Incorporating a built environment module into an accelerated second-degree community health nursing course

ABSTRACT Environmental quality is a leading indicator of population health. Environmental health content has been integrated into the curriculum of an Accelerated Bachelor of Science in Nursing program for second-degree students through development of an environmental health nursing module for the final-semester community health nursing course. The module was developed through collaboration between two professional schools at Duke University (the School of Nursing and the Nicholas School of the Environment and Earth Sciences). It focused on the role of the built environment in community health and featured a mix of teaching strategies, including five components: (1) classroom lecture with associated readings, (2) two rounds of online small-group student discussions, (3) assessment of the built environment in local neighborhoods by student teams, (4) team presentation of the neighborhood assessments, and (5) individual student papers synthesizing the conclusions from all team presentations. The goal of the module was to provide nursing students with an organizing framework for integrating environmental health into clinical practice and an innovative tool for understanding community-level components of public health.     

An analysis of psychosocial theories of ageing and their relevance to practical gerontological nursing in Sweden

BACKGROUND: Theories exist to challenge current practice, create new approaches to practice and remodel the structure of rules and principles. One question is whether nurses could find in psychosocial theories of ageing a theoretical foundation on which to base support of older people in their ageing process. AIM: The aim of the present paper was to analyse five psychosocial theories of ageing and to discover what they could mean for gerontological nursing in Sweden. METHOD: A literature search was conducted to find original works. Research questions inspired by Fawcett's framework guided the analysis. FINDINGS: Psychosocial theories of ageing cover different aspects of the ageing process, but do not address crucial issues regarding the attitudes and structure of good nursing care. These theories provide no clear guidance on how to care for older people and how to support them in their ageing process. However, the analysis did show that the theories contain underlying values that influence society and staff as regards their views on the ageing process and how care of older people should be carried out. Nursing interventions to support ageing will be quite different depending on the theoretical perspective taken by nurses. CONCLUSIONS: There is a need to translate the ageing theories into guidelines, so that staff in gerontological care will have tools to use in practice irrespective of which theoretical perspective they choose to use in care. This could also promote care that is tailored to each individual older person.     

The evolving educational needs of nurses caring for the older adult: a literature review

Recent changes in long-term care policies in the United Kingdom have resulted in many more older patients/clients, previously nursed in long-term hospital facilities, now being cared for in the community. This change has had a significant impact on nurses, forcing many to make the transition from working in hospital to within the community. This transition calls for appropriate professional educational preparation to enable these nurses to undertake their new roles effectively. The literature search that forms the basis for this paper revealed relatively little material focusing specifically on the educational needs of such nurses in transition. However, literature that addresses the needs of nurses caring for the older individual in the acute setting, and in the community environment, was found and is explored.     

A review of the literature in 2006

In this, the first of three papers, attention is drawn to the literature for one year, reflecting a sample of the interrelated themes of ageing, spirituality and nursing. It is clear that nurses are unsure how to include this component of care in their daily practice. However, with the rapidly increasing ageing population, and the recent escalation of literature on spirituality, it seems timely to analyse some of these findings and to consider the implications for practice. Some of the major emerging themes have been identified in this paper, with a view to further exploration of the themes in the second paper, and expanding the discussion in the third paper.     

Models of mental health care for older adults: a review of the literature

Aim.  This paper reviews literature that draws on models of mental health care for older adults.
Background.  It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population.
Results.  The paucity of research in this area is demonstrated.
Conclusion.  The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

Productive engagement in older adults: A concept analysis

This study aimed to clarify the concept of productive engagement as it applies to older adults. The concept analysis was based on Walker and Avant's eight‐step method. A literature review of articles published in English between 1990 and 2011 (n = 37) was conducted, using an electronic search of multiple sources. Results revealed that four defining attributes for productive engagement include continuing to work either paid or unpaid, caring for others, engaging in social activities, and growing spirituality. The antecedents of productive engagement are sociocultural factors as well as individual and institutional capacities. Meanwhile, the consequences are increased feelings of usefulness, improved health and well‐being, aged successfully, and enhanced quality of life. Model, borderline, and contrary cases are presented to illustrate the concept's defining attributes. Defining the concept of productive engagement provides a basis for nurses and other health professionals to better understand productive engagement in older adults, thus effective strategic plans or programs for promoting productive roles among older adults can be further developed.     

