ORCID Profile
0000-0003-4161-9697
Current Organisation
Edith Cowan University
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Publisher: Hindawi Limited
Date: 09-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2004
DOI: 10.1097/00002820-200401000-00009
Abstract: To determine which wound-healing factors impact on the severity of radiation skin and oral mucosal reactions in head and neck cancer and to test modifications to the Radiation Therapy Oncology Group (RTOG) acute toxicity scoring system. A consecutive s le of 53 head and neck cancer patients who were scheduled for curative or palliative radiation therapy. Therapy was planned using traditional computerized techniques. A new RTOG subscale for tongue reactions was developed. Information on potential predictors was collected during the first week of treatment. Reactions were observed and documented each week throughout treatment using the RTOG Acute Reaction Scoring System scores of acute oropharyngeal reactions and various personal factors. Significant relationships were found between severe skin and oral reactions and age, commencing radiation within 2 months of surgery and smoking. Significant relationships for severe oral mucosal reactions were found with weight at the commencement of treatment, inadequate or poor diet, having had mucositis with previous chemotherapy, and the use of a custom-made Perspex tongue immobilizer. Three conclusions can be derived from this study: (1) structures within the oral cavity should be considered separately for toxicity scoring, (2) the newly developed tongue RTOG subscale adds accuracy and specificity to the RTOG acute toxicity scoring system, and (3) wound healing factors are an important component of understanding risk for side effects in head and neck cancer treatment.
Publisher: Wiley
Date: 05-05-2020
DOI: 10.1111/JAN.14392
Publisher: Hindawi Limited
Date: 25-04-2007
DOI: 10.1111/J.1365-2524.2007.00711.X
Abstract: Advances in cancer care and treatment have created a new and somewhat anomalous category of patients with a diagnosis of non-curative disease who still have a considerable period of life remaining. During much of this time they may remain relatively well, without manifest need for clinical care. The responses of patients to this challenging situation are largely unknown. However, it has been assumed that because they confront a difficult experience they will need, or can benefit from, professional intervention. The implementation of pre-emptive support measures is anticipated to improve patients' resilience in coping with their illness and approaching death. This study aimed to investigate the impact of the keyworker role in a 3-year cancer supportive community care project to identify and provide for the needs of patients with a diagnosis of non-curative cancer. It was a qualitative study incorporating face-to-face interviews and focus groups with 19 healthcare professionals and 25 patients and carers from an urban East Midlands locality and a thematic analysis of qualitative interview and focus group transcripts. The project was positively evaluated by patients, carers and professionals. However, the findings raised questions about the different configuration of 'need' within the lay and professional perspectives and how this should most appropriately be addressed. In contrast to widespread professional assumptions about patients' need for counselling, many patients preferred to turn to their friends and families for support, and to adopt a stance of emotional and personal self-reliance as a strategy for coping with their predicament. The study highlights the continuing orientation of services around professional, rather than patient, agendas and the momentum towards increasing specialisation of professional roles and the medicalisation of everyday life that flows from this.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.IJNURSTU.2014.04.003
Abstract: Person-centered care has been widely promoted in long-term care settings. It is commonly referred to as a core concept that guides the care philosophy change in long-term care settings from a traditional medical model to a more humanistic approach to care. Current person-centered practice in long-term care settings is guided by multiple person-centered care models. However, evidence regarding the effects of person-centered practice guided by multiple models on residents' outcomes has not been well established or synthesized. To outline and compare the principal models and to synthesize current evidence of the effects of multiple person-centered care models on resident outcomes. Systematic searches were conducted using CINAHL, MEDLINE, PsychoINFO, Evidence Based Medicine Reviews, Cochrane Review databases, and ProQuest Dissertations and Theses using the following keywords (UK and US spellings) in idually and in multiple combinations: person-centered care, resident-centered care, client-centered care, in idualized care, patient-centered care, culture change, Eden Alternative, Wellspring, Green House, Pioneer Network, dementia, nursing home, assisted living and long-term care. The searches were limited to articles written in English and published from January 1990 to April 2013. Then a manual search of the reference lists of selected relevant articles was conducted. Twenty-four studies from three countries were reviewed and compared in terms of person-centered interventions, measurement, and resident outcomes. 15 culture change studies for residents who were cognitively intact or with minor cognitive impairment and 9 studies for residents with dementia were reviewed. Across the studies, culture change models had some beneficial effects on residents' psychological wellbeing. Person-centered dementia care had significant effects on decreasing behavioral symptoms and psychotropic medication use in dementia residents in long-term care. An agreed upon definition of person-centered care is essential for researchers and clinicians to guide person-centered care development and implementation. Rigorous study design and objective and subjective measurement use are needed for future studies, especially those guided by culture change models. The effectiveness of person-centered care on residents' bio-psycho-social outcomes like sleep, stress, and physical wellbeing need to be addressed and systematically examined with subjective and objective measures in future studies.
