The theory of gerotranscendence in practice: guidelines for nursing - Part II

Aim.  The aims of this article were to describe both how guidelines were derived from the theory of gerotranscendence and the actual guidelines. It also discusses the relevance of guidelines to practice.
Background.  This article describes how guidelines were derived from the theory of gerotranscendence as well as the content of the guidelines and how they could be used. The view of ageing introduced by the theory may have several consequences for nursing staff members' attitudes and treatment of older people, as it offers a new understanding of living in old age.
Resultant guidelines.  Concrete guidelines at three levels – focusing on the individual, activity and organization – were derived using focus groups. The guidelines describe different ways to support older people in their process towards gerotranscendence.
Conclusion.  The theory of gerotranscendence and the guidelines could help support nursing staff in their attitude towards older people and could be used as a supplement to enrich the present care.     

South Africans' experiences of being old and of care and caring in a transitional period

This focused ethnographic study aimed to illuminate a group of South Africans' experiences of being old and of care and caring in a transitional period. With a growing number of older people in Africa, studies on the individual experiences may help to develop care which is more sensitively based on the needs for older people in a changing Southern Africa context. Data were collected through group and individual in-depth interviews and participant observations which involved 16 individuals, aged 52-76. Data were analysed using a qualitative content analysis. The study showed two interrelated themes reflections on life and ubuntu - an orientation towards others. Findings were discussed from the viewpoint of the theory of gerotranscendence, showing similarities as well as differences, possibly due to societal and cultural differences. Shortage of formal care for older people living in poor conditions in Southern Africa, gave rise to the discussion for the need of a contextualized development of gerontological care. To enhance knowledge on the theory of gerotranscendence and develop guidelines for nursing in home-based care/community-based care in a South African context may be a first step to support older people in their process towards gerotranscendence.     

Adoption of an innovation based on the theory of gerotranscendence by staff in a Nursing home - Part III

This article presents an intervention involving introduction of the theory of gerotranscendence and practical guidelines derived from the theory. A qualitative method was used with triangulation of methods in data collection and analysis. Both the theory of gerotranscendence and the theory of innovation were used as frameworks in the analysis. Introducing this new perspective constituted an abstract intervention. It involved nursing staff changing their interpretations and values with respect to ageing and their treatment of older people in ways not compatible with extant values. The 'early adopters' were staff members who felt acquainted with the essential ideas of the theory because they perceived in themselves a personal developmental process in line with the theory. The innovation attributes, described in the innovation theory, explained some of the problems associated with adopting the guidelines.     

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 assessment of pain in older people

Pain is under-recognised and under-treated in older people. It is a subjective, personal experience, only known to the person who suffers. The assessment of pain is particularly challenging in the presence of severe cognitive impairment, communication difficulties or language and cultural barriers. These guidelines set out the key components of assessing pain in older people, together with a variety of practical scales that may be used with different groups, including those with varying levels of cognitive or communication impairment. The purpose is to provide professionals with a set of practical skills to assess pain as the first step towards its effective management. The guidance has implications for all healthcare and social care staff and can be applied in all settings, including the older person's own home, in care homes, and in hospital.     

Patient participation on a ward for frail older people

AIMS: The paper reports a study whose aims were to explore the meaning of participation for older people in hospital and their health care workers and ways in which staff can enhance patient participation in their care. BACKGROUND: Participation in care is a concept that is central to nursing practice. However, little is known about patient and staff views of participation and how it takes place in practice. METHODS: Action research was used, and data were collected by means of focus groups and in-depth interviews. Three focus groups and 24 interviews were undertaken with staff, and 19 interviews were undertaken with patients. The main action undertaken with staff aimed at raising their awareness of participation. In addition small changes in practice were introduced, such as the use of a patient biographical booklet. FINDINGS: The findings suggest that participation is a dynamic process that is integral to the work of nurses and carers. The process is enacted through the themes of facilitation, partnership, understanding the person, and emotional work. CONCLUSION: The study demonstrates how nurses can become increasingly aware of the potential for facilitation and creation of opportunities for participation. It is crucial that practitioners working with older people develop a deeper understanding of participation and are also empowered to act in ways that fit with the needs of this specific client group.     

