Promoting quality sleep in older people: the nursing care role

Sleep is a basic activity of living. Its restorative properties in healthcare settings--both hospital and community--should be considered by healthcare workers. Its significance in gerontological nursing should not be underestimated. As older people are prone to multiple pathology, disease processes may mask their need for effective sleep and rest. "Sleep architecture" is a term that applies to the mechanics of sleep or its stages and clinicians may fail to identify when this is disrupted. "Sleep hygiene" refers to measures or interventions used to promote sleep and a person-centred approach is necessary, with support from specialist agencies to achieve effective sleep hygiene. The need for long periods of sleep may diminish owing to ageing. However, the quality of the sleep experiences, i.e. feeling rested and refreshed, should be the same. Several factors have been identified in the causation of insomnia. In healthcare settings, environmental factors such as noise and light pollution are the commonest features. Other issues that may be present in both healthcare and community settings are related to varied perspectives, such as physiological, psychological and spiritual-religious. Providing a climate conducive to health sleep in all settings becomes a requisite in the planning of care.     

Promoting compassionate care with the older people: a relational imperative

We have been invited to imagine a future where the care for older people goes beyond the current paradigm. This article challenges the fundamental assumptions that underlie current care practices and, instead, promotes systems and processes that elevate nourishing and stimulating relationships with basic dignity, as well as personal agency, in the later days of life. Healthcare professionals still base current care systems on a medical model that emphasises the diagnosis, treatment and cure of disease (Kane RL & West JC, 2005It Shouldn't Be This Way: The Failure of Long-Term Care, Vanderbilt University Press, Nashville, Tennessee). In contrast, we highlight principles of relating that support care to older people during the final stages of life, and promote systems, processes, and design elements that constitute compassionate care. To do so, it is necessary to move from a model that responds to the dominant regulatory environment to a model that is designed in the ongoing processes of human relationships. Specifically, we are including all dimensions of relating including relations among the residents and between and among residents' families, and all levels and functions of caretakers and the community.     

Promoting effective continence care for older people: a literature review

Recent United Kingdom guidelines have identified the need for integrated continence services within health regions. While there is evidence of improvements in community services there is little evidence that the quality of nursing care offered for older people with urinary incontinence in care settings has improved. This literature review identifies some of the underpinning issues that impact on continence promotion for older people. Despite evidence that older people suffer physical, social and psychological distress as a result of mismanaged urinary incontinence, costs of promoting continence are higher in financial terms than containing incontinence. The extent of the problem is difficult to identify in terms of how many older people are affected by different types of urinary incontinence. Nurses' attitudes are found to affect the quality of continence care delivered, and there continues to be a lack of evidence around sustainable strategies for continence promotion in care settings.     

Assistant nurses working in care of older people: associations with sustainable work ability

Scand J Caring Sci; 2011; 25; 325–332
Assistant nurses working in care of older people: associations with sustainable work ability Indicators of health have shown improvements in the Swedish working population during the past decades, but with the exception of low‐skilled women. Earlier research has shown that assistant nurses belong to an occupational group, which has the lowest share of individuals with long‐term health in the total Swedish workforce. Sick leave research has mostly focused on determining risk factors for the development of diseases and dysfunctions. In the process of acquiring knowledge about mechanisms for sick leave, it has become obvious that there is also a need to focus on what contributes to work ability. The aim in this study was to explore what promotes sustainable work ability in female assistant nurses working in care of older people. Associations between factors related to work, health, lifestyle and sustainable work ability were investigated in a cross‐sectional nested case–control study in a cohort of 366 female assistant nurses. Data were collected in self‐reports in a questionnaire. Odds ratios were calculated, and a multiple logistic regression analysis was performed with sustainable work ability as the dependent variable. Sustainable work ability was associated with good self‐rated health, a BMI <30, ability to sleep well, recuperation, low stress level, support from family and friends, being over 25 years of age at birth of the first child, and control over one’s own life in the ≥50 age group. In the logistic regression analysis, the significant associations were good self‐rated health, being over 25 years of age at the birth of the first child and recuperation. In conclusion, the study showed that self‐rated health and factors in private life are important for assistant nurse’s sustainable work ability over time. The results from this study could be applied in health promotion work for employees in the care sector to strengthen and enhance sustainable work ability.     

Attitudes of nursing staff working with older people towards nutritional nursing care

Aim. The aim of this study was to examine attitudes of the nursing staff in geriatric care towards factors of importance for nutritional nursing care. Background. Studies show that nutritional risk assessment is seldom performed on older patients as routine and very few patients have a nutritional care plan. Patients in long‐term care who are easy to feed are also found to be looked upon more positively than those with high feeding needs. Methods. A total of 252 registered nurses and nurse aids working at geriatric rehabilitation and medical care clinics and resident homes participated in the study. Attitudes were examined using the Staff Attitudes to Nutritional Nursing Care Geriatric scale. The scale includes 18 items and was designed as a one to five‐point Lickert‐type scale. It gives a total score and five subscales representing the dimensions ‘Norms’, ‘Habits’, ‘Assessment’, ‘Intervention’ and ‘Individualization’. A higher score indicates a more positive attitude. Results. Of all nursing staff, 53% displayed a positive attitude towards factors of importance for nutritional nursing care and the rest displayed a neutral or negative attitude. The ‘Intervention’ dimension, dealing with nutritional problems and how to manage them, reflected the highest level of positive attitudes, which represents 71% of the nursing staff. The ‘Norms’ dimension had the lowest relative frequency of positive attitudes, 27%. The registered nurses held significantly more positive attitudes than the nurse aids did. Conclusions. Nutritional issues comprise an important and time‐consuming responsibility in geriatric care; however, nursing staff do not show an unequivocal positive attitude regarding this responsibility. The consequences this entails for the older patient need to be examined further. Relevance to clinical practice. Nursing staff play an important role in caring for patients who are malnourished or at risk for malnutrition. Positive attitudes might hinder the development of undernourishment or the further worsening of an already undernourished patient's condition.     

