The Effects of Slow-Stroke Back Massage on Minutes of Nighttime Sleep in Persons With Dementia and Sleep Disturbances in the Nursing Home

Purpose: This pilot study tested the effects of a 3-minute slow-stroke back massage (SSBM) on total minutes of nighttime sleep on persons with dementia with sleep disturbances aged 65 years or older in the nursing home. Design: Pilot randomized controlled trial. Methods: Participants were randomized to an intervention group ( n = 20) who received the 3-minute SSBM or a usual care control condition group ( n = 20) who received usual bedtime care. Forty-eight hours of actigraphy data was recorded and analyzed on sleep variables at baseline and postintervention. Findings: Descriptive statistics showed a 36-minute increase on minutes of nighttime sleep in the SSBM intervention group (46.1 minutes) compared with the control group (10.32 minutes). Analysis of covariance did not reveal significant differences between the intervention and control groups on minutes of nighttime sleep, F(1, 37) = 1.90, p = .18, partial η2 = .05, or on other sleep variables. Conclusions: Dose-finding studies are needed to determine the duration of SSBM for sleep promotion. Findings from this pilot study suggest that SSBM may be an effective nursing intervention for sleep in persons with dementia in the nursing home, but further testing is needed to provide definitive results.

A trial of a comprehensive nursing rehabilitation program for nursing home residents post-hospitalization

This pilot study examined the feasibility of implementing a comprehensive nursing rehabilitation program (CNRP) designed to promote the physical functioning of moderately frail nursing home residents post-hospitalization. The 4-week to 8-week CNRP incorporated three interventions: the Capacity Intervention (improving strength and balance), Performance Intervention (fostering daily mobility and activity), and Facilitating Intervention (providing education, support, and stress management). A longitudinal design was used with a convenience sample of 24 moderately frail residents. The CNRP was found to be not practical as designed because the intervention occurred too close to hospital discharge, and many prospective participants did not "feel up" to participating in a voluntary nursing rehabilitation program in addition to other prescribed rehabilitation. Regardless, participants were found to be able to perform the exercises safely and the CNRP was easily implemented in nursing homes. Testing the efficacy of the CNRP with nursing home residents is recommended after the initial post-hospitalization period.

Using spirituality to cope with early-stage Alzheimer's disease

Alzheimer's disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD.

Challenges in conducting qualitative research with individuals with dementia

Qualitative research can capture the meaningful experiences and life values of individuals with dementia not reported in quantitative studies. This article shares a personal experience of the challenges faced and the lessons learned while conducting a qualitative study of 15 people with early-stage Alzheimer's disease. The purpose of this article is to discuss the issues concerning determination of capacity to consent to research, consent/assent, communication challenges, and trustworthiness of data when conducting a qualitative study of people with dementia. Understanding communication challenges related to dementia is important to develop effective communication strategies, such as simplifying the structure of questions, allowing ample time for the participant's response, using reminiscence, and redirecting the dialogue. This information will be valuable to researchers conducting qualitative studies and the resulting contributions to the body of knowledge about Alzheimer's disease.

Nursing student descriptions that suggest changes for the classroom and reveal improvements needed in study skills and self-care

This article describes a longitudinal study that took place in a college of nursing with baccalaureate students between 2002 and 2004 at a university medical center. Its purpose was to provide a climate of success for the students yet challenge them to make additional efforts to complete the program. The qualitative section of the study consisted of students answering the following open-ended questions: (1) Describe ways that faculty can help you be successful in the future and (2) What can you do for yourself to achieve the goal of finishing the program? Students identified what change could be made in the classroom, how increased study time and skills might help, and how self-care would facilitate success. Descriptions were shared with faculty and students in an effort to improve classroom delivery, provide study tips to students, and help students become aware of increased self-care. Students as future nurses, enter practice and care for patients who will need the best care and self-care instruction. Using techniques that students identified to be successful, making efforts through hard work (increased study skills), and realizing how to better care for themselves could assist RNs in providing comprehensive and best care to patients.

Nursing home staff's views on quality improvement interventions: a follow-up study

Ongoing problems with nursing home care mandates understanding nursing home staff's perspectives on innovative quality improvement programs. This follow-up study used focus groups to examine the experiences of staff who participated in a clinical trial that involved Quality Indicator (QI) feedback reports, quality improvement training, and APN consultation. The authors found that QI reports provided staff with a benchmark to judge their care and a means to track problems; APN consultation was essential for staff to learn best practices; and staff questioned the validity of the QI reports, which hindered them from seeking new solutions to problems identified in the QI reports. Findings indicate that innovative QI programs and APN consultation can positively influence nursing home quality improvement efforts and improve care.

