Death anxiety among nursing home residents: a comparison of the young-old and the old-old

The purpose of this research was (a) to determine whether there is a comparative difference in the level of conscious death anxiety between young-old and the old-old nursing home residents and (b) to assess the predictive value of educational attainment, gender, subjective health, functional ability, social support, and length of stay on the conscious death anxiety of the persons in the two age groups. A discriminant analysis of 228 residents from three nursing homes revealed that among the 103 young-old subjects poor subjective health, poor functional ability, poor social support, and extended stays in the facilities were indicative of high death anxiety. Among the 125 old-old subjects, high death anxiety was associated with poor subjective health, poor functional ability, and higher educational attainment. Further, it was found that age was an important variable. A significantly greater proportion of the older residents compared to the younger residents had higher conscious death anxiety. The results may direct practitioners and planners in program development for the elderly nursing home patient.     

Correlates of Geriatric Loneliness in Philippine Nursing Homes: A Multiple Regression Model

Numerous studies have been conducted worldwide about loneliness in older adults living in nursing homes and the factors associated with it. However, only a few studies have focused on social factors that may predispose these older adults to experience loneliness. The purpose of this study was to examine the interplay between and among loneliness, social isolation, social engagement, and life satisfaction among Filipino elderly (n = 180) recruited from government and nongovernment nursing homes in the Philippines. A multiaspect questionnaire, which included the UCLA Loneliness Scale, Revised Index for Social Engagement, Friendship Scale, and Life Satisfaction for the Third Age-Short Form was used to gather the needed data and information. Results of single and multiple regression analyses indicate an effect of the three factors (social isolation, social engagement, and life satisfaction) on loneliness with social isolation having the greatest impact on loneliness. Notably, increased social isolation, inadequate social engagement and decreased life satisfaction consequently aggravate loneliness. Social engagement produced a positive effect to both social isolation and life satisfaction in a way that a decrease in social engagement will decrease life satisfaction and increase social isolation. On the whole, loneliness in geriatric nursing homes is evident, and it is shaped by social isolation, social engagement and life satisfaction. Impliedly, interventions and measures to minimize loneliness are necessary, and further research is needed to explore other variables contributing to loneliness in geriatric nursing homes.     

THE ROLE OF EDUCATION AND HEALTH CARE DELIVERY STRUCTURE IN QUALITY OF NURSING CARE FOR MENTALLY ILL PATIENTS IN NURSING HOMES

A study of nursing home staff found that nurses generally are not knowledgeable about psychiatric symptoms and do not seek out psychiatric intervention for their patients who need it. Even when nurses are knowledgeable about psychiatric symptoms and have had special training in mental health care it is found that they nonetheless rarely seek psychiatric intervention for their patients. The problem to be redressed lies not merely in increased education alone. It also resides in the organizational character of health care delivery in nursing homes, which makes adequate nursing response to mental illnesses impossible.     

A Multimethod Model for Practicum and Clinical Supervision in Nursing Homes

Nursing homes are an increasingly important setting for gerontological counseling. This article portrays a multimethod approach to counselor training and supervision in nursing homes.     

《老年护理学》校外实践平台合作模式的建设思路

目的：调研养老院／社区等校外实践教学平台对学生学习《老年护理学》知识和技能的可行性。方法：通过对大理市5家敬老院走访,调查了31位老年人,查阅国内相关文献,研讨了校外实践教学平台合作模式的建设与管理。结果：提出了合理设计课程结构、建立教学与实践为一体的教学基地、养老机构／社区中“标准病人”的遴选与培训、建立教学效果评价体系的建设思路。结论：校外实践教学平台可以提高学生学习兴趣,增强专业知识和技能水平,培养其独立思维能力,提高创新能力等,增强社会责任感,有利于提高《老年护理学》的教学效果。     

THE EDEN ALTERNATIVE: IMPACT ON STUDENT ATTITUDES

ABSTRACT

Nursing homes as clinical sites for student learning have the potential to produce negative attitudes toward aging. The purpose of the study reported in this paper was to determine the impact of the Eden Alternative on the attitudes of students toward elders residing in nursing homes. Prior to beginning implementation of the Eden Alternative, 61 students completed the Health Professional Beliefs and Opinions about Elders. At 2 years after implementation of the Eden Alternative, 73 students completed the same survey. The second group reflected significantly more positive attitudes toward elders living in nursing homes.     

Activity Engagement: Perspectives from Nursing Home Residents with Dementia

Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with a fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed.     

Enhancing nursing home care for seniors: impact of a living classroom on nursing assistant’s education

ABSTRACT

Nursing Assistants (NAs) are the largest workforce in nursing homes, but often lack adequate preparation for their role. The Living Classroom (LC) is an integrated learning approach, whereby a NA program is delivered in a nursing home (NH) in collaboration with a community college. This paper describes the implementation and evaluation of the LC. Mixed methods were used to gather data from 48 NA students, 5 faculty, and 42 NH staff over 30 weeks. Students, faculty, and nursing home staff described the LC as a positive learning experience. Students’ gerontological knowledge increased over time (p = .0012). Students reported very positive relationships with program mentors and NH residents. The LC provides a unique approach to prepare NAs to work in nursing homes. This model could expand to other educational programs with a gerontology focus.     

