Correlates of disruptive behavior in cognitively impaired elderly nursing home residents.

Disruptive behavior, resulting in negative consequences for both residents and caregivers, occurs in a large proportion of the nursing home population. This review of literature surveys studies that describe disruptive behavior and the correlates of this behavior in the cognitively impaired elderly. In the studies reviewed, the average prevalence of reported disruptive behavior among a total of 5,650 subjects was 42.8%. Correlates most frequently linked with disruptive behavior include cognitive status, functional ability, age, and premorbid personality. Suggestions for future research are discussed.     

Urinary incontinence: nursing home staff reaction toward residents

1. ISQ-SR is a reliable and valid tool to measure psychological stress associated with working with urinary incontinent patients. 2. ISQ-SR can be used to measure efficacy of continuing education programs aimed at reducing staff stress associated with urinary incontinence. 3. Eighty percent of the staff reported that they looked for ways to help patients with their incontinence all the time, but only 50% said that they felt comfortable working with urinary incontinent patients all of the time. 4. Sixty-three percent of the staff reported that they felt frustrated about working with urinary incontinence some of the time, indicating a need for continuing education.     

A psychoeducational program for nursing staff managing problematic behaviors of elderly nursing home residents in Taiwan

This quasi-experimental study assessed the influence of a psychoeducational train ing program on the knowledge, attitudes, and self-efficacy of nursing home staff (nursing aides [NAs] and registered nurses [RNs]) regarding elderly residents and the management of their problematic behaviors. The training, which was conducted in northern Taiwan, was based on self-directed learning theory. Participants were divided into experimental (n = 130) and control (n = 140) groups. Staff's knowledge, attitudes, and self-efficacy were assessed before, immediately after, and 3 months after the program. Total knowledge improved significantly in all participants. For RNs, attitudes toward residents with disruptive behaviors and self-efficacy in managing these behaviors also improved, but these improvements were not maintained. These findings indicate that cognition is not the only factor influencing attitudes and self-efficacy.     

Improving documentation of aggressive behavior in nursing home residents.

1. Although 66% of the 1.3 million elderly nursing home residents in the US exhibit aggressive tendencies, research indicates that caregivers underdocument aggressive incidents. As a result, the extent of aggression is unknown. 2. This study found that LPNs reported the largest percentage (41%) of the 51 documented aggressive incidents, which reportedly occurred most frequently in the bathroom (49% of the time) between 5 AM and noon (86% of the time). Most aggressive residents (55.1%) never had visitors. 3. This study concludes that nursing practice would benefit from a consistent definition of aggression, an easy-to-use clinical instrument to collect data on aggression, and caregiver education programs on assessing aggression.     

Sexual behaviour of nursing home residents: staff perceptions and responses

AIMS: This paper presents the results of a study that investigated nursing home staff perceptions of affectionate and sexual behaviour of residents. BACKGROUND: Despite growing recognition of the importance of sexual expression among residents and a increasing willingness to discuss the topic, sexual activity for nursing home residents remains an ignored component of life satisfaction. Even when 'sexuality' has been included as part of a resident's plan of care, this may not mean that attention has been paid to maintaining that aspect of their life. Thus, nursing homes can mark the end of many types of freedom for older people. Given that intimate basic care is performed by others and often by members of the opposite sex, loss of sexual freedom may also occur. METHOD: A grounded theory approach was used to study staff working in nursing homes in Australia and Sweden. Data were generated through interviews and nominal groups with nursing home staff. Thirty women volunteered to be interviewed, and 18 others were involved in the three nominal group discussions; a further five participants were involved as key informants. FINDINGS: Staff perceptions and responses to residents' sexual behaviour were found to be influenced by their own level of comfort related to sexuality issues, and the ethos within the organization where they worked. The conceptual paradigm was termed 'Guarding Discomfort' and specified the ways in which staff guard against sexuality discomfort as well as the ways their behaviour fits within different types of organizations. CONCLUSION: Both staff and nursing home managers need to work toward developing a home environment that is supportive of residents' sexuality rights, that permits sexuality expression and promotes a culture where all people concerned are comfortable with sexuality issues.     