Publisher: MDPI AG
Date: 16-06-2022
DOI: 10.3390/JAL2020013
Abstract: Most older adults desire to be as independent as possible and remain living in their ancestral home as they age. Aging-in-place maximizes the independence of older adults, enhancing their wellbeing and quality of life while decreasing the financial burden of residential care costs. However, due to chronic disease, multimorbidity, and age-related changes, appropriate conditions are required to make aging-in-place possible. Remote monitoring with smart home technologies could provide the infrastructure that enables older adults to remain living independently in their own homes safely. The health-assistive smart home shows great promise, but there are challenges to integrating smart homes on a larger scale. The purpose of this discussion paper is to propose a Design Thinking (DT) process to improve the possibility of integrating a smart home for health monitoring more widely and making it more accessible to all older adults wishing to continue living independently in their ancestral homes. From a nursing perspective, we discuss the necessary stakeholder groups and describe how these stakeholders should engage to accelerate the integration of health smart homes into real-world settings.
Publisher: Hindawi Limited
Date: 09-1999
DOI: 10.1046/J.1365-2354.1999.00153.X
Abstract: Radiation skin reactions occur in the majority of cases of patients undergoing radiotherapy for breast cancer with varying degrees of severity. Guidelines for skin care and for the use of topical agents and dressings have developed over the years of practice but there is little empirical evidence on which to base a decision for best practice. This paper describes the incidence of radiation skin reactions in a s le of 126 women treated for breast cancer post-lumpectomy. The results show that by the end of whole breast irradiation between 4-8% of patients will have no reaction and less than 10% will have moist desquamation as measured by the RTOG acute scoring system. The majority of patients did not require application of a topical agent during the treatment period. Statistical analysis of relationships between the severity of radiation skin reaction and the use of topical agents found no support for additional healing or preventative benefit. However, these topical agents were found to promote comfort. The use of Fixomull as a protector and potential preventive measure for moist desquamation is described.
Publisher: Elsevier BV
Date: 10-2008
Publisher: Elsevier BV
Date: 04-2010
Publisher: Informa UK Limited
Date: 17-12-2015
Publisher: Elsevier BV
Date: 02-2006
Publisher: Wiley
Date: 03-11-2011
DOI: 10.1111/J.1365-2648.2011.05865.X
Abstract: The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of in idual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations.
Publisher: Mary Ann Liebert Inc
Date: 09-2000
Abstract: The Karnofsky Performance Status (KPS) scale is considered to be the gold standard for quantifying the physical functioning of patients with cancer. However, problems have been identified with the scoring system when the scale is used in the home hospice setting. The goal of this study was to compare assessments of performance status using two instruments, the KPS and a modified version, the Thorne-KPS (TKPS). The TKPS avoids reference to location of care and has new descriptors for assessing the frequency of professional visits and the proportion of time spent in bed. Comparisons were made on a s le of 78 home-hospice patients in Perth, Western Australia. The median score for both scales was 60. The scales agreed in 56% of ratings overall but after correcting for chance, agreement was reduced to 47%. However, 91% of the 34 discrepancies occurred within one or two levels of the 11-point scale. TKPS scores were consistently lower than KPS scores and were spread over a wider range of the scale. The strongest agreement occurred at the higher levels of performance and the weakest agreement was within the middle levels of the scales. Further studies are required to determine which of the two scales more accurately reflects performance status and survival time. However, the results to date suggest that the TKPS may be a more objective and sensitive measure of functional performance in home hospice patients.
Publisher: Oxford University Press (OUP)
Date: 04-2005
Abstract: Currently, 24% of all deaths nationally occur in nursing homes making this an important focus of care. However, many residents are not identified as dying and thus do not receive appropriate care in the last weeks and months of life. The aim of our study was to develop and validate a predictive model of 6-month mortality risk using functional, emotional, cognitive, and disease variables found in the Minimum Data Set. This retrospective cohort study developed and validated a clinical prediction model using stepwise logistic regression analysis. Our study s le included all Missouri long-term-care residents (43,510) who had a full Minimum Data Set assessment transmitted to the Federal database in calendar year 1999. Death was confirmed by death certificate data. The validated predictive model with a c-statistic of.75 included the following predictors: a) demographics (age and male sex) b) diseases (cancer, congestive heart failure, renal failure, and dementia/Alzheimer's disease) c) clinical signs and symptoms (shortness of breath, deteriorating condition, weight loss, poor appetite, dehydration, increasing number of activities of daily living requiring assistance, and poor score on the cognitive performance scale) and d) adverse events (recent admission to the nursing home). A simple point system derived from the regression equation can be totaled to aid in predicting mortality. A reasonably accurate, validated model has been produced, with clinical application through a scored point system, to assist clinicians, residents, and family members in defining good goals of care around end-of-life care.