Geriatric Training Needs of Nursing-Home Physicians

Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training in geriatrics. A mail questionnaire survey was sent to nursing home physicians regarding their opinion on the most needed subjects and preferred training methods. Of the 210 surveys mailed, 132 (63%) were returned. More than a quarter of the respondents had not had any kind of geriatric medical education. A desire for geriatric training was evident, preferably in the form of courses and periodic seminars. Use of medications, infectious diseases, depression, dementia and cardiac disorders were the most important topics indicated by the respondents. These data can be of help in preparing the curriculum for a continuous medical education program in geriatrics, preferably in the form of courses and periodic seminars.     

The availability of education on death and dying: a survey of U.S. nursing schools

A stratified random sample of 226 U.S. nursing schools was surveyed to determine the extent and nature of current death education training for nursing students. Of the 205 responding schools, 5 percent reported offering a required death and dying course, while an additional 39.5 percent indicated that a death and dying course was available for their students on an elective basis. The authors challenge the current pedagogical approach toward death education in U.S. nursing schools. They propose the need for the development of a model that would formally link a death education course, or courses, with the clinical phase of training. It is hypothesized that such an approach would enhance the nursing students' recognition and management of their feelings regarding death and dying and therefore result in more effective means of relating to terminally ill patients.     

Enhancing care for older people living in nursing homes in rural Australia using action learning as a catalyst for change

The implementation of action learning workshops in three nursing homes in rural Victoria, Australia has been critical in the re-visioning of how care can be enhanced for residents. The workshops were designed with the intent of improving quality of care for residents by providing health care staff with opportunities to learn together and effect cultural change. Valuing what was accomplished well in these nursing homes was the starting point. The project was funded by a Commonwealth Government Rural Education Grant and was based on ‘My Home Life’ a popular programme that promotes quality of life and delivers positive change in care homes for older people across the United Kingdom. This paper provides an account of the project including key components of the action learning workshops and subsequent evaluation of the programme conducted in Australia. The lessons learnt throughout this project have provided the impetus to continue using appreciative inquiry and action learning to involve participants in reflecting on their practice, valuing what they do well while identifying areas that require change. Working together in a safe and respectful space provides participants with opportunity to harness their own collective wisdom and as the health professionals in this project experienced, also learn valuable skills that support progressive action that makes a difference to older people’s lives.     

User Democracy in Schools? Comparing Norwegian Schools With Nursing Homes

Democratic user control is a hallmark of Scandinavian schools, but also of other services of the Scandinavian welfare states. This article studies variations in parental control and influences in public and non-public schools. In addition, how the use of different governance tools inspired by markets affects user control is analyzed. The empirical investigation consists of matching public and non-public schools and nursing homes in three Norwegian municipalities. The study concludes that there is important variation between public and non-public schools, while there is little variation between public and non-public nursing homes. The organization of the quasi-market is an important explanation for this.     

The Success and Struggles of Filipino Geriatric Nurses in Nursing Homes

Geriatric nursing is a physically and emotionally demanding job in healthcare. It is a neglected field despite the growing population of the elderly, and the experiences of geriatric nurses are one of the unrecognized aspects of this field. This qualitative study purports to explore the successes and struggles of the lived experiences of a select group of Filipino geriatric nurses working in nursing homes. A total of five registered nurses selected from Philippine geriatric homes were the subjects of this qualitative study. Data were gathered from a two-part instrument: namely, a researcher-made robotfoto and a semistructured interview. Through the use of a repertory grid involving both cool and warm analyses, field texts were phenomenologically reduced in order to establish distinct conceptual clusters.

Summarily, two roles were found to be the defining elements of Filipino geriatric care nurses' sense of success and fulfillment. These include the instrumental and developmental, which describe the nurses' appreciation of their unique place in the lives of their elderly patients and, at the same time, their experiences of personal and professional growth and expansion as nurses. In regard to their struggles, the contextual conditions in the workplace typify the roadblocks of their efficient and effective delivery of quality healthcare services.     

Education Affects Attitudes of Physical Therapy Providers Toward People with Dementia

A survey was sent to every skilled nursing home (N = 495) in Indiana regarding the demographics, education, and whether the severity of dementia impacts the attitudes of people in physical therapy practice. Physical therapists (PTs) and physical therapist assistants (PTAs) practicing in nursing homes spend considerable time (44.0%) working with patients who have a diagnosis of dementia. As patients with dementia disorders declined cognitively, attitudes of PTs/PTAs become increasingly negative, and respondents feel that education, training, and resources are insufficient to maximize outcomes in the later stages of the disease.     

Examining the Structural Relationship of Physical Activity,Cognition, Fear of Falling,and Mobility Limitation of Filipino in Nursing Homes

Mobility limitation is a major issue of care in the elderly and a typical characteristic of frailty in geriatric patients. The maintenance of mobility is thought to be fundamental to active aging, allowing older adults to continue living dynamic and independent lives. While previous studies have identified the different factors affecting mobility, the relationship between other factors, such as fear of falling, physical activity, cognition, and mobility limitation, has not been investigated, hence this structural equation model investigation.

