The role of empathy in the care of dementia

The role of empathy in the care of dementia
The concept of empathy in relation to caring is reviewed. A variety of definitions of empathy are considered to show how empathy has been used within general nursing practice A wide range of literature is drawn on to gain insights into the multifaceted and diverse information on this topic. The differing perceptions that arise from various professional viewpoints are explored. A set of attributes are identified for empathy and these are considered in relation to clinical practice in elderly mental health.
Three examples of care are discussed to show how emotive empathy can be employed to give an improved direction to care of dementia clients. The concept is reviewed in relation to the particular needs of caring for dementia. It is suggested that it should be included in mental health training. It is concluded that emotive empathy has a vital part to play in the delivery of care for the elderly mentally ill.     

Reconstructing mental health nursing in home care

BACKGROUND: Psychiatric care for people in Sweden with long-term mental health problems has shifted from institutional to community and home settings. AIM: The aim of this study was to explore and describe mental health nurses' experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long-term mental health problems. METHOD: We conducted interviews with 11 mental health nurses who provided home care to people with long-term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis. FINDINGS: The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long-term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse-controlled to client-centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client-centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely. CONCLUSIONS: Our study indicates that the process of reconstructing mental health nursing in line with a client-centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.     

Measuring the Need for Nursing Care in Older Adults Living at Home

Abstract The Community Health Intensity Rating Scale (CHIRS) has been found to significantly explain variation in resources consumed by both home health care clients and high-risk public health nurse clients. Secondary analysis of CHIRS scores from two earlier retrospective studies provided insights into basic similarities and differences between older adults served by a home care program ( n = 208) and those served by a public health nursing program for frail elderly ( n = 47). CHIRS scores for both client groups demonstrated a substantial need for care, with a greater range of CHIRS global scores for home health care clients but significantly higher CHIRS total scores for the public health nurse clients ( t = -5.24, p < .001). These findings suggest that the public health nurse clients experienced needs across multiple areas whereas the home health care clients' needs were more narrowly focused and episodic. Representation of needs by an intensity rating such as CHIRS can foster more focused visit planning and more specific outcome assessment, assist in planning staffing and in-service education, and focus nursing education regarding care of older adults.     

Nursing approaches to the mental health of the elderly: a position paper

Although geropsychiatric nursing or mental health nursing with the elderly (MHNE) can be conceived of as a new subspecialty in psychiatric mental health nursing, in essence it is as old as nursing itself, for caring for people of all ages has always been within the purview of nursing. Today, however, in the more developed countries, older adults have increased both in numbers and in sophistication. These two changes have altered mental health care for the elderly. For example, mental health professionals now recognize that the elderly have an image problem which leads to underutilization of existing services. Psychiatric mental health nursing as a whole is questioning the nature of its practice and its place both within academic settings, and within the health care service delivery system. This paper explores the future possibilities and choices for the new subspecialty, mental health nursing with the elderly.     

Health promotion for frail older home care clients

AIM: This paper reports a study evaluating the comparative effects and costs of a proactive nursing health promotion intervention in addition to usual home care for older people compared with usual home care services alone. BACKGROUND: An ageing population, budget constraints and technological advances in many countries have increased the pressure on home care resources. The result is a shift in nursing services from health promotion to meet the more pressing need for postacute care. For frail older people with long-term needs, these changes combine to create a fragmented system of health service delivery, characterized by providing nursing on demand rather than proactively. METHODS: A two-armed, single-blind, randomized controlled trial was carried out with older people > or =75 years and eligible for personal support services through a home care programme in Ontario, Canada. Participants were randomly allocated either to usual home care (control) or to a nursing (experimental) group. In addition to usual home care, the nursing group received a health assessment combined with regular home visits or telephone contacts, health education about management of illness, coordination of community services, and use of empowerment strategies to enhance independence. The data were collected in 2001-2002. RESULTS: Of the 288 older people who were randomly allocated at baseline, 242 (84%) completed the study (120 nursing group; 122 control group). Proactively providing older people with nursing health promotion, compared with providing nursing services on-demand, resulted in better mental health functioning (P = 0.009), a reduction in depression (P = 0.009), and enhanced perceptions of social support (P = 0.009) at no additional cost from a societal perspective. CONCLUSIONS: Home based nursing health promotion, proactively provided to frail older people with chronic health needs, enhances quality of life while not increasing the overall costs of health care. The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care.     

Partnership in coping: an Australian system of mental health nursing

The paper identifies shortcomings of approaches used in organizing and delivering mental health nursing. It provides a rationale for the development of a new system of mental health nursing namely the Partnership in Coping system (PinC). This system has been developed by service users, clinical mental health nurses and an academic mental health nurse. Currently, it is undergoing trials in Western Australia. The PinC focuses on the strengths of clients. It uses the positive aspects of mental health nursing namely its holistic perspective, the length and nature of the informal contacts, the 'ordinariness' of relationships with clients and the nurse's knowledge of the clients' social and physical environments. It is a versatile system that can also be used across different mental health settings (community and inpatient facilities). The paper describes the philosophy behind the system, the concept of coping, the nature of the partnership between the client and nurse and their respective roles.     

