Wandering into the future: reconceptualizing wandering 'A natural and good thing'

There is still significant scope for improvement in knowledge on wandering in dementia and in the care of persons with dementia who wander. Although progress in research-derived knowledge is evident over the last 15 years, the current state of practice is influenced by an immature research base where the clarification of what wandering is still needs to be achieved. This is fuelled by research which to date, has framed wandering as a problem behaviour and generally starts from the premise that it needs to be prevented or severely controlled. People with dementia may think and feel differently about wandering, as will be suggested in this paper. The voices of those who have experiential expertise of dementia and wandering need to be included in the debate on wandering to influence both nursing research and practice. In regard to the practice context, it is suggested that there is little evidence to suggest that screening for wandering, assessment of wandering, person-centred and evidence-based care planning and interventions or evaluation are yet the norm for older persons with dementia. Thus, these areas must be the priorities for the immediate future. Whilst at a theoretical level, there are three key issues that require attention in the future: the orientation of research on wandering including reconceptualizing wandering to address the lack of theoretical frameworks to explain wandering, addressing the need some care settings might have with application of research and recognition of the experiential expertise of older persons with dementia.     

The use of life story work with people with dementia to enhance person-centred care

mckeown j., clarke a., ingleton c., ryan t. & repper j. (2010) The use of life story work with people with dementia to enhance person-centred care. International Journal of Older People Nursing 5 , 148–158 Background. Person-centred care has been linked with quality of care but difficulties remain in person-centred care being implemented in care practice. This study explores the use of life story work to enhance person-centred care with people with dementia. Aims and objectives. The study investigates how life story work is: understood and developed in practice; experienced by all participants and affects the delivery and outcomes of care. Design and methods. The experience of older people with dementia, family carers and care staff in using life story work was explored within an NHS Health and Social Care Trust. A multiple case study design was adopted within a constructivist approach. Semi-structured interviews, observation, conversations were employed. Findings. Life story work has the potential to: enable care staff to see the person behind the patient; allow family carers to uphold their relatives’ personhood; enable the voice of the person with dementia to be heard, verbally and non-verbally; be enjoyable for all concerned and enable the person with dementia to feel proud about themselves and their lives. Conclusion and implications for practice. Life story work has the potential to enhance person-centred care for older people with dementia and their families. Taking a practice development approach ensures that life story work can be implemented sensitively and is sustained in practice.     

Wandering in hospitalized older adults: identifying risk is the first step in this approach to preventing wandering in patients with dementia

People who have dementia are at risk for wandering away from the safety of the care setting and becoming lost in the community. Reported cases of people with dementia wandering off, even from locations such as hospitals, have become increasingly common. Preventing incidents in which the patient wanders away is critical because once a person with dementia becomes lost, she or he may die before being found. Three critical elements of prevention and action are accurate assessment of at-risk individuals, provision of intensive supervision, and implementation of a standardized search plan if a person with dementia is missing. Watch a free video demonstrating the best practices for preventing hospitalized patients with dementia from wandering away at http://links.lww.com/A306.     

Human rights,citizenship and dementia care nursing

Background. Human rights and citizenship are concepts widely used in health and social care literature. However, they are applied less frequently and less rigorously in dementia care. This paper briefly presents these concepts before exploring how they have been applied to dementia care policy and practice. We highlight areas of dementia care where human rights can be violated and citizenship can be denied. We suggest reasons why people with dementia can be denied their human and civil rights and discuss how such concepts provide a way to address cultural and practice change in dementia care. Aims and objectives. To demonstrate how these concepts can be used to challenge and improve dementia care nursing. Conclusions. This paper contributes to emerging discussion about dementia care nursing by challenging conventional ways of understanding dementia and the care practices that result. Taking a rights‐based approach allows nurses to examine inequity in services and address poor practice. Implications for practice. Looking at dementia through the lenses of citizenship and human rights provides a way to broaden the scope of contemporary dementia care nursing, to enable nurses to challenge inequity and to develop and improve the direct nursing care offered to people with dementia.     

What evidence underlies our practice with alzheimer families?

Registered nurses who base their practice on scientific evidence can justify their decisions and the care they provide to the families of people with Alzheimer disease (AD). The health care literature should provide an evidence base for nurses to draw on. Families care for older members with AD, regardless of whether the setting is a family home, long-term care facility, or day-support program. Sometimes families say they need information to enable them to provide quality care. Their questions may include "What happens next?" "Where do we go from here?" or "How do I stop the wandering?" This study reviewed AD education articles in five journals used by gerontologic health care workers-primarily registered nurses. Findings identified a serious lack of education-specific articles. The implication is whether registered nurses are meeting the education needs of families.     

