老年人长期护理需求及其影响因素的实证分析

伴随着我国人口的老龄化,老年人的长期护理需求将会增加。本文以北京市为例,采用2006年北京市城乡老年人口调查数据,统计分析了老年人的失能水平与健康状况,分析了失能的影响因素,测量了老年人的长期护理需求。研究发现除了年龄增长加重失能的风险外,教育水平越高,失能的风险越低。最后本文指出目前家庭已不能维持长期护理服务功能,农村比城市的情况更严重,社会提供的长期护理优质资源不足,亟待发展能满足老年人长期护理需求的护理机构。     

老年人健康状况及保健需求调查

目的了解老年人的健康状况及对医疗保健的需求,为老年人的健康保健及医疗服务提供参考依据。方法随机对来我院参加健康知识讲座的324名老年人进行问卷调查。调查内容包括健康状况、健康相关行为、医疗服务利用情况、卫生保健需求4个方面。结果老年人身体状况普遍欠佳,在被调查的老年人中,有81.6%的老年人患有高血压、心脏病、糖尿病或其他慢性病;有23.2%的老年人曾因病住院。吸烟、饮酒及少运动是影响老年人身体健康的主要因素。为老年人改善环境、增加安全性、提供日间护理、社区护理、提供健康知识教育是绝大多数老年人的保健需求。结论针对老年人的健康状况及需求,应多提供针对老年人的健康知识讲座,开展健康教育活动,加强社区保健服务,使他们了解自己的健康状况、熟悉自身所患疾病的相关知识,加强自我保健意识,去除不良习惯,以达到免除疾病、减少病痛、增进健康的目的。     

The Division of Nursing and Its Relationship to Nurse Practitioner Education

Nurses provide a large part of health care in the United States. Increasingly, among rural and underserved populations, urban and rural NPs and NMWs are taking the place of physicians who choose to specialize and to practice in metropolitan areas. Nurse practitioners and NMWs are well qualified to provide primary care for those with acute and chronic medical conditions, and to provide maternity care to the 95% of women whose pregnancies are normal and do not require specialist care by obstetricians. Since 1965, the DN, through its grant programs, has contributed to increasing the accessibility of health care in this country by helping to increase the supply of nurses in all specialties and improving the quality of graduates and undergraduates in nursing education. In the past 25 years, NPs and NMWs have proven their capability and worth. Federal support has helped to make these invaluable contributions possible.     

Themes of rural health and aging from a program of research

The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.     

The Impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses

It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders.     

Key informants' perceptions of health care for elders at the U.S.-Mexico border

OBJECTIVE: This study was part of a systematic assessment to gain an understanding of aging in a rural community along the U.S.-Mexico border in Arizona. DESIGN: It used a participatory action research design. Interviews were conducted among key informants (n = 29), including health and social services providers and community leaders. Content analysis focused on identifying common themes and concerns related to elders. RESULTS: Major themes identified were (1) social infrastructure issues, (2) community awareness of health problems, (3) socioeconomic problems, (4) cultural influences on health beliefs, practice, and use of services, (5) image of aging, (6) border issues, and (7) educational needs for service providers. CONCLUSION: Elders living at the border are a particularly vulnerable population with strong cultural affiliations and health disparities. Although the population of elders has been growing at the border, the traditional focus on the health care needs of youth and children has contributed to the neglect of issues facing elders. This study provided community key informants' perspective of aging to community members, policy makers, service agencies, and health care providers for community development. A conceptual framework was developed for educational programs and research projects for health professionals who care for elders at the border.     

The crisis nature of health care transitions for rural older adults

The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community-based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.     

The education of advanced practice nurses: a contemporary approach

The Advanced Practice Nursing of Adults and the Elderly graduate program at San Diego State University School of Nursing prepares experienced professional nurses with primary and specialized care (acute or critical care) knowledge and skills to deliver health care to adults and elders across practice settings as nurse practitioners and clinical nurse specialists. Emphasis is placed on health care that is research based and congruent with national standards of practice. This approach to graduate education is congruent with recommendations of professional nursing organizations and responds to the educational needs of professional nurses and the health care needs of adult and elders.     