Publisher: Elsevier BV
Date: 02-2006
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.IJNURSTU.2013.03.001
Abstract: Person-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-centred care and interventions should be designed to sustain their personhood. Using Kitwood's five dimensions of personhood as an a priori framework, the aim of this paper was to explore the way in which current approaches to care in acute settings had the potential to enhance personhood in older adults with dementia. Data collected to explore the current experiences of people with dementia, family carers and co-patients (patients sharing the ward with people with mental health problems) during hospitalisation for acute illness were analysed using a dementia framework that described core elements of person centred care for people with dementia. Recruitment was from two major hospitals within the East Midlands region of the UK, focusing on patients who were admitted to general medical, health care for older people, and orthopaedic wards. Participants were people aged over 70 on the identified acute wards, identified through a screeing process as having possible mental health problems. 34 patients and their relatives were recruited: this analysis focused on the 29 patients with cognitive impairment. The study involved 72 h of ward-based non-participant observations of care complemented by 30 formal interviews after discharge concerning the experiences of the 29 patients with cognitive impairment. Analysis used the five domains of Kitwood's model of personhood as an a priori framework: identity, inclusion, attachment, comfort and occupation. While there were ex les of good practice, health care professionals in acute settings were not grasping all opportunities to sustain personhood for people with dementia. There is a need for the concept of person-centred care to be valued at the level of both the in idual and the organisation/team for people with dementia to have appropriate care in acute settings.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.BREAST.2011.07.003
Abstract: The objectives of the study day were to (i) develop an in-depth understanding around the biology and treatment options (ii) explore the specific physical and psychosocial needs and consideration including patients perspective and (iii) gain insight into the development of a dedicated, holistic and multi-disciplinary clinic service and the importance of supporting research, for older women with primary breast cancer. The format included presentations (with lectures from external and local faculty, and short research papers from Nottingham) with a number of interactive discussions, and sharing of patients' experience. Four sessions were held covering (i) pathological features, (ii) role of radiotherapy and adjuvant chemotherapy, (iii) role of surgery, geriatric assessment and quality of life issues, and (iv) challenges in running research trials. A dedicated and joint team approach is required to improve clinical service and support research, in order to optimise the management of primary breast cancer in older women.
Publisher: Wiley
Date: 19-09-2013
DOI: 10.1111/JOCN.12342
Abstract: To explore the responses of healthcare professionals to the admission of people with cognitive impairment to the acute hospital setting. While improving care for people with dementia has been identified as a national priority, providing appropriate care in acute hospitals for people with comorbid cognitive impairment presents challenges to healthcare professionals. Based on the principles of ethnography, this was a qualitative interview and nonparticipation observational study. Seventy-two hours of nonparticipant observations of care together with semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had a cognitive impairment. Interviews and observations were conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. The results identified a core problem, 'disruption', and a core process, 'gaining or giving a sense of control to cope with disruption'. Healthcare professionals respond to the disruption in three ways: by acting to preserve the personhood of the in idual by seeking to protect themselves from the stresses associated with caring for the person with cognitive impairment and by suspending the personhood of the in idual. Where healthcare professionals acted to suspend the personhood of the patient, they appeared to be demonstrating signs of 'burnout'. There is a need both to challenge poor practice and for positive development work with healthcare professionals who work in acute hospitals with people with dementia and cognitive impairment so that they are equipped with the skills, emotional resilience and organisational support to be effective in meeting the needs of people with dementia and cognitive impairment.
Publisher: Elsevier BV
Date: 2003
Publisher: Elsevier BV
Date: 05-2004
Publisher: Elsevier BV
Date: 09-2003
DOI: 10.1016/S0020-7489(03)00014-2
Abstract: Clinical decision-making is an integral component of the role of the professional nurse. The aim of the study was to identify the quality of decision making of Greek and English coronary care nurses during the acute and recovery phases post-myocardial infarction (MI), and determine factors that best predict clinical decision-making in these two discrete groups of nurses. By identifying best practice from standard textbooks and expert practitioners, Clinical Decision-Making cards were developed and employed to explore nurse decision-making. A questionnaire (influencing factor questionnaire-IFQ) was also administered to determine which factors predicted quality nurse decision-making in the acute and recovery phase of post-MI patient care. The results showed that nurses in England made better quality clinical decisions in the recovery phase of MI than the Greek counterparts (p<0.001). Variables were identified which best-predicted decision-making. Interestingly, the main finding of this study was that English nurses had greater autonomy in the recovery phase and therefore made more clinical decisions concerning the patient psychosocial recovery than Greek nurses. Nurses perceived clinical experience as the strongest factor influencing decision-making.
Publisher: Oncology Nursing Society (ONS)
Date: 07-2005
Publisher: Elsevier BV
Date: 05-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2007
Publisher: RCN Publishing Ltd.