Prevalence and characteristics of nursing homes residents requiring light-care

Rising nursing home (NH) costs and the poor quality of NH care make it important to recognize elders for whom NH care may be inappropriate. As a first step in developing a method to identify these elders, we examined the characteristics of NH residents requiring light-care and changes in their care level from NH admission to 12-months. Using data from the Missouri Minimal Data Set electronic database, we developed three care-level categories based on Resource Use Groups, Version III (RUG-III) and defined light-care NH residents as those requiring minimal assistance with late-loss ADLs (bed mobility, transfer, toilet use, or eating) and having no complex clinical problems. Approximately 16% of Missouri NH residents met the criteria for light-care. They had few functional problems with mobility, personal care, communication, or incontinence; approximately 33% had difficulty maintaining balance without assistance; and 50% of those admitted as light-care were still light-care at 12-months. Findings suggest that many NH residents classified as light-care by these criteria could be cared for in community settings offering fewer services than NHs.

Health belief model and reversal theory: a comparative analysis

BACKGROUND

In recent years, an increasing number of nurses have demonstrated interest in health behaviour change interventions and research. Despite this heightened enthusiasm, there appears to have been less interest in exploring new and emerging health behaviour change theories.

AIM

The goal of this work is to assist clinicians and researchers to make more informed choices about the use of the Health Belief Model and Reversal Theory in their practice settings and research projects.

METHOD

Primary sources were analysed using qualitative data analysis methods in order to compare and contrast the two models. Four comparative categories provided the structure for analysis: origins of models, ways of knowing and behaving, role of health care providers in behaviour change, and desired outcomes.

RESULTS

Based, in part, on their historical origins, the Health Belief Model and Reversal Theory offer differing tenets regarding how individuals perceive, understand, and behave. According to Reversal Theory, ways of knowing and behaving are dependent upon innate physiological factors and subjectively structured perceptions. In contrast, the Health Belief Model suggests that health-related behaviours are largely attributable to cognitive decision-making processes. As such, health care providers are directed to approach health behaviour change in different ways.

CONCLUSIONS

Although the Health Belief Model has been widely implemented, Reversal Theory may offer a more comprehensive framework for health behaviour change interventions and research. Clinicians and researchers are urged to learn more about this theory and how it may apply to their areas of practice and research.

Why older adults with light care needs enter and remain in nursing homes

Many patients in nursing homes receive limited services. In 1996, approximately 17% of the 1.6 million nursing home residents received assistance with two or less activities of daily living (ADL). This descriptive study addressed this issue by investigating why residents with light care needs enter and remain in nursing homes. Residents with light care needs (N = 20) identified by directors of nursing were interviewed to elicit why they entered and remain in nursing homes. Their care level was estimated using the Minimum Data Set (MDS) and Resource Utilization Groups, Version III (RUG-III). In this study, older adults with light care needs who decide to enter and remain in nursing homes were found to be influenced by a prior hospitalization or a health event; the perceived inability to manage instrumental ADLs (IADLs), ADLs, or health monitoring at home; and lack of knowledge about alternatives to nursing home care. This study demonstrates the vital role nurse case managers can play in both acute care settings and nursing homes. They can help older adults with light care needs to make informed decisions about long-term care, seek out community options, and set in place assistive care systems that can help them age in the community.

Prevalence, incidence, management, and predictors of venous ulcers in the long-term-care population using the MDS

OBJECTIVE

To describe the prevalence, incidence, management, and predictors of venous ulcers in residents of certified long-term-care facilities using the Minimum Data Set.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

32,221 residents admitted to long-term-care facilities in Missouri between January 1, 1996, and October 30, 1998.

MAIN OUTCOME MEASURES

Version 2.0 of the Minimum Data Set was utilized. Assessment items included selected measures from background information, disease diagnoses, physical functioning and structural problems, health conditions, oral/nutritional status, and skin condition.

MAIN RESULTS

Venous ulcer prevalence on admission was 2.5%. The incidence of venous ulcer development for long-term-care residents admitted without an ulcer at 90, 180, 270, and 365 days after admission was 1.0%, 1.3%, 1.8%, and 2.2%, respectively. The most frequent skin treatments for residents with a venous ulcer were ulcer care, dressings, and ointments. Factors associated with venous ulcer development within a year of admission were diabetes mellitus, peripheral vascular disease, and edema.

CONCLUSION

Venous ulcer prevalence and incidence are greater in the long-term-care population than in the community at-large. Residents with a venous ulcer are likely to have comorbid conditions such as diabetes mellitus, peripheral vascular disease, congestive heart failure, edema, wound infection, and pain. Based on these data, risk factors such as history of leg ulcers, recent edema, diabetes mellitus, congestive heart failure, or peripheral vascular disease should prompt clinicians to carefully plan care that will manage a resident's risk for venous ulcer development.

