Environmental barriers and mobility in Taiwan: is the Roy adaptation model applicable?

This study tested Roy's adaptation model by exploring the relationship between environmental stimuli, specifically barriers, and the mobility, and instrumental behaviors of hip-fractured elderly persons after surgery in Taiwan. A prospective study was conducted 3 months after hospital discharge with 87 elderly persons with hip fracture who had received surgery at a medical center in northern Taiwan. After controlling for prefracture conditions, subjective environmental barriers significantly diminished the walking ability, self-care ability, and role performance of hipfractured elderly persons. The findings of this study lend to suggestions for intervening with hip-fractured elderly persons after surgery.     

A qualitative investigation of seniors' and caregivers' views on pain assessment and management.

The literature suggests that pain in the elderly, especially among seniors with dementia, is under-assessed and under-treated.This qualitative study solicited the perspectives of seniors, front-line nursing staff, nursing-home administrators, and informal caregivers of seniors with dementia on the current status of pain assessment and management. The views of these participants complement the research findings reported in the literature. While some of their explanations and potential solutions concerning under-treatment of pain in seniors echo views that have been presented in the literature, the participants also pointed to factors and avenues that have been given less formal consideration (e.g., systemic barriers to effective assessment and treatment of pain).They also highlighted the need for pain-control strategies beyond medication. The implications of these findings are discussed.     

The use of photovoice in nursing education: A scoping review

Given the variety of uses of photovoice in nursing education, the importance of clarifying and describing this method is apparent. This scoping review aimed to explore the evidence on the use of photovoice in nursing education, describe the state of knowledge in this area, and identify knowledge gaps within the existing literature. A comprehensive search was performed in seven databases including MEDLINE, CINAHL, Embase, and Education Full Text. Three gray literature databases (ProQuest Dissertations and Theses Global database, EThOS, and PapersFirst) were also searched. This scoping review was conducted with reference to the JBI scoping review guidelines and reported using the PRISMA-ScR statement. A total of 22 studies published between 2001 and 2022 were included in this scoping review. The findings indicate that photovoice is used globally in nursing education to teach in various courses and content areas within online, hybrid, and in-person environments. Despite the heterogeneity within the definition of photovoice and associated pedagogical strategies, the results of this scoping review suggest that photovoice can serve as an educational tool for nursing students.     

Health barriers to walking for exercise in elderly primary care

Health status is acknowledged by nursing theory as a factor in the probability of health behavior changes. Yet few studies have addressed the health-related barriers encountered by chronically ill elderly patients in primary care clinics who are trying to increase their physical activity. This study used self- and interviewer-administered instruments to assess potential barriers to physical activity in a sample of 60- to 80-year-old patients entering a walking program. Pain, fatigue, and mobility and sensory impairments were prevalent and could be significant barriers to participation. The authors present specific suggestions for helping patients overcome these barriers.     

Nordic walking for geriatric rehabilitation: a randomized pilot trial

Purpose: There is a need to identify effective interventions to promote walking capacity in seniors. This study compares nordic walking (NW) and usual overground walking (OW) and estimates the relative efficacy in improving walking capacity (endurance and gait speed) of the elderly. Method: Single blind, site-stratified, randomized, pilot trial designed to estimate the amount of change with NW and OW. Main outcomes were distance walked measured by 6-min walk test (6MWT) and comfortable gait speed measured by 5-meter walk test (5MWT). Explanatory variables were age, sex, number of comorbidities, walking aids, balance, pain, and leg function. Results: NW and OW participants improved, respectively, 45 and 41 m on 6MWT and increased their gait speed by 0.14 and 0.07 m/s, respectively. NW effect sizes were moderate for 6MWT (ES = 0.53) and large for gait speed (effect size (ES) = 0.68). OW demonstrated moderate effect size for 6MWT (ES = 0.53) but a small one for gait speed (ES = 0.33). Relative efficacy, which was obtained from the ratio of NW and OW effects’ sizes, was 1 for 6MWT and 2.06 for gait speed. Conclusions: NW is 106% more effective in improving gait speed among elderly than OW.

Implications for Rehabilitation

• Elderly are the fastest growing segment of the population. With advanced age, greater number of disabilities, and consequently mobility limitations, are observed among this group.

• Nordic walking is a more intensive form of walking, using muscles of upper and lower body. There’s evidence that nordic walking leads to greater cardiorespiratory workload without an increase in the level of exertion.

• In this study, nordic walking was 106% more efficient than regular walking in improving gait speed among the elderly.

• Clinicians specialized in geriatric rehabilitation may contribute to improve gait speed of seniors by adding nordic walking, a non-expensive and feasible option, to their physiotherapy sessions.