An investigation of aged care mental health knowledge of Queensland aged care nurses

Older people are at risk for developing psychiatric disorders and require highly skilled and knowledgeable nurse practitioners to provide early recognition and intervention of psychiatric problems. This study sought to identify the aged care mental health knowledge of registered nurses (RNs) employed in long-term aged care and test the validity and reliability of a North American tool for use in an Australian context. The Mary Starke Harper Ageing Knowledge Exam (MSHAKE) was sent to RNs (n = 350) in 70 long-term care facilities (LTCF) in Queensland, Australia, and 107 surveys were returned (30.5% response). Participants were found to be unprepared for the reality of caring for the mental health needs of an older population and to have knowledge deficits related to suicide, prevalence of mental illness, mental health and ethnicity, and a number of issues regarding dementia.     

Cross-boundary working: a generic worker for older people in the community

The care of older people often crosses the boundaries of health and social care. The new role of a health and social care trained generic worker was developed to provide comprehensive care for older people living at home. The role is a cross between a nursing auxiliary, health care assistant and a community support worker. The evaluation of the one-year pilot project demonstrated that clients were very satisfied with the care they received, particularly the emotional aspects of care. A high proportion of the generic workers time was spent listening and responding to their clients' mental health needs, and providing comfort and emotional support. Having been trained by local health professionals, the generic workers felt valued and respected, better able to communicate with their health colleagues, and therefore able to provide holistic care to their clients.     

Home care of the elderly with mental health needs

A King's Fund report on mental health in London (1997) highlighted the difficulty of adequately meeting the needs of older people with mental health problems. This article describes the work of the home nursing team, a London project that aims to provide appropriate care for this group of clients during the acute phase of their illness. The six-member mixed-grade nursing team provides care in the client's own home, providing an alternative to hospital admission. The team aims to be sensitive to the needs and wishes of clients and involve them in decisions about their care. Team members work closely with carers and other services, ensuring continuity of care.     

The community gerontological nurse: themes from a needs analysis

With the move of care into the community, the role of nurses caring for older people is changing. However, nurses may not be adequately prepared to cope with this changing role, especially if their training and experience have been primarily hospital based. This study involves an educational needs analysis of registered nurses working in the care of older people in nursing homes and clients' own homes. It is based on focus groups with registered nurses and individual interviews with other professionals, as well as group discussions with older people. The aim of this project is to provide research-based input into the design of a new community care of older people module, to be offered at Napier University, Edinburgh from February 1998. The results presented here consist of three themes or patterns that have emerged from the interview data. The specialist/generalist theme concerns issues of role definition and gerontological specialism. The social/medical theme addresses the shift towards a social model of care when nurses move into the community settings. Finally, the physical health/mental health theme represents the need for greater integration of skills and knowledge from both mental health and general health nursing in the field of community care for older people. The results indicate the need for significant attitude changes and provide a major challenge to educationalists.     

Nurses' knowledge and perceptions related to foot care for older persons.

The purpose of this study was to examine nurses' knowledge and perceptions related to foot care of older persons. Nurses representing hospital, home health, and extended care settings were surveyed. Data were collected using a Foot Care Survey, with questions related to the nurse's role with foot care of older adults, importance of various components of patient teaching content, and knowledge about foot care. Only half of the sample reported having content related to the mechanics of foot care in their nursing program. Ninety-five percent of the sample indicated that there is an unmet need of the elderly for assistance with foot care and that provision of this service is a nursing function. There was disagreement between practice setting as to whether the nurse needs a physician's order to do foot care. Nurses employed in home health and extended care settings indicated more independence in performing these functions. The mean score on the knowledge portion of the tool was 9.47 (possible score = 10). The data suggest that nurses possess the knowledge but have not had the opportunity to acquire the associated foot care skills. Implications for nursing education and service were discussed.     

Self-esteem: a closer look at clinical interventions

Self-esteem, a positive regard for oneself, is a universal need for every human being and a key component in restoring and maintaining mental and physical health. Yet, this important concept is remarkably neglected in nursing literature and easily overlooked in clinical practice. This article examines the existing research on the antecedents of self-esteem and compiles a list of factors which can facilitate the nurse's therapeutic effect on her client's positive self-concept. From this list, specific nursing interventions are provided for raising and maintaining a client's self-esteem. Since the impact of nursing interventions varies with clinical circumstances, the nursing actions are correlated with their most effective health care settings. This article provides a global and practical approach to the enhancement of clients' self-esteem.     

Elderly care. Automatic implantable cardioverter defibrillators.

The automatic implantable cardioverter defibrillators (AICD) is a commonly accepted treatment for an increasing number of elderly clients at high risk for ventricular dysrhythmias and sudden cardiac death. With increasingly successful use of AICDs, a unique group of gerontological patients has emerged with special physical, educational, psychosocial, and emotional needs. Gerontological nurses will encounter these clients in acute care settings as well as in home health care, nursing homes, senior citizen centers, and adult day health-care centers. Nurses need basic information about AICDs to plan for the continued care, teaching, guidance, and reassurance of these clients and their families.     