Muscle rehabilitation in impaired elderly nursing home residents

Based on observations of changes in muscle function associated with aging, and the exacerbation of these changes with frailty, a program of muscle strengthening has been developed to correct specific defects in muscles. This pilot study was undertaken on 18 functionally impaired nursing home residents (age range 60 to 90 years) with markedly deteriorated muscle function (50%) secondary to age, disuse, and multiple chronic illnesses. Fourteen of the subjects completed the six-week program without adverse effects. In 75% of the patients, there was improved muscle function, with endurance, strength, and speed increasing 35%, 15%, and 10%, respectively. After the program, many subjects increased their spontaneous activity and decreased their dependency. The improvements were still evident four months after rehabilitation. These results suggest that it may be possible, through a carefully supervised, short-term program of muscle rehabilitation, for nursing home residents to achieve an enhanced level of physical functioning.     

Spirituality and the elderly: nursing implications with nursing home residents

Spiritual care is integral to quality nursing care for nursing home residents. Spirituality can be defined as dynamic principles developed throughout the lifespan that guide a person's view of the world; influence his or her interpretation of a higher power, hope, morals, loss, faith, love, and trust; and provide structure and meaning to everyday activities. Spiritually focused nursing interventions include silent witnessing, serving as a liaison, and active listening. Nursing interventions for spiritual care can be divided into four dynamic phases: self-comfort, assessment, intervention, and evaluation. Spiritual well-being helps residents' total well-being and inner peace.     

Nursing diagnoses in elderly residents of a nursing home: a case in Turkey

There are limited studies on nursing diagnoses of the elderly living in nursing homes worldwide. This study aimed to define the most frequent nursing diagnoses in the elderly residents of a nursing home elder care and rehabilitation center. Seventy-four elderly individuals were included in the study. Data were collected using the “Elderly Individual’s Introduction Form” between April 2007 to August 2007. The content of the form was based on a guide to gerontologic assessment, and Gordon’s Functional Health Patterns. The nursing diagnoses (NANDA-I Taxonomy II) were identified by the 2 researchers separately according to the defining characteristics and the risk factors. The consistency between the nursing diagnoses defined by the 2 researchers was evaluated using Cohen’s kappa (κ). There was an 84.7% agreement about nursing diagnoses defined by the 2 researchers separately. The weighted kappa consistency analyses showed there was an adequate level of consistency (κ = 0.710), and the findings were significant (p < 0.0001). The most frequent diagnoses were ineffective role performance (86.5%), ineffective health maintenance (81.2%), risk for falls (77%), and impaired physical mobility (73%). The diagnosis of ineffective role performance was more frequent in patients with dementia (x² =10.993, df = 1, p = 0.001). There was a very significant relationship between dementia and the diagnosis of impaired verbal communication (x² = 32.718, df = 1, p = 0.0001). The relationship between mobility disorder and self-care deficit was also significant (x² = 19.411, df = 1, p = 0.0001). To improve quality in patient care, nurses should use nursing diagnoses with a systematic assessment and should help the elderly in health promotion or use of the maximum current potential.     

Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision-making

The study reported in this paper applied a qualitative and interpretative approach to nursing staff perceptions of the use of restraint with elderly nursing home residents, and into nurses' decision-making on restraint use. The data were collected using unstructured interviews with a purposive sample of 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi's phenomenological method. Three main themes were extracted from the data: (1) understanding the term restraint, (2) situations in which the decision to apply restraint is considered justified and (3) situations in which nursing staff are uncertain about the use of restraint. The underlying bases with respect to decision-making were: understanding restraint, the rights and responsibilities of both residents and staff, and the duties of staff. Staff members were ambiguous in their understanding of restraint and they showed positive as well as confused attitudes towards its use. Their behaviour was defensive and protective rather than challenging. Further research is required on what is meant by safety in care of the elderly nursing today. In nursing practice, as far as issues of restraint are concerned, greater attention should be devoted to the relationship between elderly residents' self-determination and responsibility for their actions.     

Nursing staff members' assessments of pain in cognitively impaired nursing home residents.