Nutritional screening and assessment tools for older adults: literature review

AIM: This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed. BACKGROUND: The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools. METHODS: A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk. RESULTS: Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically. CONCLUSIONS: As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.     

Improving the oral health of older people in long-term residential care: a review of the literature

Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care.
Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents.
Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools.
Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.     

A review of the factors involved in older people's decision making with regard to influenza vaccination: a literature review

Aims and objectives. The aim of this paper was to develop an understanding of the factors involved in older people's decision making with regard to influenza vaccination to inform strategies to improve vaccine uptake and reduce morbidity and mortality. Background. Influenza is a major cause of morbidity and mortality world‐wide. In the UK, it accounts for 3000–6000 deaths annually; 85% of these deaths are people aged 65 and over. Despite this, and the widespread and costly annual government campaigns, some older people at risk of influenza and the associated complications remain reluctant to take advantage of the offer of vaccination. Methods. A review of the English language literature referring to older people published between 1996 and 2005 was the method used. Inclusion and exclusion criteria were identified and applied. Results. The majority of the literature was quantitative in nature, investigating personal characteristics thought to be predictors of uptake, such as age, sex, co‐morbidity, educational level, income and area of residence. However, there was little discussion of the possible reasons for the significance of these factors and conflict between findings was often evident, particularly between studies employing different methodologies. Other factors identified were prior experience, concerns about the vaccine, perceived risk and advice and information. Relevance to clinical practice. The wealth of demographic information available will be useful at a strategic level in targeting groups identified as being unlikely to accept vaccination. However, the promotion of person‐centred ways of working that value the health beliefs, attitudes, perceptions and subjective experiences of older people is likely to be more successful during individual encounters designed to promote acceptance. Without more research in investigating these concepts, our understanding is inevitably limited.     

Older people and laxative use: literature review and pilot study report

This study explored older adults' perceptions of constipation, and the measures taken if they believed themselves to be afflicted by this condition. The paper provides an overview of the current literature surrounding laxative use, followed by a discussion of the pilot study and its findings. The objectives of the pilot study were to establish older people's definitions of the term 'constipation'; identify prescribed laxatives, over-the-counter laxatives, and home remedies used by older people to manage constipation; produce a detailed account of when these products are used; identify the older person's belief system underpinning their concepts of constipation, and their consequent use of laxative products; and produce information which will inform nursing practice, with a particular focus on nurses in community practice. People who identified themselves as being constipated were interviewed on a one to one basis. Participants shared their stories of loneliness, social isolation and anxiety related to constipation and the need to use laxatives on a daily basis, and described persistent unpleasant and often painful physical symptoms such as bloating, urges, excessive flatus, nausea and cramps, commonly associated with laxative ingestion. Nurses are challenged to work with older people within a 'wellness' framework, helping clients to maintain their bowel function, rather than fall back on short-term options, which provide only brief relief of symptoms, while ignoring the underlying causes.     

Covert administration of medication to older adults: a review of the literature and published studies

The aim of the study was to review published studies of covert medicines administration in older people, as well as carrying out a broad review of the subject. A review of MEDLINE, EMBASE, PsycINFO, BNI and CINAHL was conducted in order to identify studies providing quantitative or qualitative data on covert administration in older adults. National guidance on covert medication and the ethics and legality of the practice were also reviewed. Data were extracted from eight studies and one inspection report. In addition, one qualitative study was identified. Nine studies included a questionnaire or interview with staff and only one involved non-professional carers. Seven studies were from the UK. Disguising medication in food or drink was reported in 43-71% of nursing homes. In total, 1.5-17% of institutional patients were receiving medication covertly. Despite legislation, incomplete documentation was common and nursing staff alone often made the decision to administer medication covertly. Covert administration appears to be common in older adults with dementia but despite legislation it often takes place without documentation and consultation of all relevant parties. Staff education and training and local audit are needed to improve standards and safeguard vulnerable patients in institutions.