Older people's experience of participating in a reminiscence group with a gerotranscendental perspective: reminiscence group with a gerotranscendental perspective in practice

Tornstam's theory of gerotranscendence provides the theoretical underpinning for two small reminiscence groups that met for eight weekly sessions in a Swedish daycentre. Tornstams's theoretical perspective provides a developmental model for understanding positive progressive changes in values, attitudes and behaviour in the second half of life. Practical guidelines derived from this theory informed the group-work approach used. Participants' opinions about their reminiscence experience were analysed to determine the relevance of gerotranscendental theory as a basis for understanding older people's use of reminiscence in the ageing process. The study aimed at investigating older peoples' experiences of participating in a reminiscence group with a gerotranscendental perspective. The study used a qualitative approach. Older people were invited to participate in reminiscence group sessions arranged at a daycentre. When the sessions were finished, participants were interviewed about their experience of the reminiscence group. Data were analysed and categorized by using qualitative methods. The participants were satisfied with the arrangement of the group sessions. All participants believed they had reminisced and thought much more about their childhood and also recalled other memories from their lives during the period. Three quite different views emerged of the recall experience and effects of participating in the reminiscence group: 'An activity like any other; an activity that led to thoughts about memories from life or an activity that influenced my thoughts about life.' Findings suggest that it is possible to arrange reminiscence groups from a gerotranscendental perspective that serve as an intervention in gerontological nursing. This paper provides some guidance concerning how this type of group may be arranged and the various categories of participant response that may be expected.     

Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care

nilsson a., lindkvist m., rasmussen b.h. & edvardsson d. (2012) Journal of Nursing Management  20, 640–647 Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care Aim To explore the attitudes held by staff working in acute care units towards patients aged 70 years or older with cognitive impairment, and to explore factors associated with negative attitudes. Background Hospital staff attitudes towards older patients with cognitive impairment are of concern as older people are the main hospital users, and because staff attitudes influence care quality and uptake of evidence-based care. Method A cross-sectional survey design was used to collect data from staff (n = 391). Results Staff attitudes were not explicitly negative. However, higher perceived strain in caring for older patients with cognitive impairment, higher perceived prevalence of these patients in the ward, being younger and working as an assistant nurse were associated with negative attitudes. A majority of staff reported that these patients received the best possible care, but few reported formally assessing cognitive status or working with evidence-based care protocols. Conclusion Staff characteristics associated with negative attitudes were described and staff perception that patients received best hospital care, despite limited cognitive assessments and care guidelines, indicate areas for improvement. Implications for nursing management Supporting young staff and assistant nurses, and implementing cognitive assessments and evidence-based guidelines can promote positive attitudes and best practice.     

Supervisor experiences of supervising nursing staff in the care of older people

Aim To describe supervisors’ experiences of supervising nursing staff who care for older people in order to develop an understanding of the opportunities and limitations involved in supervision. Background Little is known of what group supervision of nursing staff means for the supervisor, particularly in regards to care of the old. Methods A reflective life‐world research approach, based upon phenomenological epistemonology was used. Two supervisors with 2 years experience of supervising nursing staff caring for older people were interviewed. Conclusions Results point to the need for support for supervisors in order to enable them to develop their supervisory abilities and skills. Implications for nursing management Support is of crucial importance for both the ability to supervise and the quality of supervision.     

From the emergency department to home

Aim. The purpose of this study was to explore dimensions of the management of the older person following care in an emergency department in preparation for discharge home by identifying perceptions and attitudes of staff in both emergency department and primary care sectors. Background. It is recognized that older people discharged home directly from the emergency department are a vulnerable group. Effective communication and liaison are seen to be keys to the provision of high quality care for older people in the emergency department and in ensuring a seamless care between sectors. Design. A purposeful sample was collected that comprised the total population (n = 222) of all grades of medical and nursing staff in both the emergency department and all nursing (Public Health Nurses & Practice nurses) and medical staff (General Practitioners) in the primary care area. Methods. Methodology used was that of a survey approach of nursing and medical staff in both the emergency department and primary care services. Standardized questionnaires were employed which comprised both open and closed questioning style. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open‐ended questions were content analysed for themes. Results. Many staff in the primary care area reported the level of communication between the emergency department and the primary care area as unsatisfactory with confusion regarding follow‐up care and a lack of support for older people on discharge. Hospital staff reported the level of communication to be much greater than that perceived by their colleagues in primary care. There was agreement of staff in both sectors in relation to the perceived usefulness of a discharge liaison nurse in the emergency department. Conclusions. Previous research highlights communication difficulties when patients are discharged from hospital. Findings from this study indicate that this problem can also be applied to the emergency department. Relevance to clinical practice. Implications for practice include a need for a multidisciplinary approach to developing referral guidelines, staff training and a comprehensive dissemination of information between sectors ultimately to improve quality and continuity of care for the older person.     

