Start a freestanding emergency center.

Community need sparked the concept for a freestanding emergency center. Key first steps: new legislation, construction, and education.

Pastoral care for the person with dementia.

We discuss the various stages of Alzheimer's disease and related disorders (ADRD) and present a psychosocial model which spiritual caregivers can use in their ministry, the Progressively Lowered Stress Threshold (PLST) model. We argue that religious activities are very important to these patients and that spiritual caregivers can make an important contribution.

Managing cognitive impairment in the elderly: conceptual, intervention and methodological issues.

PURPOSE: With the aging of society, the incidence of dementia in the elderly is also increasing, and thus results in increased numbers of individuals with cognitive impairment. Nurses and other researchers have investigated issues concerning the management of cognitive impairment. This article highlights conceptual, intervention and methodological issues associated with this phenomenon. CONCLUSIONS: Cognitive change is a multivariate construct that includes alterations in a variety of information processing mechanisms such as problem solving ability, memory, perception, attention and learning, and judgement. Although there is a large body of research, conceptual, intervention and methodological issues remain. Much of the clinical research on cognitive impairment is atheoretical, with this issue only recently being addressed. While many clinical interventions have been proposed, few have been adequately tested. There are also various methodological concerns, such as small sample sizes and limited statistical power; study design issues (experimental vs. non-experimental), and internal and external validity problems. Clearly, additional research designed to intervene with these difficult behaviors is needed. IMPLICATIONS: A variety of psychosocial, environmental and physical parameters must be considered in the nursing care of persons with cognitive impairment. Special attention has been given to interventions associated with disruptive behaviors. Interventions are complex and knowledge must be integrated from both the biomedical and behavioral sciences in order to deal effectively with the numerous problems that can arise over a long and changing clinical course. Some researchers and clinicians have suggested that a new culture regarding dementia care is needed, one that focuses on changing attitudes and beliefs about persons with dementia and one that changes how organizations deliver that care. This review identifies key conceptual, intervention and methodological issues and recommends how these issues might be addressed in the future.

Religion/spirituality and health among elderly African Americans and Hispanics.

1 It is important to view elders in a multicultural sense and also understand that there may be great heterogeneity within cultural or ethnic groups. 2 Knowledge of the impact of religion and spiritual beliefs for ethnic groups can help health care professionals design interventions that are culture-specific to the beliefs of individuals. 3 The psychiatric nurse is in a unique position to encourage the patient to use healthy religious practices to deal with their illness, whether mental or physical.

Assessment of urinary incontinence.

1. In the past, nursing practice toward incontinence has focused on urine containment and skin protection rather than on proactive treatment-oriented therapeutic care. 2. Accurate assessment and diagnosis of urinary incontinence determine the success of treatment. 3. Efforts directed at early identification, appropriate assessment and treatment, and linkage to community agencies should be initiated by the nurse.

Shining through: the humor and individuality of persons with Alzheimer's disease.

1. Elders with diminished levels of cognitive functioning are capable of providing meaningful, consistent responses that illustrate individual expressions of self. 2. The demented elder's history and experiences may provide important clues to understanding his or her current behaviors, verbalizations, and perceptions. 3. Humor may be used as a therapeutic intervention for persons with dementia and as a coping strategy for caregivers.

Freeing your patients from restraints.

New regulations and guidelines are pushing toward the goal of no restraints at all. Here's how to apply that ideal to the realities of acute care.

Unity in diversity: geropsychiatric nursing survey outcomes.

1. Most nurse respondents stated that increased education is of crucial importance in the care of geropsychiatric patients. This need for increased education covers a wide range of areas and includes the problems unique to elderly patients, medications in use, and ensuring that caregiving staff are adequately prepared to deal with geropsychiatric problems. 2. Of the 264 respondents to the survey, their degrees of education and certification and their employment settings represent a diversity of preparation and experience in their fields. This diversity allows them to incorporate a variety of skills in the care of geropsychiatric patients. 3. It is hoped that the survey information can aid in forming sound standards in geropsychiatric education and in the future, gaining certification in geropsychiatric nursing as a subspecialty.

Standardized care plan. Managing Alzheimer's patients at home.

1. Family-provided care of members with Alzheimer's disease and related disorders (ADRD) is complicated by the presence of secondary behavioral symptoms, such as agitation, that lead to caregiver depression, burden, and breakdown. 2. Caregiver education to manage secondary symptoms in ADRD can be simplified by using a theoretical framework of person-environment fit, providing a selection of interventions to modify the environment to reduce demand on the dwindling resources of the demented person. 3. The Progressively Lowered Stress Threshold (PLST) model identifies six areas of stress for persons with ADRD fatigue, change of caregiver, environment or routine, demands to achieve beyond capability, multiple and competing stimuli, affective response to perceived losses, and physical stressors.