Date: 03-2011
DOI: 10.7748/NOP2011.03.23.2.21.C8352
Abstract: To explore the meaning of falling for older people who had participated in a falls prevention programme to establish the importance of identity in falls prevention interventions. Data were collected in a 14-week video observation period of two consecutive falls prevention group programmes, examination of participant referral records and a series of semi-structured interviews with 11 participants. The meaning of falling for older people is closely related to the in idual's identity. Participants attended the falls prevention programme because a professional they respected referred them, not because they thought they would gain personal value. Participants used a collective identity, of in iduals who fall, to show how they differed from this social construct. The findings indicate the importance of the personal and collective identity of ageing on falls prevention. Professionals consulting with older people about falls prevention should offer in idual plans that are agreed and valued by the older person.
Publisher: Wiley
Date: 04-10-2023
DOI: 10.1111/AJAG.13241
Publisher: SAGE Publications
Date: 2005
Abstract: Educating parents of children with cancer is a primary nursing responsibility in pediatric oncology. A survey using Delphi techniques was conducted with nurses attending a Children’s Oncology Group Nursing Workshop to identify priority educational topics from pediatric oncology nurses’ perspective. In round 1 of the survey, nurses were asked to identify 5 priority educational topics and 5 topics they spend the most time teaching parents. Twenty-four educational categories were identified by 199 nurses, and responses were sorted by category and frequencies tabulated. Information about treatment was the most frequently cited priority. Bone marrow suppression (BMS) was the second most important priority and was the topic nurses spent most time in teaching. Round 2 of the survey was sent via e-mail to 132 consenting participants from round 1. Nurses were asked to rate the importance of the categories from round 1 (presented in random order) during 4 time periods (diagnosis, initial treatment, maintenance, and off therapy). Nurses reported different teaching priorities across the continuum of treatment. Of note, teaching about end-of-life issues and alternative therapy were ranked as low in importance across all time points. These findings can be used to inform educational programs and materials development for parents of children with cancer.
Publisher: Cambridge University Press (CUP)
Date: 19-09-2013
DOI: 10.1017/S0144686X13000561
Abstract: This qualitative study aimed to gain insight into the experience of hospitalisation from the perspectives of the older person with dementia, their family care-giver and other patients sharing the ward (co-patients). Non-participant observation of care on 11 acute hospital wards was supplemented by 39 semi-structured interviews with 35 family care-givers and four co-patients following discharge. Constant comparative analysis produced the core problem facing all those involved: disruption from normal routine meaning that the experience of hospitalisation was disrupted by the presence and behaviour of the person with dementia. Disruption adversely affected the person with dementia, triggering constructive, disengaged, distressed and neutral behaviours. Using Kitwood's model of person-centred care, these behaviours were interpreted as attempts by the person with dementia at gaining a sense of control over the unfamiliar environment and experience. Family care-givers' lives and experiences both inside and outside the hospital were disrupted by the hospitalisation. They too attempted to gain a sense of control over the experience and to give a sense of control to the patient, co-patients and staff. Co-patients experienced disruption from sharing space with the person with dementia and were left feeling vulnerable and sometimes afraid. They too attempted to gain a sense of control over their situation and give some control by helping the person with dementia, the family care-giver and the staff.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.NEDT.2008.08.017
Abstract: This article describes the implementation and evaluation of a novel form of assessment of communication skills and knowledge for all branches of nursing students in a multi-c us UK Midlands university. The assessment took the form of a recorded scenario which was presented on DVD and a series of assessment questions inviting students to consider communicative and care delivery aspects of the events depicted. This 'DVD trigger' assessment yielded theoretically informed, practically relevant answers from the students, over 80% of whom passed. Student reactions to the assessment were elicited via a specially designed questionnaire which indicated broad approval for the assessment and yielded a high degree of internal reliability, and suggested that attitudes to the assessment could be grouped into three major factors. The first factor comprised items relating to the practical aspects of the examination, the second to teaching, learning resources and exam support and the final factor represented the perceived relationship between the examination and the skills involved in care delivery and communication in professional practice. This highlights the value of evaluating students' responses to assessment in developing new forms of examination and in harmonising assessments with learning resources, teaching and appropriate preparation for exams. Moreover, we argue that the face validity of assessments is important in ensuring students' engagement with the learning tasks and assessment activities and may contribute to the broader validity of the assessment enterprise in predicting and enhancing skills in subsequent professional practice.
Publisher: Elsevier BV
Date: 2010
Publisher: Mary Ann Liebert Inc
Date: 02-2003
DOI: 10.1089/10966210360510136
Abstract: To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in 1999. Nursing homes. Residents of nursing homes designated as either hospice or end-stage on admission MDS. Percentage of hospice residents having various conditions as compared with other end-stage residents. Overall the clinical conditions of both hospice and nonhospice end-stage residents were similar. A greater percentage of hospice residents were found to have living wills, DNR orders, and cancer, and to be in moderate or severe pain. Hospice and nonhospice residents experienced similar time from admission to death or discharge (20 and 36 days, respectively). Based on the clinical condition of the two groups, it would appear that there are limited clinical reasons for the low utilization of the hospice benefit in nursing homes. The increased prevalence of advance care planning may lead toward use of hospice or may result from hospice enrollment. Hospice services seem to be thought of more frequently for residents with cancer and residents experiencing pain. Nursing homes must recognize their role as caregivers to the dying before palliative care is seen as a need for nursing home residents. Nursing homes need education in determining when a patient is appropriate for palliative care as only 4% are designated as end of life, and only 2% are shown to be receiving hospice care in hospice-contracted facilities.