     

Unspoken phenomena: using the photovoice method to enrich phenomenological inquiry

Photovoice is a powerful method that is gaining momentum in nursing research. As a relatively new method in nursing science, the situatedness of photovoice within or alongside various research methodologies in a single study remains in a stage of early development. The purpose of this paper is to discuss the photovoice method as a means to elicit phenomenological data when researching the lived experience. While the foundational bases of phenomenology and photovoice differ substantially, the argument presented in this paper suggests that the photovoice method can be successfully used in phenomenological inquiry provided that significant rigour checks are pursued. This includes reflecting upon the origins and understandings of both methodology and method to promote methodological congruency. Data collection and analysis approaches that contribute to phenomenological inquiry using the photovoice method in addition to rigour and ethical considerations are discussed. The use of data generated from photovoice in phenomenological inquiry may fill a void of understanding furnished by limitations of traditional phenomenological inquiry and of spoken language and can enhance understanding of the lived experience, which may not always be best understood by words alone.     

Promoting seniors' health--confronting the issue of incontinence

Incontinence is a demoralizing and costly problem that severely affects the quality of seniors' lives. With the aging Canadian population expected to double within the next 15 years, the elderly are at the highest risk of developing incontinence. It is now recognised that incontinence can be successfully managed, and in many cases, resolved. A survey was conducted with seniors experiencing problems with incontinence who were receiving home care services. Results showed that incontinence has a significant impact on their lives. Seniors tend to mistakenly see the problem as an inevitable factor in the aging process; consequently many hesitate to seek information. In addition, they face barriers to receiving incontinence care that includes knowledge and access to services and resources. Nurses have the potential to take a leading role in reducing the problem of incontinence and in reducing the impact on the lives of seniors. In order to realize this potential, nurses need to be more aware of their attitudes towards incontinence and more informed about conservative treatment options. Some thought needs to be given to the role of the general nurse, and the role of a specialized nurse such as the nurse continence advisor.     

An exploration of social justice intent in photovoice research studies from 2008 to 2013

In an age where digital images are omnipresent, the use of participant photography in qualitative research has become accessible and commonplace. Yet, scant attention is paid to the social justice impact of photovoice amongst studies that have used this innovative method as a way to promote social justice. There is a need to review this method to understand its contributions and possibilities. This literature review of photovoice research studies (i) explores whether authors implicitly or explicitly related the methodologies to their aims of promoting social justice (methodology–method fit) and (ii) outlines the social justice research impact of photovoice findings using the framework of social justice awareness, amelioration and transformation. PubMed, Scopus, PsycINFO and Web of Science databases were searched from the years 2008–13 using the following keywords: photovoice; photonovella; photovoice and social justice; and photovoice and participatory action research. Of the 30 research studies reviewed, only thirteen identified an underlying methodology guiding the photovoice method. The social justice impacts emphasized were more related to social justice awareness (n = 30) than amelioration (n = 11) or transformation (n = 3). Future researchers using photovoice as a way to promote social justice are encouraged to assess and plan for the social justice impact desired.     

Listening to the quiet voices of Hispanic migrant children about health

There is a paucity of literature related to school-aged migrant children's perceptions of their own health. To best provide culturally competent care, more information is needed about migrant children's experiences. Focus-group methodology allowed the voices of migrant children to be heard by primary health care providers at a summer school program for children of migrant farm workers in south Georgia. Seventy-three children participated in 14 focus-group sessions. Six themes emerged from the data that were analyzed by using a qualitative software system. They are healthy behaviors, acculturation issues, environmental influences, health care actions, health behavior outcomes, and learning needs. Emerging patterns within each theme render insight about these migrant children. The findings suggest implications for pediatric nurses related to culturally competent care.     

Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty: a randomized,controlled trial

OBJECTIVE: Patients with endstage hip arthritis have poor ambulatory function. The aim of this study was to determine if perioperative exercise programs are well tolerated by these elderly patients and if a customized program can achieve an earlier recovery of normal ambulatory function after total hip arthroplasty. DESIGN: Twenty-eight subjects scheduled for total hip arthroplasty were randomized to either the exercise group and received a perioperative customized exercise program or the control group and received the routine perioperative care. Ambulatory function was assessed by measurement of gait parameters during a 25-m walk test, and walking endurance was assessed by a 6-min walk test. RESULTS: Exercise group subjects attended 97.3% of scheduled exercise sessions with no training injuries. Exercise group subjects demonstrated greater stride length and gait velocity at 3 wk postsurgery. At 12 and 24 wk postsurgery, gait velocity was greater, and the 6-min walking distance was significantly greater than the control group. CONCLUSION: The study indicates that perioperative customized exercise program are well tolerated in the elderly patient with endstage hip arthritis and are effective in improving the rate of recovery in ambulatory function in the first 6 mo after total hip arthroplasty.     

