Beth Mastel-Smith

TESTING THERAPEUTIC LIFE REVIEW OFFERED BY HOME CARE WORKERS TO DECREASE DEPRESSION AMONG HOME-DWELLING OLDER WOMEN

The purpose of the study was to test a psychosocial intervention, therapeutic life review, offered by home care workers to decrease depression among home-dwelling older women. A quasi-experimental, one-group time-series design measured the effect of a once-a-week, 40-minute therapeutic life review intervention, delivered for six weeks by home care workers, on the depression scores of women 65 years and older, compared to their scores during the ten weeks prior to the intervention. Over time, depression scores improved with a significant decrease in depression immediately following the six-week intervention. Based on these findings, we concluded that home care workers can deliver a community-based psychosocial intervention that decreases depression in their home-dwelling clients.

Resident strategies for making a life in a nursing home: a qualitative study

AIM To identify strategies that older adults use to adapt to live in long-term care. BACKGROUND The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Moving into a long-term care setting has been documented internationally as an overwhelming life change for many older adults. It has been observed that residents adjust differently over time, but the basis for these differences needs further exploration. DESIGN A qualitative design using grounded theory method was employed. METHODS A total of in-depth interviews were conducted in October 2008-February 2009 with a sample of 21 participants. Participants ranged in age from 65-93 years, 81% women and 19% men; mainly Caucasian with one African American and one Hispanic. Length of stay ranged from 3 days to over 9 years living in long-term care so that all stages of adjustment were included in the study. Ground theory method was used to analyse the data. FINDINGS The results of this study yielded 21 facilitative strategies. The core category identified was personal resiliency, which served as the underpinning for the strategies used by the participants. Strategies were identified in making the decision to move into long-term care and in day-to-day living. CONCLUSION Understanding the strategies that facilitate residents to make a successful transition to long-term care life will assist nurses to intervene in ways that are supportive. The strategies identified in this study may be used to develop interventions for residents that are having difficulty living in long-term care. Further exploration of how resiliency has an impact on strategies used by residents is clinically relevant, but further research is needed.

“It’s Like We’re Grasping at Anything”: Caregivers’ Education Needs and Preferred Learning Methods

In this qualitative descriptive study, we explored caregivers’ educational needs and preferred methods of information delivery. Descriptions are based on five focus groups (N = 29) conducted with ethnically diverse, current and past family caregivers, including those who had previously attended a structured educational program. Themes arose from verbatim data transcriptions and coded themes. Four categories of educational needs were identified: (a) respite, (b) caregiving essentials, (c) self-care, and (d) the emotional aspects of caregiving. Advantages and disadvantages of learning methods are discussed, along with reasons for and outcomes of attending caregiver workshops. An informed caregiver model is proposed. Health care providers must assess educational needs and strive to provide appropriate information as dictated by the care recipient’s condition and caregiver’s expressed desires. Innovative methods of delivering information that are congruent with different caregiving circumstances and learning preferences must be developed and tested.

Cultural Competencies for Graduate Nursing Education

Nursing is challenged to meet the health needs of ethnic and socioculturally diverse populations. To this end, American Association of Colleges of Nursing (AACN) charged an expert nursing faculty advisory group to formulate competencies for graduate nursing education, expanding them to integrate leadership and scholarship. The Cultural Competency in Baccalaureate Nursing Education served as the springboard for the initiative. In formulating the graduate cultural competencies and the toolkit, the advisory group reviewed all AACN Essentials documents and the cultural competency literature, drew upon their collective experiences with cultural diversity, and used cultural humility as the supporting framework. Six core competencies were formulated and endorsed by the AACN board of directors and key professional nursing organizations. A companion toolkit was compiled to provide resources for the implementation of the competencies. A 1-day conference was held in California to launch the cultural competencies and toolkit. Dissemination to graduate nursing programs is in process, with emphasis on faculty readiness to undertake this graduate educational transformation. The AACN Cultural Competencies for Graduate Nursing Education set national standards to prepare culturally competent nurses at the graduate level who will contribute to the elimination of health disparities through education, clinical practice, research, scholarship, and policy.

Voices of Elders Culture and Person Factors of Residents Admitted to Long-Term Care Facilities

Purpose: The aim of this study was to investigate person and environment factors of elders that facilitate adaptation to relocation to long-term care skilled nursing facilities. Results represent findings from Phase 1 of three phases of a 2-year study to develop and test a cultural heritage intervention to improve adaptation to nursing home relocation. Design: Qualitative interviews were conducted with 23 newly admitted Caucasians and African Americans residing in skilled nursing facilities. Findings/Results: Themes that emerged include (a) spirituality, death and dying, and philosophy of life; (b) life experiences with change; (c) cultural heritage; (d) health; (e) ethnicity; (f) social support, family and friends; (g) long-term care facility (LTCF) relationships; (h) LTCF system maintenance; and (i) LTCF support of personal growth. Comparison of African Americans and Caucasians showed more similarities than differences between the groups. Discussion: Implications for research, clinical practice, and cultural heritage interventions for LTCF adaptation are discussed.

