Roles of Nurse Practitioners: Health Consequences of Climate Change in Vulnerable Older Adults

Nurse practitioners (NPs) have key roles in addressing health consequences of climate change across the lifespan for patients, families, communities, and populations. The role of the NP in the health and well-being of vulnerable populations is critical in understanding the deleterious consequences of climate change. Older adults are considered a vulnerable population for health challenges in our climate-changing world. The link between climate and health via a systems approach includes engaging in health assessment, physical examination, differential diagnoses, and plans for interventions. Social determinants of health, community health, and population health are discussed, with recommendations for the roles of NPs.     

Climate,Health, and Nursing Tool (CHANT): A confirmatory factor analysis

Objective

To confirm the factor structure of the Climate, Health, and Nursing Tool (CHANT) tool via confirmatory factor analysis.

Design and sample

This is a cross-sectional analysis of voluntary, anonymous responses collected online in 2019, from a non-representative sample of 489 nurses from 12 nations with 95% of the respondents from the United States.

Measurements

A confirmatory factor analysis (CFA) was conducted to test a five-factor measurement model of the 22-item CHANT. Reliability was examined via Cronbach's α coefficient.

Results

The five CHANT subscales demonstrated acceptable reliability with Cronbach's α ranging from 0.67 to 0.91. The five-factor model of CHANT demonstrated good fit, x²(199) = 582.747, p < .001, CFI = 0.94, RMSEA = 0.06, and SRMR = 0.04 with statistically significant item-factor loadings.

Conclusion

CHANT is a reliable and robust instrument to measure nurses’ awareness, concern, motivation, and home and work behaviors regarding climate change and health, and is ready to be utilized in research, policy, professional settings, and among educators.     

Older adults' knowledge of pressure ulcer prevention: a prospective quasi-experimental study

hartigan i. , murphy s. & hickey m . (2011) Older adults’ knowledge of pressure ulcer prevention: a prospective quasi‐experimental study. International Journal of Older People Nursing 7 , 208–218
doi: 10.1111/j.1748‐3743.2011.00274.x Aim. To test an evidence base patient education leaflet to evaluate older adults’ knowledge of pressure ulcers and prevention strategies. Background. The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional’s verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. Methods. A quasi‐experimental uncontrolled pre‐test, post‐test study of participants’ knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult’s knowledge was measured pre‐ and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. Conclusion. The results indicate that an education leaflet enhanced patients’ knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. Implications for practice. An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.     

Older family caregivers' diet-related disparities: Cross-sectional evidence from Finland

Background

Some older family caregivers experience financial vulnerabilities due to their caregiving role, which may affect their ability to afford appropriate food. This study aimed to assess the extent to which there are diet-related disparities among older family caregivers in Eastern Finland.

Methods

This study is based on the multidisciplinary LifEstyle, NutriTion and Oral health in caregivers (LENTO) study. In total, 125 family caregivers were included. Data were collected between June and December 2019. Participants were assessed on health, nutritional status and sociodemographic factors. The associations and predictors of diet-related disparities were assessed using the independent samples t-test, ANOVA-test, χ²-tests and binary logistic regression.

Results

The mean age of family caregivers was 74 years (SD = 8). Most were female (72%), 20% had malnutrition risk and 30% reported having ‘moderately enough money’ or less, which was identified as ‘subjective poverty’. Family caregivers experiencing subjective poverty were less likely to consume two or more portions of fruit and vegetables daily and were more likely overweight. Study participants' diet-related disparities were further associated with several health inequalities, including comorbidity, depression, diabetes (Type I or II) and osteoporosis.

Conclusions

Older family caregivers have diet-related disparities, further associated with health inequalities. Family caregivers' diet-related disparities require increasing attention in healthcare. Addressing family caregivers' food insecurity risk would enhance their health equity. Lack of assessment of diet-related disparities will only deepen health inequalities.     

Mental Health Impacts of Climate Change: Considerations for Nurse Practitioners

Climate change is the most critical public health crisis of the 21st century. Physical and medical sequelae of climate and weather-related events are well documented and may be addressed in clinical practice. Mental health impacts of climate change are increasingly addressed in the literature but remain underrecognized by clinicians. This report focuses on mental health impacts of climate change through the theoretical framework of Maslow’s Hierarchy of Needs. It offers a broad overview of mental health impacts, particularly for vulnerable populations, and introduces screening, assessment, and treatment considerations for the nurse practitioner.     

Race to Beat the Heat: Climate Change Impacts Physical Activity

Climate change has led to increased frequency, intensity, and duration of extreme heat events with dire consequences for health. These are the deadliest of climate change impacts with preventable mortality from heat-related illnesses and increased threat to safe participation in physical activity and sports. Nurse practitioners can collaborate with community and professional sports health organizations to ensure evidence-based health and safety policies to reduce health-related risks. Adverse consequences on engagement in key health-promoting physical activity and sports may catalyze urgent action to address climate change.     

Older Adult Surgical Patients: Presentation and Challenges

The age of the population is increasing dramatically, and the age of the surgical population parallels that of the general population. This is occurring at a time when there are fewer health care providers with geriatric expertise in all disciplines.All health care providers must be knowledgeable about the normal changes of aging and must understand communication challenges with older adult patients. Health care providers must understand the specific risks and benefits of surgery and perform a complete individualized preoperative assessment to improve older adult patients' outcomes. AORN J 90 (August 2009) 223-240. © AORN, Inc, 2009.     

