Exploring the applicability of interdependence theory to CNA-resident relationships

This study explored the quality of certified nurse assistant (CNA)-resident relationships. Of interest was the extent to which interdependence theory could be used to code CNAs' responses to questions about their relationships with residents and factors that promoted or limited these relationships. Interdependence theory defines closeness in terms of outcome interdependence and provides an account of how trust and commitment can develop. Seventeen socially skilled CNAs from nine long-term care facilities participated in structured personal interviews. All of the CNAs said they had developed close relationships with some residents. CNAs' answers to interview questions indicated they were thinking "relationally" about their interactions with residents. Many CNAs made reference to commitment and pro-relationship behaviors that promoted relationships, and their responses supported the applicability of interdependence theory. Implications for training are that CNAs should be encouraged to think relationally, as well as dispositionally, and that boundary issues need to be explored.     

Do residents want automated external defibrillators in their retirement home?

PURPOSE: The administration of a continuing care retirement community (CCRC), while weighing practical and ethical questions surrounding installation of automated external defibrillators (AEDs), wanted to consider resident opinions. No databased studies on this subject were found. DESIGN AND METHODS: After an information session about AEDs, CCRC residents were surveyed concerning their opinions on AED installation, their beliefs and concerns regarding AEDs, their advance directive status, and their demographic characteristics. Correlations were sought between choices about AED installation and beliefs, advance directives, and demographics. RESULTS: Seventy-eight percent of 107 eligible residents participated. Twenty-seven percent wanted AEDs installed, 37% were not sure, 23% were opposed, and 11% did not answer this question. Univariate analysis showed that women, the widowed or single, and those with a college degree were more likely to oppose AEDs. In the best logistic regression (LR) model the hope that "AED use could be life saving" and the fears that "AED use might lead to a very poor quality of life" and that "AEDs might be misused" were more important than any demographic variables and only education remained in the model. Those opposing AEDs supplied powerful written comments to support their choice. CONCLUSIONS: There is no consensus and great indecision about AED installation among the residents of this CCRC. The subjects were somewhat older and more affluent than the typical retirement home population, pointing to the need for replicating the investigation with a larger and more diverse study population. However, these findings suggest that AED installation in a retirement home would be premature without engaging the entire community in discussions and education in a process considerate of the wishes of all residents, which are likely to be quite diverse.     

Person-centered caregiving instruction for geriatric nursing assistant students: development and evaluation

This research describes the development and evaluation of a 2-hour program that taught geriatric nursing assistant students person-centered caregiving skills. The person centeredness of caregiving skills among students who completed the training, as well as those who did not, was evaluated by coding their videotaped interactions with a standardized long-term care resident. Residents reported more satisfaction with students who had completed the special training, although there was little difference between the actual behavior of students in the intervention and control conditions. Students' interpersonal cognitive complexity was associated with their ability to provide care in person-centered ways.     

Promoting signing of advance directives in faith communities

OBJECTIVE: To develop a participatory educational program implemented in faith communities that would increase discussion and signing of two types of advance directives-living will and durable power of attorney for health care decisions. DESIGN: Longitudinal study with four annual cycles of program implementation, evaluation, and revision incorporating a program that fostered the discussion, signing, and/or revision of advance directives. The program involved an educational workbook and ongoing support by parish nurses. SETTING: Seventeen faith communities in Wichita, Kansas. Faith communities included several predominantly white congregations, as well as several primarily African-American and Hispanic congregations. PARTICIPANTS: Seventeen faith communities, their pastors, and 25 parish nurses worked with 361 self-selected residents, living in community settings, to participate in the program as members of their faith communities. Congregations were recruited by the executive director of a local interfaith ministries organization and parish nurses. MAIN RESULTS: Two hundred forty-eight (69%) of the congregants who started the program completed it. Of the program completers, 83 (33%) had a directive prior to the program and 140 (56%) had a directive after completion. One hundred eighty-six of the completers discussed directives with family members. Overall, 89 (36%) of the 248 program completers revised an existing directive or signed one for the first time. Age was positively related to having signed/revised a directive prior to the program. Fear that advance directives would be used to deny medical care was negatively related to signing both prior to the program and after program completion, and contributed to participants' reluctance to sign directives. CONCLUSIONS: Educational programs implemented by parish nurses in faith communities can be effective in increasing rates of discussion, revision, and/or signing of advance directives.     

Increasing Mexican American attendance of support groups for parents of the mentally ill: Organizational and psychological factors

Research was carried out to identify organizational and psychological factors associated with the attendance by Mexican Americans at family support groups. Qualitative and action-oriented pilot research identified parents' preferences for organizational arrangements, and two support groups were created that were Spanish speaking, facilitated by bilingual mental health professionals, and closely linked to ethnic mental health agencies. A prospective study was then carried out that involved 32 Mexican families with a son/daughter being treated for schizophrenia at one of the two agencies. The parent who was the primary caregiver in each family was interviewed and then referred to one of the two groups; parents' attendance was followed for 1 year. Parent attendance was related to the level of burden experienced and assumptions about the causes of their son/daughter's problems.     

Social networks and links to isolation and loneliness among elderly HCBS clients

Objectives: The purpose of this study was to explore the network types of HCBS clients based on the structural characteristics of their social networks. We also examined how the network types were associated with social isolation, relationship quality and loneliness.

Method: Forty personal interviews were carried out with HCBS clients to assess the structure of their social networks as indicated by frequency of contact with children, friends, family and participation in religious and community organizations. Hierarchical cluster analysis was conducted to identify network types.

Results: Four network types were found including: family (n = 16), diverse (n = 8), restricted (n = 8) and religious (n = 7). Family members comprised almost half of participants’ social networks, and friends comprised less than one-third. Clients embedded in family, diverse and religious networks had significantly more positive relationships than clients embedded in restricted networks. Clients embedded in restricted networks had significantly higher social isolation scores and were lonelier than clients in diverse and family networks.

Discussion: The findings suggest that HCBS clients’ isolation and loneliness are linked to the types of social networks in which they are embedded. The findings also suggest that clients embedded in restricted networks are at high risk for negative outcomes.