Caring connections with older persons with dementia in an acute hospital setting - a hermeneutic interpretation of the staff nurse's experience

Background: The literature highlights the challenges inherent in caring for older persons with dementia in the acute care context. However despite concerns relating to the quality of care available to persons with dementia in this setting, there is a paucity of research with which to guide practice. Specifically the existing literature lacks in-depth knowledge on nurses' experiences. Aim: The aim of this paper is to report the findings of a study exploring nurses' experiences of caring for older persons with dementia in an acute hospital setting. Methods: Using a hermeneutic approach, a purposive sample of seven nurses was interviewed regarding the research phenomenon. Interview texts were subjected to thematic content analysis. Multiple data sources were employed to expand the horizon of understanding including: the textual data, personal and professional understandings, reflective journal data and conceptual frameworks derived from theoretical and research literature. The data were collected in 2002. Results: The findings reported here relate to the theme 'Meeting the patient as a person'. Meaningful care for the older person with dementia in the acute context required a respectful connection with the patient as person, which required establishing a bond with the person. The meaning of the caring experience was found to relate to the personhood of both the nurse and the patient, experienced within the context of relationship. To make this connection it was necessary to work with those who knew the patient best i.e. relatives/carers. Conclusions: Despite the contextual limitations of the acute setting, the importance of knowing and respecting the person with dementia and the centrality of relationship as the medium within which caring is experienced is demonstrated. However, nurses lack specific knowledge on which to base care. Further research is therefore recommended to identify how care which promotes the integrity of the person with dementia may be effectively operationalized across the acute care setting.     

Responding to responsive behaviours: A clinical placement workshop for nursing students

As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.     

Dementia, personhood, and nursing: learning from a nursing situation

Appreciation of the personhood of people with dementia calls for care that looks beyond the disease to the person within. In this column the author discusses the concept of personhood for people with dementia and presents a method of teaching person-centered care developed within the theoretical framework of nursing as caring. The study of an aesthetic expression of a nursing situation, written by a nurse who cares for people with Alzheimer's disease in a nursing home, is presented to assist nurses to learn to see beyond the disease to the person and to develop relationships that nurture personhood.     

The impact of discrimination against older people with dementia and its impact on student nurses professional socialisation

This paper aims to review the literature to identify persistent areas of concern in the care of the older person with dementia, and factors that may impact on the students experience both now and in the future. It is argued that despite recent policy initiatives, professional socialisation is impacted upon by resource limitations, negative attitudes and poor practice development in the care for people with dementia. A recognition of the interaction between societal, practice and curriculum issues is fundamental to overcoming negative professional socialisation and is a key aspect towards providing social justice for this group. The feasibility of making progress in this area is explored.     

Close relatives in intensive care from the perspective of critical care nurses

Aim. The aim was to describe critical care nurses’ experiences of close relatives within intensive care. Background. There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives. Design and method. The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis. Results. The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given. Relevance to clinical practice. This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.     

Academic reawakening: Situated experiences of undertaking a post graduate masters course in dementia

Master's level education can play important function in developing the knowledge and skills for nurses and allied professionals working in advanced roles in dementia care. However, little is known about the challenges experienced by professionals when making the transition to post-graduate study. This was a qualitative study comprising individual interviews with 15 graduates, nine of whom were nurses, who had experience of attending a part-time Master's in Dementia Care in the Northwest of England. Four sequential themes emerged from the data: ‘Deciding what to do’, ‘Taking it on’, ‘Keeping going’ and ‘Endings and New beginnings’. Findings confirmed that Master's education for nurses and other professionals is significant in developing knowledge and instilling confidence in changing practice. Nevertheless, professionals experienced challenges in juggling the competing demands of education, family and work and were seen to navigate and negotiate their student journey by drawing on internal resources and external supports. The study adds to evidence that Master's level study is likely to benefit practice in dementia care; however, employers and Higher Education Institutions need to develop effective and flexible supports to enable nurses and allied professionals to engage effectively in part-time taught post graduate education.     