Midlife women's adherence to home-based walking during maintenance

BACKGROUND: Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. OBJECTIVE: The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. METHODS: There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. RESULTS: Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DISCUSSION: These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.     

Convalescence care for seniors of lower Manhattan: an interdisciplinary outreach, rehabilitation, and education model

The purpose of this study was to test the efficacy of an interdisciplinary geriatric outreach, rehabilitation, and education program for seniors. Community-dwelling Chinese seniors in lower Manhattan were recruited through outreach activities (17 educational workshops, three community health fairs, media interviews) and community physician referrals to offer rehabilitation services. The instrument administered at entry and exit included questions about pain intensity, quality of life, activities of daily living (ADLs), and an assessment of a variety of intrinsic and extrinsic barriers to life participation. The sample included 70 seniors (53 women) with a mean age of 70.5 +/- 7.48 years (range 60-93 years old) of whom 86% were Cantonese-speaking Chinese. The barriers-to-life participation assessment revealed cultural, communication, transportation, and physical environmental barriers as well as insufficient financial resources. Thirty-four patients who completed the program showed a significant improvement in quality of life. Patients' reports reflected a high degree of satisfaction with the program. Interdisciplinary team-oriented patient care, including a physiatrist, social worker, and rehabilitation staff, may result in good outcomes and high patient satisfaction in ambulatory community seniors.     

‘If We are Going to Include Them We have to do it Before We Die’: Norwegian Seniors’ Views of Including Seniors with Intellectual Disability in Senior Centres

Background Concepts of inclusion and participation are at the core of both international and Norwegian policy for people with intellectual disability. The aim of this study was to identify senior centre users’ views of the barriers and solutions to the inclusion of seniors with intellectual disability in community senior centres. Method Thirty seniors without intellectual disability participated in one of four focus groups. The groups were recorded and transcribed verbatim. Data were analysed for themes using the constant comparative method of qualitative analysis. Results Major themes included benefits, perceptions of people with intellectual disability, barriers and solutions to inclusion, need for support and need for information. Conclusions The findings suggest that participants agreed that seniors with intellectual disability could benefit from being a senior centre user. Consideration must be given to this group’s need for assistance, staff education, economic resources and ways to overcome negative community attitudes towards people with intellectual disability.     

Eccentric isokinetic strengthening in hamstrings of patients with multiple sclerosis]

OBJECTIVE: To assess the benefit of a program of rehabilitation involving eccentric isokinetic muscle strengthening for hamstrings of patient with multiple sclerosis. PATIENTS AND METHODS: A total of 28 patients with multiple sclerosis and abnormalities when walking who underwent a program of rehabilitation involving eccentric isokinetic muscle strengthening associated with classical neurological rehabilitation. Assessment was by use of an isokinetic test, clinical examination and score on a visual analog scale (VAS) about quality of walking at the beginning and end of the rehabilitation program and three months later. The rehabilitation program involved eccentric isokinetic exercises during 12 sessions. RESULTS: Patients with multiple sclerosis and difficulty walking showed weak hamstrings on manual muscular testing. After 12 sessions of isokinetic eccentric rehabilitation, hamstring and quadriceps strength increased, VAS score increased, and recurvatum of the knee improved in 26 cases. Three months later, the score for quality of walking remained the same, but that for strength returned to a previous level. CONCLUSION: Hamstring strength in patients with multiple sclerosis can be improved without complication with use of eccentric isokinetic rehabilitation. This is an interesting way to improve the quality of walking in these patients.     

Surgical nurses’ responses to worry: A qualitative focus-group study in the Netherlands

BackgroundHospital nurses observe and respond to deterioration using the ‘National Early Warning Score 2’. Surgical nurses are highly engaged in the early recognition of and response to deterioration. Responses to deterioration are based on deviating vital signs, while nurses also act on subjective indicators like worry. Scientific literature and (inter)national guidelines do not mention any information about acting upon worry.ObjectiveTo gain an in-depth understanding of the actions nurses on surgical wards undertake to generate an appropriate response to nurses’ worry when the ‘National Early Warning Score 2’ does not indicate deterioration.MethodA qualitative focus-group study with surgical nurses working at a hospital in the Netherlands. Data was collected by focus-group interviews supported by vignettes and analysed thematically.FindingsFour focus-group interviews with a total of 20 participants were conducted between February and April 2020. Two sequential themes emerged: ‘Searching for explanation and confirmation’ and ‘Responding by actively applying nursing interventions’. Nurses gathered additional information about the patient and searched for a reference point to place this information in perspective. Nurses also approached others for co-assessment and verification. However, nurses faced barriers in calling for medical assistance. They felt physicians did not take them seriously. After gathering additional information, nurses responded by applying nursing interventions to comfort the patient.ConclusionNurses mainly try to formalise an in-depth understanding of their feeling of worry to convince a physician to accurately treat the patient. Spending much time on a search to this understanding leads to delays in escalating care.     