Improving quality of care in nursing facilities. Gerontological clinical nurse specialist as research nurse consultant

It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review QI reports, investigate problems areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activities in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.

Initial field testing of an instrument to measure: observable indicators of nursing home care quality

The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were tested in 109 Missouri and 11 Icelandic nursing homes. Content validity was established using experts. Concurrent and known groups validity was evaluated using Minimum Data Set quality indicators, survey citations, and a process of care measure. Interrater and test-retest reliabilities were calculated as well as coefficient alpha. The "Observable Indicators of Nursing Home Care Quality" instrument is a new measure that can be used by researchers, and potentially by regulators, consumers, or providers, to observe and score specific indicators of quality care following a 20- to 30-minute inspection of a nursing home.

Light care residents in nursing homes: why they come, why they stay

With the increasing numbers of frail elderly, why light-care nursing home (NH) residents enter and remain in NHs is important to understand. Light-care residents (n = 98) from 11 NHs and their nurses were interviewed using open-ended questionnaires. Residents' care requirements were estimated using Resource Use Groups, Version III (RUG-III). We found that residents entered and remain in NHs because of the inability to perform instrumental activities of daily living, the fear of injury, ambulation problems, health problems, the lack of daily assistance, and a recent hospitalization. Most residents and nurses did not know of other options. These problems could be managed in the community if appropriate systems were in place.

Nursing home care quality: a multidimensional theoretical model integrating the views of consumers and providers

This exploratory study was undertaken to discover the defining dimensions of nursing home care quality from the viewpoint of consumers of nursing home care. Eleven focus groups were conducted in five Missouri communities. The seven dimensions of the consumer multidimensional model of nursing home care quality are: staff, care, family involvement, communication, environment, home, and cost. The views of consumers and families are compared with the results of a previous study of providers of nursing home services. An integrated, multidimensional theoretical model is presented for testing and evaluation. An instrument based on the model is being tested to observe and score the dimensions of nursing home care quality.

Minimum Data Set and Resident Assessment Instrument. Can using standardized assessment improve clinical practice and outcomes of care?

Regulating and standardizing the assessment of residents was envisioned by the 1986 Committee on Nursing Home Reform to have many advantages for facility management, government regulatory agencies, and clinical staff to evaluate changes in resident status and adjust the care plans accordingly. Standardized assessment data was viewed as a source of management information to be used to track case mix (i.e., acuity) of residents, allocate resources such as staff, and evaluate care quality. The Resident Assessment Instrument is a clinically relevant assessment process that can facilitate effective care planning, interventions, and quality improvement. It is a clinically complex process requiring care delivery systems developed by RNs to support the implementation of individualized care.

Making do with fewer nurses in the United States, 1945-1965

PURPOSE

To analyze the perceptions that nurses and hospital administrators had about the nursing shortage between 1945 and 1965 and the actions they took. Reasons nurses' wages remained low during this period of shortages and high demand were also examined to expand knowledge of nursing labor during a critical time in nursing history.

METHOD

Historical analysis of primary and secondary sources generated between 1945 and 1965 including: (a) American Nurses' Association's (ANA) central files in Washington, DC; (b) ANA archives at the Mugar Memorial Library, Boston University; (c) official proceedings of the ANA's and American Hospital Association's (AHA) conventions; (d) nursing and hospital journals; (e) ANA and U.S. Government statistical documents and reports on the status of nursing labor; and (g) monographs on nursing, hospitals, the history of women's labor and the history of women in the 1940s, 1950s, and 1960s.

FINDINGS

Hospital administrators and nurses disagreed on the causes of the nursing shortage and its remedies in the 20 years after World War II. Hospital managers believed the shortage occurred because many nurses left the work force to remain at home with their families. Nurses, however, identified low wages and deplorable working conditions as the cause.

CONCLUSIONS

Hospital managers were successful at easing the shortage and controlling nursing costs by employing ancillary workers to replace RNs. Nurses took several different actions to deal with poor working conditions: initiating the ANA Economic Security Program, joining unions, and leaving hospital nursing.

The ANA's Economic Security Program: the first 20 years

This historical study is an analysis of the American Nurses Association's (ANA) Economic Security Program (ESP) from 1946 to 1966. Primary data sources include ANA Biennial Convention proceedings, ANA headquarters files, the ANA Collection at Mugar Memorial Library, and selected nursing journals. The findings indicate that although ANA took a bold step in initiating the ESP and collective bargaining, the ESP was minimally effective for several reason: nurses would not support collective bargaining, hospitals would not negotiate with nurses, ANA would not use coercive tactics, and hospitals were not included under existing labor laws. As a result, ANA resorted to an old tactic, education, to secure its economic goals.