Our aim was to assess the reliability and validity of nursing staff members' assessments of pain in cognitively impaired nursing home residents. Participants were 57 cognitively impaired nursing home residents and 52 nursing staff members. Twenty-eight residents had mild/moderate cognitive impairment and 29 were severely impaired. Nursing staff members were asked to evaluate their patients' pain using 2 scales: the Nurse Global Scale of pain (NGS) and the Present Pain Inventory (PPI). Independent measures of pain were obtained from patient interviews, physician assessments, and from the Minimum Data Set (MDS) items; these were used to measure validity of the nursing staff's perception of pain. Test-retest and inter-rater reliabilities were also computed. Significant correlations were obtained between most of the physician-derived measures and the PPI for the moderately impaired group, but not for the severely impaired group. Both measures of nursing assistants' pain assessments correlated significantly with MDS-based measures; these correlations were higher for the less cognitively impaired group. Finally, the PPI correlated significantly and positively with resident-derived measures for those with moderate rather than severe cognitive impairment. Nursing staff members' ratings of pain were correlated with residents' level of cognitive functioning and with intake of pain medication. The results underscore the difficulty in assessing pain in those with severe cognitive impairment.     

Aggressive behavior in cognitively impaired nursing home residents

Aggressive behavior was documented in a sample of 124 residents on units for the cognitively impaired in four nursing homes over a period of 7 days using the Ryden Aggression Scale. Some form of aggression was found in 86.3% of the residents, with no differences among facility, gender or diagnostic group. Neither mental status nor physical dependency was associated with aggression. The 68.5% who received psychotropic drugs had significantly higher aggression scores. Most incidents of aggression involved response to invasion of personal space and occurred during the day shift.     

Views on dignity of elderly nursing home residents

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.     

The relationship of nursing staff to the hospitalization of nursing home residents

Researchers have found registered nurse (RN) staffing unrelated to the prevention of hospitalizations of nursing home residents. Although most nursing home admissions are from hospitals, their studies involved residents who probably were not admitted from hospitals. In this study I examined data on 6,623 discharges of nursing home residents admitted or not admitted from a hospital. For patients with longer stays (>30 days), higher RN staffing levels in nursing homes reduced hospitalizations only for residents admitted from hospitals. Higher RN levels reduced hospitalizations more than higher licensed nurse levels or skill mix. Only among longer-stay residents not admitted from hospitals was RN staffing unrelated to hospitalizations. Researchers may have found RN staffing unrelated to hospitalizations because samples were primarily longer-stay residents not admitted from hospitals.     

Organizational and staff attitudinal determinants of falls in nursing home residents

Falls are the second leading cause of accidental death in the U.S., with the elderly suffering 75% of these accidents. Previous research has primarily focused on the relationship between personal factors such as medical diagnosis, medications, physiologic changes, mental alertness, environmental hazards, and falls among the elderly. The potentially important roles of organizational and staff attitudinal determinants, the foci of this study, have received little previous research attention. Specifically, leadership, work group cohesion, job involvement, attitudes toward the elderly, and job expectations were related to falls in 12 Veterans Administration (VA) nursing homes in New York, Ohio, and Pennsylvania. Data analysis reveals that these organizational and staff attitudinal factors account for 25% of the variance (P less than 0.05) in this sample. Unlike the majority of other institutional studies, in this VA sample, there was no significant correlation between medical diagnoses, length of stay, mental alertness of the residents, and number of falls. The implications of this study for preventing falls in long-term care facilities are discussed.     

Aggression toward staff by nursing home residents: findings from a grounded theory study

Aggressive behaviors by nursing home residents are common and can result in injury to both staff and residents. In addition, such aggressive behavior may lead to resident abuse by staff. This article describes a grounded theory study of nursing home staff response to aggressive residents and explores the problem of aggressive behaviors by nursing home residents, the conditions and context of aggression, and strategies staff use to prevent and manage aggression. To effectively deal with resident aggression, staff must become proactive, which involves three dynamic and interactive processes: practicing vigilance, intuiting, and strategizing. This article details these processes as well as the strategies staff use to deal with aggressive behaviors and makes specific recommendations for handling aggression toward staff.