The outcomes of anxiety, confidence, and self-efficacy with Internet health information retrieval in older adults: a pilot study.

Technology has a great impact on nursing practice. With the increasing numbers of older Americans using computers and the Internet in recent years, nurses have the capability to deliver effective and efficient health education to their patients and the community. Based on the theoretical framework of Banduras self-efficacy theory, the pilot project reported findings from a 5-week computer course on Internet health searches in older adults, 65 years or older, at a senior activity learning center. Twelve participants were recruited and randomized to either the intervention or the control group. Measures of computer anxiety, computer confidence, and computer self-efficacy scores were analyzed at baseline, at the end of the program, and 6 weeks after the completion of the program. Analysis was conducted with repeated-measures analysis of variance. Findings showed participants who attended a structured computer course on Internet health information retrieval reported lowered anxiety and increased confidence and self-efficacy at the end of the 5-week program and 6 weeks after the completion of the program as compared with participants who were not in the program. The study demonstrated that a computer course can help reduce anxiety and increase confidence and self-efficacy in online health searches in older adults.

THE FEASIBILITY OF HOME CARE WORKERS DELIVERING AN INTERVENTION TO DECREASE DEPRESSION AMONG HOME-DWELLING, OLDER WOMEN: A QUALITATIVE ANALYSIS

Depression is associated with poorer functioning and may even increase the risk of dying. Home-dwelling frail older women with depression often receive inadequate treatment or no treatment at all. Therapeutic life review, an intervention based on Eriksons developmental stages, delivered by home care workers (HCWs) with three hours of training, is a cost effective way to enhance mood in these women. Nine HCWs who had implemented therapeutic life review participated in one of two focus groups and reported enhanced moods among their frail older clients.

Online Teaching: “Are You There, and Do You Care?”

Much of nursing education is moving online, and faculty must learn to deliver content and communicate differently. A hybrid model of concept development provided insight into facultys perceptions and expressions of online caring presence. Phase one of concept development revealed many related concepts. Phase two involved (a) six qualitative interviews with doctoral-prepared nursing faculty who taught 100% online, and (b) Watsons Ten Caritas Processes were revised for application in online nursing education and used as a guide for course review. Four themes emerged from the interview data: (a) online teaching experiences, (b) similarities and differences between online and face-to-face teaching, (c) online presence, and (d) online caring presence. Course review suggested that faculty promoted helping-trusting-caring relationships and addressed individual learning needs. Phase three integrated findings from phases one and two; a comprehensive definition of online caring presence was developed. Recommendations regarding technology and communication skill acquisition and Caritas Process application are suggested.

The Lived Experience of Fathers Whose Children Are Diagnosed with a Genetic Disorder

OBJECTIVE To describe the fathers experience of having a child diagnosed with a genetic disorder. DESIGN Interpretive phenomenological analysis. SETTING In-person interviews for participants living within 100 miles of the researcher; phone interviews with participants living more than 100 miles from the researcher. PARTICIPANTS Six fathers of children diagnosed with genetic disorders. METHODS Participants were recruited with the assistance of nurses, physicians, and genetic counselors. Snowball sampling, Internet and e-mail recruitment, and word of mouth were also used. Semistructured interviews were completed, audio recorded, and transcribed verbatim. RESULTS Five themes emerged: the impact of diagnosis, seeking understanding, coping with effects of the disorder, looking to the future, and addressing a fathers needs. CONCLUSION Fathers of children diagnosed with genetic disorders described a lack of education and information regarding the diagnoses. They attributed this deficiency to a lack of knowledge among physicians, nurses, and other health care professionals. Coping with the effects of the disorder was identified as an integral part of adapting to meet the childs needs. Understanding the experience of a father whose child is diagnosed with a genetic disorder is necessary to ensure provision of proper intervention and care.

Addressing future demands: Development of an online gerontological nursing course

Nursing students often hold negative views of and do not want to work with older people. Innovative approaches to engage nursing students in geriatric content hold the potential to improve attitudes, a crucial step in meeting the aging populations healthcare needs. This article describes the process of developing, implementing and evaluating an online, undergraduate nursing gerontology course. Development was based on Mezirows Transformative Learning Theory. Student reflections collected from approximately 200 individuals over two semesters about knowledge gained and the effect on attitudes about aging and older adults are summarized.