Caregivers' deepest feelings in living with Alzheimer's disease: a Ricoeurian interpretation of family caregivers' journals.

Caring for a person with Alzheimer's disease (AD) challenges family caregivers with existential questions about what is the right thing to do for themselves and their care recipient. This study extracted themes spontaneously occurring in self-disclosure through expressive writing and sheds phenomenological insight into the deepest feelings revealed by caregivers of loved ones with AD. The personal journals of 24 caregivers were analyzed in the framework of Ricoeur's philosophy of ethics based on the concept of personal identity. Caregivers reflected on themes in friendship, self-esteem, authenticity, and capacity to act with the ethical intention to stay present while the care recipient is disappearing. Engaging the text within Ricoeur's ethically sensitive philosophy and methodology illuminated the benefit of writing interventions that allow caregivers to speak about conflicted states regarding their own humanity in the caregiver experience.

Use of pain-behavioral assessment tools in the nursing home: expert consensus recommendations for practice.

Many tools are available for the assessment of pain in nonverbal older adults; however, guidelines are needed to help clinicians select the proper instrument for use in the nursing home setting. This article describes a project to identify clinically useful pain-behavioral assessment tools that have undergone sufficient psychometric testing. Phase 1 of the project included a comprehensive review and critique of currently available tools. In Phase 2 the National Nursing Home Pain Collaborative developed criteria to evaluate an updated list of tools and then rated 14 tools using these criteria. As a result, two tools were recommended as most representative of current state of the science, most clinically relevant, and practically applicable to integrate into everyday practice and support adherence to regulatory guidelines. Such recommendations for selection of best-available pain assessment tools are a cornerstone for clinicians in regard to managing pain of nursing home residents who, due to dementia, are unable to self-report pain.