Journal of Gerontological Nursing

<h4></h4> <p>Despite high levels of distress among stroke caregivers, research on resource use and unmet needs is limited. The major purposes of this study were to identify the most difficult times, unmet needs, and advice of caregivers during the first 2 years of caregiving; and to examine resource use and perceptions of resource importance. Qualitative and quantitative methods were used. The hospitalization period and first months at home were most difficult for 76% of caregivers. Unmet needs were related to caregiver preparation, promoting the survivor&rsquo;s function, and sustaining the self and family. Although 50% or more of caregivers rated most resources important, only home health care was used by 50% of caregivers. Findings can aid clinicians in educating and counseling caregivers to reduce distress. </p>

ABSTRACT

Falls among elderly individuals have been significant sources of disability and death. Falls have affected as many as 10% of older adurtsduring an acute care inpatient stay. The acute care environment has contributed to elderly patient falls. Additionally, manifestations of acute illness, porypharmacy, and medication side effects have been risk factors for falls in the acute care setting. Individualized fall prevention strategies, initial patient assessments, and ongoing patient reassessments have been linked to a decrease in falls in the acute care setting. Approaches to fall prevention have included identification of high-risk patients, communication among staff and family members about an individual's risk of falls, and both case-specific and universal interventions for fall prevention. The purpose of this article is to describe a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Moreover, this article addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.

Strategies must be developed to design programs that might change nursing attitudes so that the elderly can be seen in a more positive way.

<h4>EXCERPT</h4> <p>The use of physical restraints in health care institutions has been an acceptable and frequent aspect of care (Minnick, Mion, Leipzig, Lamb, &amp; Palmer, 1998; Whitman, Davidson, Rudy, &amp; Sereika, 2001). However, a growing body of knowledge calls to question the use of restraints because there is little evidence to support the assumption that restraints prevent injuries (Maccioli et al., 2003; Woo, Hui, Chan, Chi, &amp; Sham, 2004). Evidence has shown the adverse effects of restraint use and its ineffectiveness in preventing falls and injuries (Capezuti, 2004; Capezuti, Maislin, Strumpf, &amp; Evans, 2002). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (JCAHO, 2000) has challenged the routine use of physical restraints and supported reduction in the use of restraints in hospitals.</p>

Physical restraints continue to be used in acute care settings, despite the challenges and calls to reduce this practice. The current guideline on restraint use is updated with evidence that includes critical care settings and issues related to restraint use in acute care units. Nurses play a significant role in the use of restraints. Factors such as nurse's knowledge and patient characteristics combined with the culture and resources in health care facilities influence the practice of physical restraint use. Nurses can identify patients at high risk for restraint use; assess the potential causes of unsafe behaviors; and target interventions in the areas of physiological, psychological, and environmental approaches to address those unsafe behaviors. Members of the interdisciplinary team can provide additional consultation, and institutions can provide resources and education and implement monitoring processes and quality improvement practices to help reduce the practice of physical restraint use. [ Journal of Gerontological Nursing, 42 (2), 17–26.]

As part of the National Plan to Address Alzheimer's Disease, reducing potentially avoidable emergency department (ED) use by individuals with dementia has been identified as a component of enhancing the quality and efficiency of care for this population. To help inform the development of interventions to achieve this goal, an integrative review was conducted to: (a) compare rates and reasons for ED visits by community-dwelling individuals with and without dementia, considering also the effect of dementia subtype and severity; and (b) identify other risk factors for increased ED use among community-dwelling individuals with dementia. Nineteen articles met inclusion criteria. Individuals with dementia had higher rates of ED visits compared to those without dementia, although differences were attenuated in the last year of life. Increased symptoms and disability were associated with increased rates of ED visits, whereas resources that enabled effective management of increased need decreased rates. Gerontological nurses across settings are on the frontlines of preventing potentially avoidable ED visits by community-dwelling individuals with dementia through patient and family education and leadership in the development of new models of care. [ Journal of Gerontological Nursing, 44 (3), 23–30.]

The purpose of this study was to determine the extent to which nursing home staff adhere to current evidence-based guidelines to assess and manage persistent pain experienced by elderly residents. A retrospective audit was conducted of the medical records of 291 residents of 14 long-term care facilities in western Washington State. Data revealed a gap between actual practice and current best practice. Assessment of persistent pain was limited primarily to intensity and location. Although prescribing practices were more in line with evidence-based guidelines, a significant number of residents did not obtain adequate pain relief. Nonpharmacological pain management methods were rarely implemented. Nursing home staff and administrators must critically examine both system and individual staff reasons for failure to comply with best pain management practices. Research is needed to determine factors that contribute to less-than-optimal adherence to evidence-based guidelines for pain management, as well as the best methods for implementing practice change.

BEGINNING NURSING STUDENTS CAN