Evaluation of a Contact Sensor Skirt for an Anti-Collision Power Wheelchair for Older Adult Nursing Home Residents With Dementia: Safety and Mobility

We studied an anti-collision power wheelchair's ability to enable safe, independent mobility in nursing home residents with dementia. The device had a contact sensor skirt that compensated for drivers' absent or delayed responses to obstacles. Safety observations were tracked during device use. In six single-subject studies, distances traveled by residents in manual and anti-collision wheelchairs were compared. Two residents could use the device: One resident's mobility and well-being improved; the other thought it was unhelpful. Another resident with potential for use did not like its usability, speed, and appearance. For two other residents, the device did not compensate for decreased initiation, motor planning, and awareness of obstacles above the sensors. Another resident was withdrawn because of verbal aggression. Interviews and focus groups revealed the device's usefulness. Perceptions of safety were mixed. Further work should improve environmental coverage, sensor skirt reliability, and safety; match technology to the needs of a wider range of residents; and enhance usability, functionality, and acceptance.     

Social justice: added metaparadigm concept for urban health nursing

Historically, the nursing metaparadigm has been used to describe 4 concepts of nursing knowledge (person, environment, health, and nursing) that reflect beliefs held by the profession about nursing's context and content. The authors offer an assessment of the metaparadigm as it applies to community and public health nursing in urban settings and offer an amendment of the metaparadigm to include the central concept of social justice. Each of the metaparadigm concepts and the central concept of social justice is discussed as it applies to a model of urban health nursing teaching, research, and practice.     

The Effects of the Nintendo Wii Fit on Community-Dwelling Older Adults with Perceived Balance Deficits: A Pilot Study

ABSTRACT

The purpose of this study was to determine if a 6-week intervention program using the Nintendo Wii Fit Balance Board would lead to improvements in balance in community-dwelling older adults over the age of 65 with a perceived balance deficit. Balance, balance confidence, and limits of stability were measured at preintervention and postintervention using the Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale, and the Multi-Directional Reach Test, respectively. The center of pressure excursion was calculated by the Wii Balance Board. The intervention consisted of 30-min sessions, 2×/week using the Balance Board. No statistically significant changes were found for any outcome measure, although 4 of the 6 participants demonstrated clinically significant improvements on the BBS, using established clinical guidelines. These findings suggest that an intervention program including the Wii fit may be an effective rehabilitation option for older adults with perceived balance deficits.     

Older people with depression: pilot study

BACKGROUND: Although a substantial number of studies have identified the prevalence of depression experienced by older adults living in the community and the factors that may precipitate this depression, few have focussed on depression in older people who attend day centres. Consequently, there is no literature suggesting how depression in this population may be psychologically managed. AIMS: The aim of this paper is to present the results of a pilot study investigating the incidence of depression in people attending a London Age Concern day centre, and its associations with perceptions of handicap, loneliness, social support networks, satisfaction with social support, and satisfaction with life. METHODS: A quasi-experimental, cross-sectional pilot study was conducted with attendees at a London Age Concern day centre between November 1998 and January 1999. The day centre manager selected a convenience sample of 24 of 156 participants. Inclusion criteria were that participants must attend the day centre regularly and be over or equal to 65 years of age. The exclusion criterion was known psychiatric illness. Participants were interviewed using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy, which identifies caseness of psychopathology and includes a loneliness subscale, and completed the Satisfaction with Life Scale, Social Support Questionnaire and London Handicap Scale. RESULTS: There was a higher level of depression in this day centre setting than that found in other community-based studies. There were the expected significant associations between depression and loneliness, and depression and satisfaction with life. However, unexpectedly, there were no associations between depression and social support, or depression and handicap. CONCLUSIONS: The study has several limitations. However, the high level of depression and significant relationships between depression, loneliness and satisfaction with life may indicate that the social function of day centres is not meeting expectations. This suggests that there could be a role for community mental health nurses in offering psychosocial interventions to alleviate some of the distress experienced.     

Film as a pedagogical tool for climate change and mental health nursing education

The relationship between climate change and worsening mental health is of increasing concern globally. Climate change is ubiquitous, yet marginalized populations bear a disproportionate burden of the physical and mental health impacts, while youth are more likely to report mental health concerns related to climate change than older generations. Mental health nurses will inevitably see these impacts play out in their practice, thus it is important to explore innovative tools for teaching about and responding to the emotional and psychological impacts of climate change. This perspective paper presents an educational project that utilized film and structured reflection to engage with the intersecting topics of planetary and mental health. The authors created a documentary film that presents the relationship between mental health and climate change as well as an accompanying reflective toolkit. Both the film and toolkit were integrated into an undergraduate course about the health impacts of climate change. This paper explores the relevance of climate change to mental health nursing education and practice, describes the process of creating and integrating the film and toolkit into a course and advances the position that film is an innovative way to engage individuals and communities (such as student or community groups) with the emotional and psychological concerns that arise in response to complex challenges of climate change. More research is needed to better understand the mental health impacts of climate change and to explore novel approaches to education and advocacy about this topic. We hope that sharing our project and experiences will inspire additional discussion and research related to these emerging issues that are of great relevance to mental health nursing.