interventions designed to meet the needs of functionally declining older adults. However, only one of the studies including HVNs that have demonstrated successful impacts on Activities of Daily Living (ADL) has reported how those interventions affected individual ADLs such as bathing, instead reporting the effect on means of various ADL indices and scales. Reporting impacts on means is insufficient since the same mean can consist of many different combinations of individual ADL impairments. The purpose of our study was to identify which individual ADLs were affected by a specific HVN intervention. Methods: This is a secondary analysis comparing two arms of a randomized controlled study that enrolled Medicare patients (mean age = 76.8 years; 70% female) with considerable ADL impairment. At baseline difficulty with individual ADLs ranged from a low of 16.0% with eating to a high of 78.0% with walking. Through monthly home visits, the HVN focused on empowering patients and using behavior change approaches to facilitate chronic disease self-management. Three categories of analyses were used to compare difficulty with and dependence in 6 individual ADLs between the HVN (n = 237) and care as usual (n = 262) groups (total N = 499) at 22 months after study entry: (1) unadjusted analyses that strictly depend on random assignment, (2) multinomial logistic regression analyses adjusting for baseline risk factors, and (3) multinomial regression analyses that include variables reporting post-randomization healthcare use as well as the baseline risk factors. Results: Compared to care as usual, patients receiving the HVN intervention had less difficulty performing bathing at 22 months. However, there were no effects for difficulty performing the other 5 ADLs. While no effects were found for lower levels of dependence for any ADLs, impacts were detected for the most dependent levels of 4 ADLs: patients experienced less dependence in walking and transferring, a substitution effect for toileting, and more dependence in eating. Conclusions: Future research is needed to confirm these findings and determine how HVN interventions affect individual ADLs of older adults with multiple ADLs.
Family members are an important but often underappreciated resource in caring for hospitalized ol... more Family members are an important but often underappreciated resource in caring for hospitalized older adults. The Family Preferences Index is a 14-item approach to exploring caregivers' personal choices for participating in the care of hospitalized older adult family members. It can be administered as a structured interview or as a questionnaire. Higher scores indicate a greater preference to participate in care. The nurse can use the responses to the index to plan care that builds a partnership with the family. To watch a free video demonstrating the use of the index, go to http://links.lww.com/A296.
American Journal of Alzheimer's Disease and Other Dementias, 2008
To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with... more To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL). Concurrent mixed methods (quantitative retrospective chart review and qualitative field study). Three NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit. Residents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult. The role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.
This article shows how social network studies contribute to development of knowledge about social... more This article shows how social network studies contribute to development of knowledge about social support and describes research on the social networks of elderly institutionalized people. Network patterns emerged from data obtained through an anthropological fieldwork approach to network analysis. They are discussed in connection with a conceptualization of support as esteem enhancement and coping assistance. Residents' points of view are reported in their own words as much as possible to preserve active images that confront stereotypes of elderly people as passive and dependent. Their responses illustrate important aspects of social support in institutional settings that have implications for scientific nursing practice.
Building therapeutic nurse-patient relationships is pivotal to the provision of optimum nurse car... more Building therapeutic nurse-patient relationships is pivotal to the provision of optimum nurse care management for geriatric home health care (HHC) patients. However, little is known about which strategies most effectively treat older adult HHC patients with concomitant depression and disability. This qualitative descriptive study was conducted in two parts to explore the issue further. The first part involved interviews regarding HHC nurse perceptions of geriatric depression and disability care management. The second part, which is the focus of the current analysis, describes HHC nurses' use of care management and therapeutic during home visits. Observation of nurse-patient interactions involved 25 nurses home visits to HHC patients 60 and older who had depression and disability. Drawing on clinical knowledge and interpersonal skills, nurses built relationships and fostered trust. However, despite their disabilities to make these connections, multiple missed opportunities occurred for nurses to engage in more productive interactions. Four training components to support improvement of nurse-patient therapeutic relationships are described and recommended.
ABSTRACT The presence of refractory dyspnea is often associated with illness progression to advan... more ABSTRACT The presence of refractory dyspnea is often associated with illness progression to advanced stages. Opioid medications are the first-line pharmacological treatment for the palliation of refractory dyspnea, and indication for this intervention could signal the need for palliative care or hospice. The aims of this study were to describe opioid use and enrollment in hospice care among Medicare beneficiaries with heart failure, chronic obstructive pulmonary disease, or lung cancer during their last year of life. Using Medicare data, we conducted a retrospective cohort study of beneficiaries with heart failure, chronic obstructive pulmonary disease, or lung cancer who died in 2009. Slightly more than one-third of the 110 218 decedents used an opioid medication during the last year of life. Beneficiaries with lung cancer had the most opioid and hospice use. Hospice was initiated in the last month of life, whereas opioids were first prescribed 9 to 12 months before death. Findings suggest that the symptoms experienced by this population in the last year of life may not be well managed. The introduction of an opioid medication to manage refractory dyspnea could be used as an indicator to begin discussions about palliative care or hospice among patients with advanced illnesses.
