Management of Relocation in Cognitively Intact Older Adults.

Relocation, a major life transition that can affect health positively and negatively, is moving from one permanent home to another. Many older adults will relocate at some time during their life. Relocation is also a complex process that requires careful consideration and planning before the move (i.e., pre-location) and adjustment to the new home after the move (i.e., post-relocation). The current article is a summary of content based on a comprehensive evidence-based practice guideline focused on management of relocation in cognitively intact older adults. The guideline was designed to be used across diverse settings by nurses and other providers. Pre-relocation guidelines include assessment for the need for relocation, interventions prior to moving, and outcomes for evaluation of the pre-relocation process. For post-relocation, content focuses on assessment of risks for not adjusting after the move as well as intervention guidelines to promote adjustment and outcomes for evaluation. Implications include advocacy for older adults by using the guideline, disseminating it, and conducting future research. [Journal of Gerontological Nursing, 42(11), 14-23.].

Nursing delegation and medication administration in assisted living.

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

Assessing students' learning needs and attitudes: considerations for gerontology curriculum planning.

The growing number of older adults with multiple healthcare needs underscores the importance of teaching gerontological content to students in healthcare fields. To effectively accomplish this educational goal, it is essential to consider students' attitudes and learning needs related to caring for elderly persons. The purpose of this study was to identify prelicensure undergraduate nursing students' (N=200) perceived learning needs and attitudes toward older adults. Current knowledge of gerontology and attitudes were correlated with multiple variables including comfort and confidence in caring for older persons. Students identified their desire for more information on selected topics such as supportive resources for elders and their caregivers. Students who intended to learn more about gerontological nursing chose more topics; the two most commonly chosen topics were end-of-life issues and specific disorders. The data from this study can be used to design courses and curricula related to the care of elderly persons. Similar approaches to obtain student input can be adopted in designing other gerontology curricula.

Early identification of relocation risk in older adults with critical illness.

One aspect of an evidence-based practice (EBP) guideline on managing relocation in cognitively intact older adults is elaborated upon in this article. The older population is at particular risk for needing to relocate to a new permanent home following hospitalization for a critical illness, but planning for these moves is often done in crisis mode. The purpose of this article is to sensitize nurses to risks for relocation in critically ill older persons and to encourage application of the EBP guideline in practice. Recommendations for risk assessment are made including using existing and supplementary assessment methods and data. Implementing EBP guidelines such as this is one key element in providing quality care to critically ill older adults.

An emerging typology of academic interdisciplinary gerontology centers in the United States.

Little is known about the organization, characteristics or services offered by academic interdisciplinary gerontology centers located in higher education institutions. This article presents a description and an emerging typology of academic interdisciplinary gerontology centers based on information collected from the Websites of 47 centers. The emerging typology comprised three dimensions: focus, functions and specialty areas. Significant relationships were found between the center's function and focus as well as function and number of specialties. The newly developed typology is useful for classifying and learning about academic interdisciplinary gerontology centers. Students who have an interest in gerontology might use the classification system to select a school that matches their academic goals. Educators and educational administrators might apply the typology's dimensions in program development. The typology might also serve as a useful framework for future research and policymakers could use the information from the typology and center's Websites to support proposed policies. Furthermore, older adult consumers, their families and professional caregivers can use the information to learn about services and resources.

Management of relocation in cognitively intact older adults.

As the older adult population grows, the rate of relocation from one home to another will also increase. To promote planning for relocation to a new home and adjustment to this stressful life event, pre-relocation and post-relocation risks need to be assessed and interventions designed to facilitate relocation decision making and adjustment. The evidence-based guideline by Hertz et al. (2005) provides detailed tools and recommendations for management of pre-relocation and post-relocation processes with cognitively intact older adults by nurses and other health care providers in community-based care, long term care, and acute care settings.

Older women's breast screening behaviors: what nurses need to know.

A study was conducted to assess whether the screening behaviors of breast self-examination, mammography, and clinical breast examination differed among older women. Results have implications for nurses caring for older women.

Ensuring a knowledgeable and committed gerontological nursing workforce.

There is a growing societal need for professional nurses who are knowledgeable and committed to working with older adults. In order to address this need, a small study that included self-evaluation and curriculum review was conducted by faculty at one Midwestern nursing program in the United States. A moderately positive attitude, moderately high knowledge, and moderate pursuit of knowledge of older adults were identified with the faculty in the presence of limited curricular content of gerontology. Implications for nursing education included continuing education for nursing faculty and program support in nursing curricula.

Collaboration to promote best practices in care of older adults.

A successful grassroots collaboration of faculty members from one Midwestern school of nursing to promote best practices in gerontological nursing is described. Recommendations are made for developing similar collaborations in other settings.

Relationships among perceived enactment of autonomy, self-care, and holistic health in community-dwelling older adults.

The purpose of this article is to report findings from two studies of community-dwelling older adults. The focus of both studies was on delineating relationships among perceived enactment of autonomy (PEA) and selected self-care and health variables from the perspective of Modeling and Role-Modeling nursing theory. Results indicated that PEA, representing the potential for self-care action, was positively correlated to perceived control and morale in Study 1 and to life satisfaction in Study 2. Significant differences in PEA scores were found based on the health indicators of participation in social activities and reliance on others for shopping in Study 2. In addition, Study 1 found that morale, gender, age, perceived control, and education accounted for 39% of the variance in PEA. Implications are discussed for designing theory-based holistic nursing interventions to support PEA in older adults and to direct future research.