Publisher: Wiley
Date: 21-02-2012
Publisher: Hindawi Limited
Date: 11-2009
Publisher: Springer Science and Business Media LLC
Date: 16-01-2008
DOI: 10.1007/S00520-007-0377-X
Abstract: The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines rotocols, 47% reported not having received any education about oral CT drugs. While 64% report being involved in patient education, 58% of subjects indicated lack of patient education materials that are specific for oral CT agents. Only 27% stated that they gave all necessary information such as when and how to take the drugs, drug safety and storage, side effects, and symptom management. Reasons for not being involved in oral CT education and follow-up included beliefs that the physician plans the oral CT and gives patients necessary instructions (34%), that nurses only see patients who receive intravenous chemotherapy (16%), that nurses have lack of knowledge about oral agents (15%), and belief that physicians are responsible for patient follow-up. The nurses suggested better education and follow-up of patients to include the written patient education materials (33%) and professional education for nurses (30%). Findings revealed the need for professional education for nurses to ensure comprehensive, consistent patient education and development of written materials for patients receiving oral CT treatment.
Publisher: Hindawi Limited
Date: 14-10-2009
Publisher: Hindawi Limited
Date: 03-2002
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.JAMDA.2013.01.013
Abstract: Person-centered care (PCC) is a revolutionary approach to the culture change of elder care that is being adopted by nursing home providers across the nation. One aspect of PCC is the introduction of more self-contained units or households within long term care facilities. This study aimed to evaluate the effect of households on nursing home residents' physical and psychological outcomes using the Minimum Data Set (MDS) comprehensive assessment data. A retrospective, longitudinal study. Two care units in a large urban nursing home within the Western New York long term care system. Residents living in two units (household unit and traditional care unit) within one nursing home during January 2005 to April 2007. The MDS 2.0 is a standardized and comprehensive assessment tool that measures long term care facility residents' functional, medical, cognitive, and psycho-social status. The de-identified MDS 2.0 records of residents living in these units during this time period were retrieved from the New York Association of Homes and Services for the Aging. The residents' cognitive patterns, mood and behavior pattern, physical functioning, pain, fall, nutritional status, number of ulcers, medication use, and special treatment were compared. Descriptive and correlational statistics were used for data analysis. MDS records of 35 household-unit residents and 33 traditional-unit residents were analyzed. After adjusting for baseline differences, household-unit residents had better self- performed eating ability, daytime sleepiness, and restraint use however, more fall incidents were reported for the household unit. Our findings indicate that households generated some better outcomes for residents and provide preliminary evidence to support households in nursing homes. Further research is needed to overcome design issues however, the MDS may be useful for PCC outcomes measurement.
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-059783
Abstract: To systematically review and synthesise evidence on the experiences of older immigrants living with dementia and their carers. A systematic review and meta-synthesis of qualitative studies. Studies exploring the experiences of older immigrants living with dementia and their carers were eligible. Databases were searched including CINAHL, MEDLINE, PsycINFO, PubMed, Embase, Web of Science and Cochrane Library from January 2000 to April 2021. Quality assessment was undertaken using the Critical Appraisal Skills Programme checklist for qualitative studies. Data were then synthesised using the thematic synthesis approach. The results of this meta-synthesis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Enhancing transparency in reporting the synthesis of qualitative research statement. A total of 3857 studies were returned from the database search. Eighteen studies were included for meta-synthesis. Five synthesised findings were identified: living with dementia and caregiving family relationships barriers to dementia care services stigma and discrimination and legal and financial issues. The experiences of living with dementia and caregiving presented multiple challenges for older immigrants living with dementia and their families. However, there seems to be very little difference between the experiences of those who have migrated to a new country and those who were born and aged in the same country, but the ability to access and use the available services is different. A lack of culturally appropriate dementia services, language barriers and dementia stigma can impede access to dementia care for older immigrants. Strategies to mitigate these barriers are urgently needed to ensure people from culturally and linguistically erse backgrounds with dementia and their families have the information, education and support to access dementia services, in addition to research that explores the experiences of culturally and linguistically erse populations. CRD42021277913.
Publisher: Wiley
Date: 13-08-2002
DOI: 10.1046/J.1365-2648.2002.02307.X
Abstract: The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use. The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing. A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms. There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed. The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.