Professional holistic care of the person with a stoma: online learning

Stoma care nurse specialists are valued for their diverse expertise, but it is essential that all practitioners who regularly care for people with stomas have the opportunity to develop professionally and influence this important area of practice. The vision of a clinical and educational team from Suffolk and south Norfolk led to the development of innovative web-based learning material. The aim is to inspire nurses to engage actively with people who have a stoma. 'Professional care of the person with a stoma' is about caring for the whole person, physically and emotionally, from the period before surgery, to their continuing care in the community. An overview of four aspects of stoma care is presented here as a way of sharing with a wider audience the expert practice harnessed during the development of this web-based module.     

Translating person-centred care: a case study of preceptor nurses and their teaching practices in acute care areas

Aims and objectives. The research aims to explore how preceptors interpret, operationalize, document and teach person‐centred care as they guide students within an acute surgical environment. Background. Person‐centred care is a term that is widely used in the nursing literature; however, its interpretation in nursing practice remains virtually unexplored. This is of great significance to nurses in general but to Irish nurses in particular on whom this study is focused. As preceptor nurses have been identified as key people in the education of clinical students, it was considered important to explore how clinical preceptors promote person‐centred care to current undergraduate nursing students. Design and method. Using a case study design and a qualitative approach, six preceptors were chosen to participate in this study. Data were collected by means of participant observation, review of nursing care records and semi‐structured interviews. Data were analysed in two stages. The first stage involved the identification of themes. In the second stage data were analysed using a number of propositions to examine and explain what was gleaned from the data in the context of what was originally identified in the literature. Results. Findings highlighted that preceptors had a limited conception of person‐centred care. Measures of care reflected the medical model of nursing. Beyond that, preceptors expressed care in terms of good manners or respectful etiquette. Preceptors also had limited appreciation of what learning entails and were sceptical about classroom theory other than what they considered essential for safe practice. Conclusions. This study highlights that preceptors need both internal and external support to implement the changes advocated by the Commission in Nursing in 1998 , the Nursing Education Forum in 2000 , the Department of Health and Children in 2001 and An Bord Altranais in 2003 . Relevance to clinical practice. Person‐centred care is a relatively new concept in nursing and recommended for practice. Preceptors need facilitation with its implementation. In an effort to promote changes in the delivery of health care, it is suggested that university‐based lecturers empower students to practice evidence‐based nursing as students and subsequently as qualified nurses.     

Work related predictors for "satisfaction with dementia care" among nurses working in nursing homes

In German nursing homes dementia care is gaining increasing relevance. Dementia care is known to bear the high risk of a substantial occupational burden among nursing staff. Within this context, the "nurses' satisfaction with the care for residents with dementia" is investigated. Secondary data of the German 3q-study is used to assess degrees of nurses' satisfaction with the care for residents with dementia and potential work related predictors. Data from 813 nurses and nursing aides working in 53 nursing homes were included. 42% of all nursing staff was dissatisfied with the care for residents with dementia in their institution, however, pronounced differences were found between the institutions. Registered nurses and nurses in leading positions were more dissatisfied. A multiple regression analysis indicates that high "quantitative demands", low "leadership quality" and "social interaction with other professions" are strong predictors for nurses' satisfaction with the care for residents with dementia. No association was found for "emotional demands" and "possibilities for development". The results indicate that the "nurses" satisfaction with the care for residents with dementia" may be a highly relevant work factor for nursing staff in nursing homes which deserves additional attention in practice and research. The high predictive power of several work organisational factors implies that preventive action should also include work organisational factors.     

A comparison of wandering behavior in nursing homes and assisted living facilities

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF). This study compared wandering behavior of residents (N = 108) in 21 long-term care facilities (15 NH, 6 ALF). Staff used the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) to quantify wandering. While there were some differences in demographic variables (i.e., race, motor ability) between NH and ALF participants, no significant differences were found in either RAWS-NH overall or any of the 6 subscale scores. This suggests that the expression of wandering is similar in long-term care residents across all dimensions of the RAWS-NH regardless of facility type. Findings are of concern for those involved in the safe management and protection of residents at risk for wandering, particularly in long-term care facilities with underregulated staffing and training requirements.     

Nursing in today's multicultural society: a transcultural perspective

The argument that nurses need to consider the different ethnic and cultural backgrounds of their patients, in order to provide effective and safe nursing care, is presented The concept of culture is then discussed in order to provide the conceptual context for examining transcultural nursing which is described as nursing practice that accounts for patients' cultural difference This paper also explores how transcultural nursing is the means for nurses to enable their patients to improve or sustain their health as both nurses and patients struggle with the contradictions of racism, oppression and'caring'that co-exist in a multicultural society