Assessing the risk of falls for the elderly in Basic Health Units

The world population is aging rapidly, which poses a greater challenge for the institutions involved which, in turn, require new public health policies that include the prevention of falls. The objective of this study was to assess the risk of falls in the elderly. This epidemiological, cross-sectional study was performed at a family health unit, using a quantitative approach. The sample consisted of 150 elderly individuals evaluated from January to April 2009. Data were collected using the Fall Risk Score, which was analyzed using SPSS 17.0. Of all seniors evaluated, 58.8% did not suffer falls. However, 63 seniors did suffer falls, 71.4% of this total experienced 1 to 2 falls, and the main intrinsic cause they reported was dizziness/vertigo, whereas the extrinsic cause was wet or slippery floors. Therefore, it is concluded that it is important to assess the risk of falls among the elderly so that preventive measures can be taken, with a view to maximizing their quality of life.     

Programme to improve the use of drugs in older people and involve general practitioners in community education

As part of a multi-pronged approach to improving the quality of drug use in the elderly, a pharmacist was contracted by the Division of General Practice (Northern Tasmania) to develop educational material and implement two academic detailing sessions for general practitioners on the issues of adverse drug reactions and drug interactions in older people. The project aimed to involve general practitioners in community education after optimizing relevant therapeutic knowledge and standardizing prescribing practices. Sixteen general practitioners were involved in the project and 13 of these agreed to participate in academic detailing. The pharmacist developed prescribing guidelines for general practitioners and discussed these and illustrative case studies at the academic detailing sessions. General practitioner-conducted education sessions were completed by nine general practitioners to groups of carers, general practitioners, nurses and older people. Despite the relatively low numbers of general practitioners involved, the results of the project were encouraging. Academic detailing by the pharmacist was well received by the general practitioners, who indicated they would be willing to participate in further sessions. Pre- and post-project multiple-choice tests on therapeutic issues in the elderly indicated a strong trend for an increase in knowledge. Analysis of general practitioners' patient records found a statistically significant decline in the median number of medications prescribed per patient during the project. There was also a statistically significant decline in prescribing of 'indicator' medications, particularly psychoactive drugs and nonsteroidal anti-inflammatory drugs in patients resident in nursing homes. The project demonstrated that academic detailing by a pharmacist can be effective as part of a combined approach to improve the quality of drug use in older people.     

Place de la posturographie à domicile dans un concept de prévention de la chute de la personne âgée

Falls in the elderly are a major public health concern because of the extent of their social repercussions, not just in terms of government budgets, but also with respect to the psychosocial disintegration of seniors. The mechanisms of falls in individuals over age 65 involve several factors. A consensus exists in the international literature that fall prevention programmes targeting the elderly must integrate all factors so that multifocal and multidisciplinary responses and proposals can be developed with optimal efficacy. The authors present the Padchute® concept, a multifactor program assessing the risk of falls at home and incorporating multidimensional intervention.     

Motor Learning in the Community-dwelling Elderly during Nordic Backward Walking

[Purpose] The aims of this study were: 1) to confirm the motion learning process of Nordic backward walking (NBW) in older adult community-dwelling volunteers and, 2) to check the change in psychological condition resulting from NBW. This study examined whether the learning process and psychological condition become more efficient after repeated sessions of NBW. [Methods] The subjects were 19 community-dwelling elderly individuals between the ages of 64 and 78 years. [Results] Significant differences in walking speed during NBW were only found between the first and second sessions and between the second and third sessions. The walking speed in the sixth session, measured one hour after the fifth session, was decreased in comparison with that in the fifth session. Significant differences in stride length during NBW were only found between the first and second sessions and between the second and third sessions. The stride length in the sixth session, measured one hour after the fifth session, was decreased in comparison with that in the fifth session. Significant differences in VAS score (sense of fear) after NBW were found for each session. VAS score for the sixth session, measured one hour after the fifth session, was decreased in comparison with that for the fifth session. [Conclusions] The findings in the present study suggest that NBW is indeed a novel task and that motor learning occurs as a result of practice, leading to a more efficient recruitment of motor units.Key words: Nordic backward walking, Motor learning, Community-dwelling elderly