农村贫困地区老年人心理社会问题及应付方式的研究

目的分析讨论农村贫困地区老年人心理社会问题及应付方式,探讨心理社会问题与应付方式的关系。方法采用老年人心理社会问题调查表及应付方式问卷对62名农村贫困地区老年人进行调查研究。结果农村贫困地区的老年人存在的主要社会问题依次是收入减少(79％),功能减退或慢性疾病、孤独、丧偶、面临死亡和害怕等。应用最多且有效的应付方式为解决问题(8．81士2．41),其次是退避和合理化,应用最少的是自责。孤独、害怕、独居、代沟．搬迁、离退休、收入减少、丧偶、面临死亡与应付方式有相关关系。结论社区护理人员应关注贫困老年人的心理社会问题,开展老年健康教育活动,鼓励积极的应付方式。配合有关部门积极开展扶贫项目,完善社会保障制度,提高老年人生活水平。     

Emergency nursing experience in Malawi

Malawi has a population of 13 million with the vast majority of its people living in the rural areas. Government health facilities are the main providers of health care services in the country with a few private facilities charging for their services. Emergency medical care in Malawi is offered in all health care delivery areas, however the quality offered and its accessibility is compromised especially in rural areas. Every health care professional receives a component of emergency training during their generic programme although there are very limited specialized emergency professionals. Working as a nurse in the emergency department in Malawi is a challenging experience due to these various difficulties.     

Promoting awareness of LGBT issues in aging in a baccalaureate nursing program

It is estimated that up to 10 percent of the American population is lesbian, gay, bisexual, or transgender (LGBT) and that up to 7 million members of this population are elderly. Both the Institute of Medicine and Healthy People 2020 have addressed the health disparities that affect elderly members of the LGBT community. Nurses are well positioned to bridge health disparities and provide culturally sensitive care across the lifespan, but compared with that of other disciplines, the nursing literature is lacking in content addressing LGBT health. Eliminating health disparities in the care of LGBT elders should be a priority in nursing education.The authors review the issues LGBT elders face and recommend how content related to LGBT aging can be integrated into nursing curricula.     

Challenges and solutions for care of frail older adults

Frail older adults are at risk for negative outcomes and are the most significant consumers of health resources across both acute and community settings. Both formal systems and families are involved in this care of frail elders. This article reviews health care issues for frail older adults and addresses the impact of frailty on the future health care system. It also presents challenges for future care, creative solutions that are currently being tested and explored, and suggestions for future nursing priorities. Challenges in the care of frail elders include: the organization and sustainability of the continuum of services, resource allocation, and cultural competence in service delivery. Creative solutions include intensive case management programs, targeting at risk older adults, partnerships with families, enhanced use of telemedicine and assistive technology, and promoting healthy aging. Nurses have the potential to improve elder health across settings through clinical practice, education, leadership, and research.     

The essential elements of spirituality among rural Thai elders

The essential elements of spirituality among rural Thai elders The purpose of the study reported here was to understand and describe the essential elements of spirituality among rural Thai elders. The research question that guided the study was: How do rural Thai elders experience and describe spirituality in their daily lives? This question was explored through in‐depth, audio‐taped, face‐to‐face interviews with 12 rural Thai elders living in the Nakhorn Prathom Province in the central part of Thailand during the period from January to March 1998. Prior to implementing the study, approval to conduct this study was granted from the Institutional Review Broad of the University of Alabama at Birmingham. Through the process of hermeneutic phenomenological data analysis, three categories and nine themes emerged. The findings of the study provide a knowledge base for Thai nurses to explore and explain spirituality to enhance nursing science and provide holistic nursing care. Further research should be conducted throughout the health and illness continuum with all age groups and with individuals of different cultures and belief systems.     