Integrating health and social care: implications for joint working and community care outcomes for older people

In England, the theme of promoting collaborative working between social and primary health care remains high on the policy agenda. The underlying assumption, largely untested, is that a greater degree of structural integration benefits service users. This paper reports the findings from a feasibility study comparing two models of joint working and examining the relative impact of personal characteristics, service use and co-location on the likelihood of older people remaining in the community. Baseline standardised interviews with 79 older people aged 75?+ with complex needs in two social services departments were carried out following referral, covering social circumstances, physical and mental health and services received, with follow-up interviews after six months. Contacts between social workers and primary care were tracked. The findings suggest that co-location does not necessarily lead to substantially closer interprofessional working in terms of greater contact between social workers and GPs or social workers and community nurses. Factors affecting outcome were degree of cognitive impairment, intensity of home care received and whether the older person lived alone. Whatever the model of collaborative working, its effects on remaining in the community must be assessed in the wider context of the characteristics and services received by older people.     

Integrating health and social care: implications for joint working and community care outcomes for older people

In England, the theme of promoting collaborative working between social and primary health care remains high on the policy agenda. The underlying assumption, largely untested, is that a greater degree of structural integration benefits service users. This paper reports the findings from a feasibility study comparing two models of joint working and examining the relative impact of personal characteristics, service use and co-location on the likelihood of older people remaining in the community. Baseline standardised interviews with 79 older people aged 75 + with complex needs in two social services departments were carried out following referral, covering social circumstances, physical and mental health and services received, with follow-up interviews after six months. Contacts between social workers and primary care were tracked. The findings suggest that co-location does not necessarily lead to substantially closer interprofessional working in terms of greater contact between social workers and GPs or social workers and community nurses. Factors affecting outcome were degree of cognitive impairment, intensity of home care received and whether the older person lived alone. Whatever the model of collaborative working, its effects on remaining in the community must be assessed in the wider context of the characteristics and services received by older people.     

Promoting travel health for older people

Older people are spending more time travelling for recreation than ever before. Irene Schofield considers what advice should be given to older clients to reduce any associated risks.     

Promoting urinary continence with older people: key issues for nurses

Urinary incontinence is one of the most common and distressing of the conditions experienced by older people. It is not just associated with physical and cognitive frailty but also features significantly in the fit community living population. Urinary incontinence is known to be hidden and under-reported. Yet the needs of older people across the globe in relation to urinary incontinence will increase with the changing demography.
Palliative strategies to contain urinary incontinence predominate in practice, although the reasons for this are not fully understood. Conservative approaches including lifestyle adjustments and behavioural therapies form the mainstay of active continence promotion but their routine use by nurses working with older people seems to be minimal. Promoting continence with older people is an area of practice long overdue for significant and sustainable practice development.     

Nurses' attitudes towards older people: a comparison between nurses working in acute medical and acute care of elderly patient settings

Drawing on a sample of 76 nurses from two health authorities working in acute medical or acute care of elderly patient wards, a quantitative approach was taken to compare their attitudes A questionnaire which identified possible predictors of attitude, knowledge about older people (via a modified Palmore's Facts on Ageing Quiz) and attitudinal disposition (via Kogan's Old People Scale) was distributed Results indicated a statistically significant difference ( P =003) in attitudes, with elderly care nurses scoring more favourably Factors which might explain such a finding are identified, namely post-basic gerontological education, age of respondent and knowledge of older people, and their relative influences discussed Conclusions are based on the premise that any variation based on specialist area is unacceptable since care of older people is now within every nurse's remit, and suggested interventions are outlined     

Student nurses' attitudes towards working with older patients

BACKGROUND: The ageing of the United Kingdom (UK) population means that the care of older people will become an increasingly important part of nurses' remit. However, employment statistics suggest that this is an unpopular nursing specialism. This may be due to a number of factors, one of which may be nurses' negative attitudes towards working with older people. This constitutes a potential problem, especially if such attitudes have an impact on the quality of care provided. AIM: To examine the attitudes held by student nurses towards working with older patients. METHODS: Questionnaires incorporating Likert-type scales, two vignettes and demographic questions were designed using the theory of planned behaviour. These were distributed to 172 student nurses undertaking preregistration nursing courses in the UK during the academic session 2000-2001. RESULTS: Student nurses displayed positive intentions towards working with older patients. These were based on their own attitudes and beliefs about what others would wish them to do. Participants believed that their behaviour towards older patients was to a large extent under volitional control. Analysis of the beliefs underlying student nurses' views showed that they differentiated between those participants who had a relatively positive approach to their work with older patients and those with a less positive approach. In addition, the results offered mixed support for the view that more knowledgeable or experienced nurses hold more positive views towards older people. CONCLUSIONS: The findings offer some support for previous studies that have looked at the more general issue of attitudes towards older people. However, the results also indicate that a more rigorous and more highly focused approach to the study of such attitudes is required if the research is to be relevant to the issue of working with older patients. The theoretical, methodological and practical implications of the findings are discussed.