Unity in diversity. Outcomes of the Geropsychiatric Nursing Survey.

The 264 persons who responded to the geropsychiatric nursing survey were diverse in both preparation and practice arenas. They remained up-to-date in the field through journals, certification and professional memberships, and they supported clinical geropsychiatric nursing research and the need to develop standards in geropsychiatric nursing education. Finally, these nurse respondents expressed a wide variety of policy, practice and educational concerns, most related to improved care for geropsychiatric patients and their families. Obviously, limitations exist to the generalizability of these survey results. First, respondents to this survey, which appeared in two journals, may not be representative of the overall geropsychiatric nursing population. Additionally, the methods for summarizing the survey results are not scientific. However, these results enable us to develop a picture of the geropsychiatric nursing community and provide a foundation for understanding the population and its characteristics.

Managing the care of patients with irreversible dementia during hospitalization for comorbidities.

Caring for the patient with AD hospitalized with comorbidities is a nursing challenge. By educating staff, using the PLST model, working with families, and implementing patient-focused care, positive outcomes are not only possible but probable. It is important for staff to work with caregivers in all aspects of care of the patient incorporating the patient's personal and medical historical knowledge into the care plan. Nursing facilities and families can provide a wealth of information, and communication before and after hospitalization maximizes positive outcomes for all concerned.

Developing a restraint use policy for acute care.

Restraint use has been a recent focus of attention in long-term care facilities. The Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, and the Food and Drug Administration have devoted attention to the prudent use of restraints. The authors address efforts of an acute care facility to comply with these regulations.

Suicide among elderly white men: development of a profile.

1. Older white men have the highest suicide rate in the nation; a linear increase of suicide occurs with each passing year of chronological age. 2. Elderly who attempt suicide are more likely to communicate their intentions less frequently and to use violent and lethal means. 3. Chronic sleep problems, pain, degenerative illness, or clinical depression may be experienced by older white men at suicidal risk; somatic complaints including imaginary symptoms can mask depression. 4. Educational programs, outreach mental health programs, and enhanced consultation/coordination improve case findings and early intervention. Holistic nursing care, including pain alleviation, depression assessment, and simple comfort measures, are imperative in suicide prevention in the elderly.

Iatrogenesis in the elderly. Drug-related problems.

Drug reactions are generally related to the influence of age, toxicity, side effects, immunologic reactions, idiosyncratic reactions, drug-drug interactions, and drug-disease interactions. In addition to age-related changes, the elderly are susceptible to the incidence of adverse drug reactions because of polypharmacy, incorrect self-administration of drugs, omission of drugs, taking another's prescriptions, use of over-the-counter drugs, and medication errors by health-care personnel. To prevent or predict adverse drug reactions, the gerontologic nurse can obtain thorough drug histories, educate clients and health-care providers, use nursing measures to alleviate symptoms, and be astute for the potential for problems through drug review.

Iatrogenesis in the elderly. Nosocomial infections.

The elderly are increasingly susceptible to nosocomial infection because of age-related changes and the presence of multiple chronic illness. Epidemics frequently occur in long-term care facilities with upper respiratory infections, diarrhea, conjunctivitis, and antibiotic-resistant bacteria the most common. Other common nosocomial infections are those of the respiratory tract, gastrointestinal tract, genitourinary system, and integumentary system. Infection control programs, systematic surveillance, regular inservice programs on infection control (especially handwashing), and employee and resident health programs can be instituted to decrease the incidence of nosocomial infections.

Caring for patients with Alzheimer's disease. Recommendations for nursing education.

1. Most educational programs for healthcare professionals stress acute rather than chronic care and provide little education or training related to caregiving of persons with dementia. 2. Long-term care facilities employ a minimum of licensed staff with the bulk of direct caregiving done by nursing assistants. 3. Licensed nurses and nursing assistants who work with the cognitively impaired should have specialized training and education in caring for persons with AD or other dementias. 4. Annual ongoing training and education should be provided for all caregivers of persons with a dementing illness.

The effects of pet therapy on the social behavior of institutionalized Alzheimer's clients.

Twelve (N = 12) Alzheimer's (AD) residents of a Special Care Unit in a large midwest Veterans' Home were observed for the effects of the presence of a pet dog on eight social behaviors: smiles, laughs, looks, leans, touches, verbalizations, name-calling, and others. Observations took place on three separate occasions (absence of dog, temporary presence of the dog, and permanent placement of the dog) in both group and individual settings. The results showed that the presence of the dog increased the number of total social behaviors of the AD clients, but no differences were found in behaviors between the temporary and permanent placement of the dog.