Publisher: SLACK, Inc.
Date: 08-2015
DOI: 10.3928/00989134-20150710-02
Abstract: The current article reports the consensus recommendations from in iduals living with dementia and their care partners on priorities for public policy and research funding, which were found using a nationwide, Delphi study. A modified snowball s le was used. Listservs, personal contacts, and advocacy groups were asked to distribute the survey. Paper versions were provided upon request. In Rounds 1 and 2 of the study, 388 and 301 responses, respectively, were received. Borda counts produced a ranked order consensus of priorities. Research ranked third, after the need for caregiver support and resources for the provision of long-term care. Education and training in person-centered practices for all care partners was also a high priority. Responses indicated that research funding should be expanded beyond its current emphasis on cure. Policymakers should reconsider the current priorities of the National Alzheimer’s Project Act to better address the long-term needs of in iduals living with dementia and their care partners. [ Journal of Gerontological Nursing, 41 (8), 9–16.]
Publisher: Wiley
Date: 23-04-2013
DOI: 10.1111/JAN.12159
Abstract: To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members. Qualitative interview study. Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. The findings elaborate a core problem, 'disruption from normal routine' and a core process, 'gaining or giving a sense of control to cope with disruption'. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided. Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously.
Publisher: Wiley
Date: 27-06-2019
DOI: 10.1111/JNU.12488
Abstract: The provision of quality care in nursing home (NH) facilities is an ongoing challenge, and the literature indicates that the quality of care (QOC) is often suboptimal. While it is highly recommended that NH facilities adopt a culture of person-centered care (PCC) to ensure quality care, the outcomes of this shift on staff working in NH settings has not been well studied. The purpose of this article was to understand the theoretical relationship between staff and job satisfaction, stress, turnover, and staff outcomes in PCC NH settings, by utilizing Cohen-Mansfield's (1995) comprehensive occupational stress model. An integrative review of the electronic databases of research published in English between 2000 and 2015 was conducted. A review of 11 papers suggested that job satisfaction in the nursing workforce is positively related to consistency in QOC delivery and increased quality of life among residents in NHs. Management support and PCC practices positively correlate with improved QOC, staff satisfaction, and staff retention. This review showed that PCC intervention and training representing the key concept of workplace resources has a positive impact on NH staff job stress and satisfaction. Supporting the NH workforce through PCC training is essential for promoting job satisfaction and reducing job-related stress as well as turnover, which in turn will improve QOC delivered to the residents living in NHs.
Publisher: Springer Science and Business Media LLC
Date: 16-07-2010
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.COMPBIOMED.2004.07.001
Abstract: This article uses a human factors evaluation framework to assess the usability of commercially available videophone technology. One study focuses on minimally functionally impaired seniors living in an assisted living facility. The second study focuses on usability for hospice staff. Seniors found the technology easy to use and were willing to accept the equipment in their homes, especially if requested by a healthcare provider. Administrators and hospice care providers also reported that the videophones were easy to use and would be of benefit to the patients they care for. The results indicate that videophones are a promising intervention with identifiable limitations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
DOI: 10.1097/00124645-200611000-00007
Abstract: Pain is a significant health issue, especially among hospitalized patients and elders. Nurses are the key to effective pain management however, several studies over the past 20 years have demonstrated that nurses lack the knowledge necessary to manage pain effectively. Staff development educators have used a number of education methods to address this deficit. Additionally, educators in staff development have the task of providing education in an effective and cost-efficient manner. The purpose of this study was to assess the pain knowledge scores of a group of nurses practicing in a rural Midwest retirement community before and at two points after a pain education intervention to determine the effectiveness of Knowles' Adult Learning Theory in increasing and sustaining rural nurses' pain knowledge scores.
Publisher: Walter de Gruyter GmbH
Date: 04-2014
DOI: 10.5372/1905-7415.0802.275
Abstract: Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium. Objective: To quantify the reported factors associated to delirium for patients with hip fracture. Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors. Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%-39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03-1.09), male sex (ES = 1.34, 95% CI = 1.08-1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91-4.42), and function (ES = 1.75, 95% CI = 1.39-2.2), comorbidity (ES = 1.59, 95% CI = 1.30-1.96), and health problems (ES = 2.64, 95% CI = 2.04-3.42). Precipitating factors were hypo- or hypernatremia (ES = 1.73, 95% CI = 1.14-2.64), depression (ES = 4.07, 95% CI = 1.95-8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10-1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42-3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60-2.75). Conclusion: This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important.
Publisher: Informa UK Limited
Date: 20-02-2009
Publisher: Elsevier BV
Date: 10-2010
Publisher: Wiley
Date: 21-04-2004
Publisher: Mary Ann Liebert Inc
Date: 04-2006
Abstract: This project reports on the experience of two hospice caregivers using videophone technology to enhance communication with their care providers. The data show the overall satisfaction and technical feasibility with videophone technology in home hospice. The case studies have great implication for future research because they reveal many unexpected issues relevant for future large-scale interventions.