Elderly people's perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden

Many countries encounter a demographic change where the number of elderly people will increase. As a result, the number of very old people needing care, services and medical assistance will increase. Care in the private home is often described as providing the best alternative for many elderly people. The aim of this study was to describe elderly people's perceptions of how they wanted to be cared for, from a perspective of becoming in need of assistance with personal care, in the future. Twelve couples of healthy elderly people living in a couple hood participated in an interview study. They were all 70 years and older and received no kind of professional care or social support. Open individual semi-structured interviews were conducted with the support of written vignettes. The vignettes were formed as scenarios that described three levels of caring needs where the elderly people would become ill. A qualitative content analysis was used to analyse the interviews. The findings were interpreted in one main theme: maintaining the self and being cared for with dignity to the end. The theme was built from three categories: at home as long as possible, professional care at nursing home when advanced care is needed and fear of being abandoned. The categories reflect the perception that when minimum help was needed, care and support by the partner and nursing staff were preferred. As the scenarios changed to being totally dependent on care, they preferred care in a nursing home. There was a pervading concern of the risk of not being seen as an individual person and becoming a nobody with no meaningful relations. Thus, there must be a singular goal to support old people, in all stages of their lives, through the recognition and affirmation of self, and providing care with dignity to the end.     

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.     

The use of physical restraint in institutional care of older people in Finland: nurses’ individual,communal and alternative modes of action

Aims and objectives. The aim of the study was to map nursing staff’s individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland. Background. The use of physical restraint in institutional care of older people involves modes of action that are linked to the personalities and modes of operation of individual nurses or to communal modes of operation mutually agreed on in the workplace. Nurse’s individual modes of operation are linked to consideration towards older people when using physical restraint. Communal modes of operation include joint discussion among nurses, decision‐making and written guidelines concerning the use of physical restraint. Design. A quantitative survey. Methods. The data were collected from nurses (n = 1148) working in healthcare centre wards, municipal and private nursing homes in Finland using a structured questionnaire (response rate 78%). Results. Older nurses and those with the longest working experience were most active in using individual modes of operation in situations where physical restraint was applied. Nurses’ participation in continuing education in care of older people increased the use of both individual and alternative modes of action. The alternative modes of action were one that understands the older person and one that focuses on negotiation. The use of physical restraint was often discussed in the workplace during information sessions or during work, but only 33% had written guidelines on the use of physical restraint. Conclusions. Education can be used to increase nurses’ ability to use alternative modes of action and thus decrease the use of physical restraint in institutional care of older people. Nursing management has a key role in making sure that units caring for older people receive written guidelines on the use of physical restraint. Relevance to clinical practice. Locums especially need more education to avoid the use of physical restraint.     

Caring for the Elderly

In the present article an endeavour is made to present an introduction to a new theoretical framework for caring for the elderly. The theory of gerotranscendence holds that old age is a stage with its own specific quality of life. The venture included two main phases—the introductory phase and the impact evaluation phase. During the introductory phase, ways of understanding and caring for the elderly (the new theory) were presented and discussed among 90 nurses and aids, constituting almost the entire staff working with the elderly in institutional settings in a small Swedish municipality. Six months after the end of the introductory phase, the impact evaluation was carried out using a mail survey. The impact evaluation revealed that almost half of the staff came to a new understanding of specific care recipients and that a third of the staff also changed their attitude towards caring for specific care recipients. The introduction of the new theory also reduced staff members' feelings of guilt about inadequacy at work.     

Supportive leadership in Swedish community night nursing

gustafsson c., fagerberg i. & asp m. (2010) Journal of Nursing Management 18, 822–831
Supportive leadership in Swedish community night nursing Aim The aim of the present study was to examine the support night nurses’ give to staff in community night nursing. Background Studies have shown that support given to staff is one of night registered nurses’ (RNs’) experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described. Methods All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations. Results The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership. Conclusions Out of ‘concern for the staff’ the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs’ awareness that by giving support to staff this affects the staffs’ caring for older people. Implications for nursing management The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.