关怀性触摸对失能老年人抑郁症状的干预效果

目的探索关怀性触摸对失能老年人抑郁症状的干预效果。方法由接受过培训的36名护生对某养老院36名失能老人(其中22名为重度抑郁患者、14名为轻度抑郁患者)进行连续6个月的关怀性触摸。干预前后,对失能老人和护生分别采用老年抑郁量表(geriatric depression scale,GDS)和护士人文关怀品质量表(护生版)进行测量。结果干预后失能老人的GDS得分低于干预前,护生的人文关怀品质评价量表得分优于干预前,差异均有统计学意义(均P0.05)。结论关怀性触摸不仅有助于改善失能老人的抑郁状况,同时能有效提高护生人文关怀品质。     

Elder-family caregiver relationships. Determining appropriate nursing interventions

Providing excellent care to elders involves more than the nurse's ability to minister to them; it is dependent on nurses' focusing assessment and intervention on the elder-caregiver dyad. Only by planning nursing care within the context of the dyad and considering the needs of the elder, the caregiver, and the unit, is it possible for nursing to realize its potential for improving the care of all elderly clients.     

Palliative care in long-term care: a system in change

The provision of palliative care for older people within the next decade will need to be substantially different to that provided today. In long-term care settings the achievement of quality palliative care will require attention to all levels of the health and social care system, in both its formal and informal manifestations. We suggest that long-term care facilities will become the hospices of the future, caring for older people with chronic conditions with a long trajectory to death, the most common being dementia. We see this progression as inevitable and appropriate if the right support is provided. We discuss the impact that transferability and sustainability has had on the present provision of palliative care for older people and how that may affect the future. Four forces which are important factors in public policy; leadership, a culture that supports learning throughout the care process, an emphasis on effective team development and the use of information technologies for quality activities are used as a framework for our vision of social planning. We then go on to discuss the impact of costs, workforce, service planning and public awareness as vital areas where progress needs to be carefully tackled. We suggest some likely poor outcomes if this planning does not occur, but indicate that if planning and implementation is effective then services can provide the kind of care the baby boomer generation seeks.     

Empirical validation of a teaching course on spiritual care in Taiwan

AIM(S) OF STUDY: The aims of this study were threefold: (a) to develop the first spiritual care program for master of science in nursing degree students (MSNDS) in Taiwan, since most of these students are or will be nursing leaders in clinical practice, education, administration, or research; (b) to facilitate the MSNDS in applying the contents of this program to care of their clients; and (c) to understand the MSNDS' appraisals of the usefulness of the program in helping them provide spiritual care in clinical settings. BACKGROUND: The World Health Organization (WHO) (1998) proclaimed that health needs should include spiritual well-being in addition to physical, mental, and social domains. Nevertheless, many dominant medical educational systems have not yet encompassed spiritual care as part of their comprehensive or core curricula. DESIGN/METHODS: The methodological triangulation research design used in this project included various strategies of developing a novice course entitled 'Spirituality in Nursing Practice' which was given to the subjects over 18 weeks from September 1998 to February 1999. The course included classroom lectures, field trips, clinical implications, and presentation-appraisal. A convenience sample of 22 female MSNDS who were or had the potential to be nursing leaders from two schools of nursing in northern Taiwan was obtained. RESULTS: Four types of help were identified: (a) help in clarifying the theoretical concepts of spiritual care (100%); (b) help in providing a culturally bonded spiritual care plan (100%); (c) help in self-disclosure of the nurse's personal value systems and spiritual needs (91%); and (d) help in clarifying the symbolic meaning and the impact of religious rituals (86%). The explicit spiritual care plans and an empirical example of spiritual care were provided. CONCLUSIONS: This study presented the first spiritual care program for MSNDS in Taiwan. All subjects considered the course helpful in providing spiritual care for their clients in various clinical settings. The concept of spirituality is arousing great interest in the world, and this is evident in the spiritual care courses appearing in nursing curricula for nursing leaders in Taiwan.     

Cognitive behavioural therapy for clients with schizophrenia: implications for mental health nursing practice

1. This paper discusses the application of cognitive behavioural therapy (CBT) in the treatment of clients with schizophrenia and the implications for mental health nursing practice. 2. The literature shows that CBT has positive effects for clients in improving mental state and reducing relapse rate. 3. Because of their direct client contact, mental health nurses are in the best position to assess, address and manage clients' psychotic symptoms and problems. 4. A nursing care plan is used to illustrate how the principles of CBT could be incorporated into nursing care. 5. Education and training are important to equip nurses with the necessary knowledge and skills to implement the therapy. 6. Nurses have to take into account cultural issues related to the use of CBT. 7. Culturally sensitive research needs to be conducted to assess the outcome of the therapy.