Publisher: SAGE Publications
Date: 11-1997
DOI: 10.1177/026921639701100603
Abstract: Transfer of patients from palliative care services to nursing homes is necessary at present when a patient is relatively stable, but does not have adequate support systems at home. With the ageing of the population and the increasing incidence of cancer, the need for inpatient palliative care beds is growing with corresponding pressure for patients to be transferred to nursing homes. Transfer to a nursing home in the general population has been described extensively in the gerontology literature where a critical early phase of relocation has been identified by a high incidence of morbidity and mortality. The vulnerability of terminally ill patients means that they are at increased risk of suffering from stress associated with a transfer. The prognosis of a patient may be shorter than the time required for adjustment to the patient's new home. The issues surrounding transfer of palliative care patients to nursing homes and possible strategies designed to reduce distress associated with transfers are explored.
Publisher: Springer Science and Business Media LLC
Date: 13-05-2011
Publisher: Wiley
Date: 25-08-2005
Publisher: Elsevier BV
Date: 10-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2003
DOI: 10.1097/00006199-200311000-00004
Abstract: This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). This analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences. The presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c =.952): "heaviness in past year," "swelling now," and "numbness in past year." Using this model, prediction of absolute maximal circumferential limb difference (i.e., >or=2 cm) in study B showed that "heaviness in the past year" (p =.0279) and "swelling now" (p =.0007) were predictive. "Numbness in the past year" was not predictive. However, those with lesser limb differences reported this symptom more often. The findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.
Publisher: Wiley
Date: 09-09-2005
Publisher: Springer Science and Business Media LLC
Date: 19-07-2023
DOI: 10.1186/S12877-023-04116-5
Abstract: The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings. Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.
Publisher: Wiley
Date: 04-2010
DOI: 10.1111/J.1365-2648.2009.05213.X
Abstract: This paper is a report of a study of the perceptions of nurses who work in abortion services. International debate surrounds abortion. In England and Wales the Abortion Act which was introduced in 1967 recently came under public review in relation to its legal limit of 24 weeks gestation. The review did not extend to those working within abortion services, and these nurses' views remained unknown. Investigating the perceptions of nurses who work in abortion services adds a dimension to the debate from a professional perspective which has hitherto been absent. Qualitative semi-structured interviews were conducted in 2007 with nine nurses working in three different abortion clinics in the United Kingdom. NVivo was used to manage the interview data and thematic analysis identified patterns of nursing concepts and attitudes. Two global themes of 'Attitudes Towards' and 'Coping With' abortion were identified. Six organizational themes detailed these: 'society', 'nurses' and 'reasoning' in 'Attitudes Towards' and 'role', 'clients' and 'late gestation abortion' in 'Coping With'. Eleven basic themes further described the organizational themes. Kim's theory of Human Living was used to clarify and provide a rationale for the nursing approach to care in this setting. The ability of participants to care for their clients as in iduals illustrates the nature of empowerment of the nurses to attain the goals of the client. Making this support explicit through defined roles for nurses would potentially enable nurses in abortion services to perform their role more effectively at all gestation times.
Publisher: Hindawi Limited
Date: 12-2005
Publisher: SAGE Publications
Date: 14-05-2009
Abstract: This study used participant feedback to qualitatively evaluate an intervention (Assessing Caregivers for Team Intervention through Videophone Encounters [ACTIVE]) that used videophone technology to include patients and/or their family caregivers in hospice interdisciplinary team meetings. Data were generated during in idual interviews with hospice staff members and family caregivers who participated in ACTIVE intervention. Modified grounded theory procedures served as the primary analysis strategy. Results indicated that ACTIVE intervention enhanced team functioning in terms of context, structure, processes and outcomes. Participants discussed challenges and offered corresponding recommendations to make the intervention more efficient and effective. Data supported the ACTIVE intervention as a way for hospice providers to more fully realise their goal of maximum patient and family participation in care planning.
Publisher: Elsevier BV
Date: 06-2002
Publisher: Mark Allen Group
Date: 12-2009
DOI: 10.12968/IJPN.2009.15.12.45864
Abstract: The majority of patients in the United Kingdom would choose to die at home, however, less than 20% of patients achieve this. Community nurses are central to care at the end of life, however, little attention has been given to the attitudes of community nurses to this role and how these may influence patient care, and ultimately facilitate patient preferences. This study aimed to identify the attitudes of community nurses to the care of the dying patient and discover the factors that influence these attitudes. Almost 40% of community nurses held negative attitudes to care of the dying. These attitudes improved with training and education but were not significantly influenced by experience alone. Attitudes were also influenced by levels of support, workload and time constraints. The study recommends the development of training and educational interventions to improve knowledge and practical competence, thus improving attitudes. Further study should also examine how the intensity of community nursing visits affects the number of home deaths.