The physical, mental, and emotional health of older people who are living alone or with relatives

In Korea, as in other countries, the number of older adults is growing substantially, and the proportion of older adults is projected to be 14.3% by 2022 [Ministry of Health and Social Affairs, Republic of Korea. (2003). Yearbook of health and social affairs statistics for 2003, vol. 49. Seoul, Korea: Government Printing Office]. The number of older people who are living alone in rural areas has been sharply increasing as a result of the migration of younger adults to urban areas for employment. However, information on the health status of elders who live alone is limited. Therefore, the purpose of this study was to compare the physical, mental, and emotional health status of elders who are living alone and those living with relatives in rural areas in South Korea. A cross-sectional survey design was used, and data were collected by interviewing subjects. A two-stage cluster sampling process was utilized for those living alone (n = 110) and those living with family members (n = 102). Both groups were enrolled in KyungRo-Dangs (senior centers), which are like community centers in the province. The results indicate that elders who are living with relatives scored significantly higher on several physical and mental health parameters than elders who are living alone. However, elders who are living with relatives had a significantly higher emotional health status in almost every item than elders who are living alone. These findings suggest that interventions to increase health status, especially the emotional health of elders who are living alone, are imperative and that the intervention should be sensitive to changes in the social structure of elders who are living alone in rural areas. Further studies are needed to understand the factors that are associated with the physical, mental, and emotional health of elders who are living alone and those who are living with relatives.     

The effects of a reminiscence education program on baccalaureate nursing students' cultural self-efficacy in caring for elders

The increase in our minority elder population has created a need to develop innovative programs that prepares students who are competent in gerontological nursing skills and sensitive to cultural differences. The purpose of this pilot study was to test the effects of a reminiscence education program on BSN students' cultural self-efficacy in caring for elders. An interrupted time series design with a nonequivalent, no-treatment control group was used with 64 nursing students recruited from a northeast university in the United States. The intervention consisted of a two-hour reminiscence education program and a 13 week period in which the experimental group implemented integrative reminiscence with elders during their community health practicum. The eldercare cultural self-efficacy scale was the outcome measure. Results indicated that students receiving the reminiscence education program demonstrated significantly higher levels of eldercare cultural self-efficacy F(1, 62)=5.34, p=0.024 than those not receiving the intervention. Reminiscence education programs implemented as part of clinical practicums may assist to increase nursing students' perceptions of confidence in caring for elders. Implications for nursing education and the care of diverse elders are discussed.     

Utilization of mental health services among rural elderly

Rural elders are an undeserved and vulnerable population with compromised access to health and human services leading to premature institutionalization. Even though elders living in rural areas have psychiatric illnesses that would prompt them to use mental health services, their use of these services remains low. This study developed predictive models of psychiatric hospitalization, use of mental health services, and use of crisis intervention by rural elders participating in an outreach case-management program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression. Being married and having supplemental insurance in addition to Medicare predicted 23% of the variance for utilization of psychiatric hospitalization. Only one variable, Medicaid, predicted 14% of the variance for use of mental health services. Type of caregiver, marital status, household composition, and Medicaid insurance accounted for 23% of the variance in utilization of crisis intervention by rural elders. Overall, the two variables that most likely predicted use of psychiatric mental health services were marital status and type of insurance.     

The pain management knowledge of nurses practicing in a rural midwest retirement community.

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.     

空巢老人对社区医疗护理需求的质性研究

目的探讨空巢老人对社区医疗护理的具体需求,为空巢老人的社区健康管理提供参考信息。方法采用质性研究方法 ,以半结构式的开放性访谈问卷对25名城市社区空巢老人进行个体化的深入访谈,使用内容分析法分析资料。结果空巢老人对社区医疗护理的需求包括基本医疗护理服务和具有社区特色的医疗护理服务,这些需求可以通过改善社区医疗条件、完善管理制度、提高服务质量和水平等途径来实现。结论针对空巢老人对社区医疗护理的需求,应拓展社区医疗护理服务项目和内容,为其提供个体化的服务。