Since the vast majority of older adults experiencing and recovering from disability prefer to liv... more Since the vast majority of older adults experiencing and recovering from disability prefer to live in the community nurse home visiting offers an effective method to deliver targeted geriatric strategies to improve measures of disability and promote health. The nurse intervention of the recently concluded Medicare Primary and Consumer-Directed Care Demonstration is one of only seven nurse home visiting studies that have reported positive disability outcomes for community dwelling elders with disability. A process evaluation of this intervention was completed in order to determine which components of the nurse intervention were most related to maintenance of function (ADL status). Outcomes were assessed using data from the nurse notes, case studies, and Demonstration databases. Results showed high levels of participation, dose, and fidelity for the intervention components. The results of the logistic regression (predict the change in ADL disability; maintenance/improvement vs. worsen...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 27, 2014
Research is scarce on how depression is identified and treated among Medicare home healthcare (HH... more Research is scarce on how depression is identified and treated among Medicare home healthcare (HHC) patients age 65+ with disability. The Centers for Medicare & Medicaid Services (CMS) recently incorporated depression screening into the OASIS-C HHC assessment. Our study objectives were to evaluate and characterize depression care management (DCM) in an HHC agency after CMS increased its depression requirements and to determine if there was an association of DCM with disability (activities of daily living [ADLs]) outcomes. The authors conducted a retrospective chart review of 100 new Medicare HHC admissions patients age 65+ (mean age: 81.7) who screened positive for depression and had disability and multimorbidity. Clinical and administrative records were examined and descriptive analyses used. Multivariate regression analyses investigated the association of six DCM components with ADLs improvement. Depression was recognized in care plans of 60% of patients. Documentation of only one...
Psychosocial interventions alone or combined with antidepressant medication can effectively treat... more Psychosocial interventions alone or combined with antidepressant medication can effectively treat mild to moderate geriatric depression. However, most home health care patients with depression and disability do not receive these interventions. Moreover, relatively little is known about home health care nurse views about depression management. Therefore, our research purpose was to provide a deeper understanding about how home health care nurses perceive and experience depression detection and evaluation within the context of caring for geriatric patients with disabilities. Design and Methods: This qualitative descriptive study involved 2 focus groups and 16 semistructured interviews with nurses providing care to geriatric home health care patients followed by observation during 25 nurse home visits to geriatric patients who had depression and disability. Findings: Nurses demonstrated confidence in caring for elderly patients with disabilities. However, they expressed different views about the nature of depression and the integration of depression and disability care in daily practice. Evidence points to a need for advanced training that supports an enhanced role for generalist homecare nurses in providing depression care management for this vulnerable geriatric population. Implications: Policy challenges are associated with ways in which home health care is fiscally organized primarily to address patients' physical and acute skilled care needs and not depression.
Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (... more Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses.
In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Crea... more In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Creating Avenues for Relative Empowerment) for improving outcomes of hospitalized older adults and their family caregivers (FCGs). FCG-patient dyads (n = 407) were randomized into two groups. The CARE group received a two-session empowerment-educational program 1-2 days post-admission and 1-3 days pre-discharge. The attention control group received a generic information program during the same timeframe. Follow-up was at 2 weeks and 2 months post-discharge. There were no statistically significant differences in patient or FCG outcomes. However, inconsistent evidence of role outcome differences suggests that CARE may benefit certain FCG subgroups instead of being a one-size-fits-all intervention strategy. Closer examination of CARE's mechanisms and effects is needed.
Core clinical questions for nursing practice include the nature of human responses to health situ... more Core clinical questions for nursing practice include the nature of human responses to health situations. Nurses need to recognize human responses to health situations in order to provide individualized, holistic care. Evidence derived from qualitative studies has great utility to address these needs. The human response question domain involves clinical questions about the ways people process and manage health issues in their everyday lives.
Context. Despite rapid proliferation of hospital-based palliative care consultation services (PCC... more Context. Despite rapid proliferation of hospital-based palliative care consultation services (PCCSs) across the country, there is little description of the dynamic processes that the PCCS and the non-PCCS hospital cultures experience during the institutionalization of a successful PCCS.
Undergraduate nursing students in one university conduct quality assurance studies in the clinica... more Undergraduate nursing students in one university conduct quality assurance studies in the clinical setting as part of the requirements for a fonnal research course. The joint guidance of student projects by the nursing practice quality assurance coordinator and the research course instructor constitutes a type of collegial relationship that unijies practice and educational goals. There are mutual advantages to the nursing quality assurance program and to nursing students.
The purpose of this narrative literature review was to describe the state of the science on the e... more The purpose of this narrative literature review was to describe the state of the science on the effectiveness of opioid medications to palliate dyspnea in older adults with advanced disease. A three-stage critical appraisal process was used to evaluate articles published between 2000-2011 that were retrieved from the CINAHL, Ovid MEDLINE, and PsycINFO databases. Low-dose opioid medication use was associated with statistically significant reductions in dyspnea intensity scores in the majority of studies included in the analysis. Many recent articles on this topic shed light on the importance but underuse of opioid agents to palliate dyspnea, particularly in older adults with advanced chronic illnesses, such as heart failure and chronic obstructive pulmonary disease. ADRA (Assess, Document, Re-assess, Advocate) is a proposed framework that gerontological nurses can use to ensure patients receive adequate symptom management for refractory dyspnea.