This study was conducted in various nursing homes located in the National Capital Region and Region IV of the Philippines. A five-part survey-questionnaire was given to 125 Filipino elderly aged 60 years and above in nursing homes. The survey was conducted from May to August 2013. Results showed that high levels of fear about falling will lead to less physical activity and have a negative effect on cognition. Cognition levels also showed to have a direct impact on the physical activity. Physical activity was found to have a direct effect on the mobility of elderly patients. The emerging model can guide health care professionals in developing programs that can maximize the physical and mental functioning of the elderly in institutionalized settings.     

Development of a Curriculum for Long-Term Care Nurses to Improve Recognition of Depression in Dementia

There is increasing recognition of the severe consequences of depression in long-term care residents with dementia. Most health care providers are unprepared to recognize and to manage the complexity of depression in dementia. Targeted educational initiatives in nursing homes are needed to address this growing problem. This paper describes the development of competencies, learning objectives, and learning outcomes for a curriculum on depression in dementia for nurses working in nursing home settings. This work provides the foundation for a curriculum to improve learning for nurses and, ultimately, to advance health care outcomes for residents with cooccurring depression and dementia.     

应对广州城市养老难题 改革高职院校护理专业课程

广州城市养老急需高素质的专业护理人员,高职院校要应对这一需求,改革护理专业课程：增加实用的养老护理专业知识和操作技能训练,增加中医护理知识和技能,加强敬老爱老职业精神和素质的培养。要加快课程改革,就必须充分认识培养养老护理人才的重要性和紧迫性,加强社区和养老院、福利院等养老机构实习基地的建设,把职业技能证书考核内容纳入专业知识学习范畴,同时学习日本、香港等地的先进养老经验,不断完善课程改革。     

LEARNING ABILITY FOR TWO SPATIAL ORIENTATION SYSTEMS IN ELDERLY NURSING HOME RESIDENTS

Disorientation and confusion have been identified as significant problems for older persons newly admitted to nursing homes and other institutions. The purpose of this study was to determine which of two orientating systems might be best for helping older people become accustomed to a strange environment. Middle‐aged and elderly residents of a nursing home were dichotomized by performance on three memory tests and then were given two paired‐associate learning tasks. In one task colors and a place in the nursing home were to be associated; in the other symbols and a place in the nursing home were to be associated. The results indicated that the symbol‐place paired‐associate task was learned more rapidly than the color‐place task by both high and low memory ability groups, and that the lower memory ability group showed slower learning of the color‐place task compared to the higher memory ability group. In addition, learning was slower on both tasks when the color‐place task was the first presented. These results indicated that symbol‐place codes may be more useful than color‐place codes as orientation markers and suggested that evaluation of learning performance should include examination of order effects.     

The long and winding road: A grounded theory of reminiscence among Filipino residents in nursing homes

Although reminiscence is a naturally occurring process in late adulthood, not all older adults reminisce effectively. Notably, feelings of guilt, loneliness, bitterness and regret lead to despair and remorse rather than integrity. In spite of this, little is known about the process of reminiscence among Filipino older adults. This grounded study aims to develop a model that describes how a select group of older Filipino patients residing in nursing homes in the Philippines experience reminiscence.

Strauss and Corbin’s (1990) grounded theory design was employed in this study. A total of eighteen (18) Filipino older adults in nursing homes were purposively selected to participate in one-on-one, semi-structured interviews. These were then transcribed into field texts and analyzed through open, axial and selective coding. Member checking procedure was employed to ensure that the emerged themes were sensible and consistent with the participants’ lived experiences.

Through constant comparative method, the findings of this study presented the development of a three-phase process (Reactivating, Reconstructing and Reframing) that describes the reminiscence experiences of a select group of Filipino nursing home residents. The emergent theoretical model invites nurses as quality care providers to renew and restructure interventions to promote effective reminiscence.     

EVALUATION OF A GERIATRICS ROTATION FOR POSTGRADUATE RESIDENTS IN LEBANON

As we enter the 21st century, increasing numbers of older adults will reside, either temporarily or permanently, in nursing homes. Training in nursing home care must become an integral part of the curriculum for internal and family medicine residency programs. The changing demographics of the Lebanese population have created an imperative for medical schools to increase their emphasis on the education and training of residents in the care of the elderly. A four-week block rotation was started for residents in the family medicine department in Hotel Dieu (The French Medical School). The rotation is taking place at the comprehensive Geriatric Program at Ain Wazein Community Hospital. The goal of the rotation is to provide formal training in nursing home care to family practice residents as a component of the geriatrics curriculum. The organization and the curriculum content of the rotation are presented. The initial evaluation of the rotation by the residents showed that the residents became more comfortable with elderly issues by the end of the rotation. Residents responded on a scale of one to six regarding four constructs. The rotation was positively evaluated by residents and staff. Consequently, the rotation has been incorporated into the curriculum of family medicine residents in Hotel Dieu.