Publisher: Oncology Nursing Society (ONS)
Date: 05-2005
Publisher: SAGE Publications
Date: 27-05-2014
Abstract: A retrospective, cross-sectional study was conducted to describe the occurrence of daytime sleep (DS) and to examine factors associated with DS in nursing home residents. We used the Minimum Data Set 2.0 records of 300 residents in a nursing home from January 2005 to March 2010. Descriptive statistics, independent t-test, chi-square, Pearson correlations, and logistic regression were utilized in analysis. About 71.3% of the residents slept more than 2 hours during the day, and this was significantly associated with residents’ comorbidity ( t = 2.0, p = .04), cognitive performance ( t = 7.3, p = .01), activities of daily living ( t = 3.7, p = .01), and social involvement ( t = −7.6, p = .01). Cognitive performance and social involvement significantly predicted the occurrence of DS with social involvement being the strongest predictor (odds ratio: .58 95% confidence interval: [.45, .75]). The findings suggest that interventions to engage nursing home residents in more social activities during the day may be beneficial to minimize their DS, especially for those who have difficulties with engaging socially on their own.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2018
Publisher: Springer Science and Business Media LLC
Date: 08-09-2007
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.JGO.2014.09.180
Abstract: Breast cancer in older women raises a number of discrete issues, including how healthcare professionals can best decide which patients are candidates for surgery. A pilot study involving women aged ≥70years newly diagnosed with early operable primary breast cancer was conducted aiming to explore the potential value of comprehensive geriatric assessment (CGA). Decision of primary treatment followed consultation with the clinical team and was not guided by any aspect of this study. CGA, using a validated cancer-specific tool, was conducted within 6weeks and 6months after diagnosis, complemented by formal measures of quality of life (QOL) (using EORTC QLQ-C30 and QLQ-BR23) and semi-structured interviews. A total of 47 female patients with a new diagnosis of clinically early (stage 1 or 2 cT0-2N0-1M0) operable primary breast cancer proven histologically, were recruited. CGA determined that increasing age (≥80years) (p=0.001), greater (≥4) comorbidity (p=0.022), greater number (≥4) of daily medications (p=0.002), and slower (≥19s) timed up and go (TUG) (p=0.016) score were significantly related to non-surgical treatment at 6weeks after diagnosis. Baseline QOL scores were generally good and they remained stable at 6months follow-up. As opposed to CGA, there was no correlation between QOL scores and the treatment modality identified. Semi-structured interviews identified themes consistent with findings from QOL assessment. The pilot study confirmed the feasibility of conducting CGA in a research setting which appeared to have value in assessing this patient population. More data will be required to definitively identify the components for geriatric assessment in this setting. The study has now extended into two more centres.
Publisher: BMJ
Date: 02-07-2013
DOI: 10.1136/BMJ.F4132
Publisher: SAGE Publications
Date: 09-2010
Publisher: Informa UK Limited
Date: 04-05-2018
DOI: 10.1080/01612840.2017.1418034
Abstract: Alzheimer's disease is one of a variety of progressive and ultimately fatal neurodegenerative diseases that are characterized by a number of nervous and mental symptoms and behavior disorders. These problems are likely to cause burden and strain on caregivers. In this study, we demonstrated the level and relationship of burden and strain among caregivers of dementia patients in China. A total of 212 caregivers of family members with dementia responded to the survey. A 22-item of the Zarit Burden Interview and a 13-item Caregiver Strain Index (CSI) were used. The results showed that women comprised 88.2% of caregivers, and 58.5% of caregivers reported a level of medium burden. Over one-half of the caregivers reported a level of high strain, with the low income group being more likely to have high levels of burden and strain. Chinese familial caregivers of patients with dementia experience a moderate level of burden and a high level of strain. The main strain factors that affected the burden were changes in personal plans, time demands, and emotional adjustment.
Publisher: Mary Ann Liebert Inc
Date: 09-2010
Publisher: Springer Science and Business Media LLC
Date: 08-2015
Publisher: SAGE Publications
Date: 11-2006
DOI: 10.2190/3P8G-5JAD-J2NF-BKGK
Abstract: The project analyzed staff descriptions of undocumented care given to dying nursing home residents. Registered nurses, licensed practical nurses, certified nurse aids, and social service designees were interviewed using an unstructured interview guide. Transcripts were coded by two members of the team and a thematic analysis was guided with the theoretical framework of Erving Goffman's dramaturgical model of social interaction. Analysis of interview transcripts revealed practices related to end of life care that went undocumented. Viewed through the lens of Goffman's theoretical model, this undocumented care revealed “secrets” related to socialization processes, communication, tension, superstitions, and interactions between staff and dying residents. Findings show that while dying is not formally acknowledged in the nursing home setting, staff experiences the reality of death and informally responds to the special needs of residents.
Location: United States of America
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United States of America
No related grants have been discovered for Davina Porock.