A process evaluation of a primary care affiliated home visiting nurse intervention was performed ... more A process evaluation of a primary care affiliated home visiting nurse intervention was performed to determine which intervention components were associated with disability maintenance/improvement. This secondary analysis (N = 238) used data recorded in intervention databases and patient interviews among community-dwelling elders with disability. Intervention components were examined in descriptive, correlational, bivariate, and logistic regression analyses. Results demonstrated that two structure components--physician-patient-family-nurse conference visits and intervention (education) materials--and three process components--disease management activities, goal setting, and medication management activities--were linked to maintaining/improving activities of daily living disability status. Confirmation of these findings may help home care nurses to delay disability worsening.
ABSTRACT This mixed method study examined nursing home resident, family and staff views regarding... more ABSTRACT This mixed method study examined nursing home resident, family and staff views regarding spiritual nurturance and support for persons with dementia and analyzed institutional resources/approaches for meeting residents’ spiritual needs. For residents able to communicate in words (n = 47/83 or 57%), this topic evoked a range of emotional content, brought back memories, and yielded information about what mattered to them spiritually/religiously. Some observations and reported behaviors of residents unable to be interviewed directly (n = 36/83 or 43%) suggested emotional awareness of spiritual activities. Family member/staff perspectives revealed beliefs, concerns, and needs for support/training in the provision of spiritual care. Quantitative findings were consistent and identified differences between surveyed nursing homes (n = 48) with and without religious affiliations. Discussion of personhood, spiritual/ religious coping, and meeting spiritual care needs led to conclusions about the role of professional chaplaincy in educating and modeling for staff and others appropriate behaviors for providing spiritual support as well as the importance of accommodating diversity and maximizing resources.
Background: Home visiting nurses (HVNs) have long been part of home and community-based care inte... more Background: Home visiting nurses (HVNs) have long been part of home and community-based care interventions designed to meet the needs of functionally declining older adults. However, only one of the studies including HVNs that have demonstrated successful impacts on Activities of Daily Living (ADL) has reported how those interventions affected individual ADLs such as bathing, instead reporting the effect on means of various ADL indices and scales. Reporting impacts on means is insufficient since the same mean can consist of many different combinations of individual ADL impairments. The purpose of our study was to identify which individual ADLs were affected by a specific HVN intervention. Methods: This is a secondary analysis comparing two arms of a randomized controlled study that enrolled Medicare patients (mean age = 76.8 years; 70% female) with considerable ADL impairment. At baseline difficulty with individual ADLs ranged from a low of 16.0% with eating to a high of 78.0% with walking. Through monthly home visits, the HVN focused on empowering patients and using behavior change approaches to facilitate chronic disease self-management. Three categories of analyses were used to compare difficulty with and dependence in 6 individual ADLs between the HVN (n = 237) and care as usual (n = 262) groups (total N = 499) at 22 months after study entry: (1) unadjusted analyses that strictly depend on random assignment, (2) multinomial logistic regression analyses adjusting for baseline risk factors, and (3) multinomial regression analyses that include variables reporting post-randomization healthcare use as well as the baseline risk factors. Results: Compared to care as usual, patients receiving the HVN intervention had less difficulty performing bathing at 22 months. However, there were no effects for difficulty performing the other 5 ADLs. While no effects were found for lower levels of dependence for any ADLs, impacts were detected for the most dependent levels of 4 ADLs: patients experienced less dependence in walking and transferring, a substitution effect for toileting, and more dependence in eating. Conclusions: Future research is needed to confirm these findings and determine how HVN interventions affect individual ADLs of older adults with multiple ADLs.
Family members are an important but often underappreciated resource in caring for hospitalized ol... more Family members are an important but often underappreciated resource in caring for hospitalized older adults. The Family Preferences Index is a 14-item approach to exploring caregivers' personal choices for participating in the care of hospitalized older adult family members. It can be administered as a structured interview or as a questionnaire. Higher scores indicate a greater preference to participate in care. The nurse can use the responses to the index to plan care that builds a partnership with the family. To watch a free video demonstrating the use of the index, go to http://links.lww.com/A296.
American Journal of Alzheimer's Disease and Other Dementias, 2008
To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with... more To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL). Concurrent mixed methods (quantitative retrospective chart review and qualitative field study). Three NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit. Residents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult. The role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.
This article shows how social network studies contribute to development of knowledge about social... more This article shows how social network studies contribute to development of knowledge about social support and describes research on the social networks of elderly institutionalized people. Network patterns emerged from data obtained through an anthropological fieldwork approach to network analysis. They are discussed in connection with a conceptualization of support as esteem enhancement and coping assistance. Residents' points of view are reported in their own words as much as possible to preserve active images that confront stereotypes of elderly people as passive and dependent. Their responses illustrate important aspects of social support in institutional settings that have implications for scientific nursing practice.
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Papers by Bethel Powers