Cynthia S. Teel

Rural practitioners’ experiences in dementia diagnosis and treatment

When diagnosis of dementia occurs earlier in the disease process, more time is available for treatment aimed at maintaining patient function and delaying decline, and for family education about the disease and its management. Primary care providers often, however, face challenges in making timely diagnoses. Nineteen practitioners in mostly rural areas of a mid-western state were interviewed about their experiences in diagnosis and treatment, to develop a more comprehensive understanding of barriers encountered by providers in non-metropolitan areas. Participants estimated that the time from symptom onset to diagnosis ranged from several months to one year, largely dependant upon family recognition. Limitations in access to consultants and limited or non-existent community support and education resources were major impediments to diagnosis and treatment, respectively. Like their colleagues in more urban communities, denial among family members, or families who were absent or uncooperative, created additional challenges for providers in making and communicating diagnoses and in supporting home-based or institutional care. Conversely, supportive and motivated families played a central role in positive patient care experiences. Participants agreed that support and education services were important for family caregivers, but generally had few resources to offer families, which constrained their ability to provide optimal care. Identifying challenges faced by rural practitioners is essential to planning appropriate interventions for consultative support and educational outreach.

Family Experiences in the Journey Through Dementia Diagnosis and Care

Families caring for loved ones with dementia encounter multiple challenges. This study aimed to describe experiences of families seeking diagnosis and subsequent care and treatment for relatives with dementia. Using a descriptive qualitative approach, 14 family caregivers living in diverse areas of Kansas were interviewed regarding their experiences with dementia diagnosis and treatment. Initially uncertain about symptom interpretation, caregivers encountered marked delays in getting a diagnosis once they sought medical care. The diagnostic process often took several years and visits to numerous physicians, required considerable diligence, and ultimately resulted in feelings of mistrust toward the medical community. Caregivers described the physical and emotional strain of providing care, although support groups facilitated access to some educational and community resources. Nurses are in an opportune position to educate families about dementia and caregiving and to ease the considerable challenges they face by providing more active support during the diagnosis and care process.

Developing and testing a self-care intervention for older adults in caregiving roles.

BackgroundTheory-based interventions incorporating a self-care perspective for health promotion and protection are needed for older adults. The Self-Care for Health Promotion in Aging (S-CHPA) model provided the basis for development of an intervention focused on promoting health among older adults who provide care for their spouses with dementia. ObjectivesTo describe the development of a theory-based intervention (Self-Care Talk) and to describe the process of evaluating the implementation of the intervention when it was pilot tested with older spouse caregivers of persons with dementia. MethodsThe S-CHPA model was used to guide development of Self-Care Talk, a series of telephone-based sessions between advanced practice nurses and older adults. Session content included practicing healthy habits, building self-esteem, focusing on the positive, avoiding role overload, communicating, and building meaning. Specific self-care strategies were explored in the context of an individuals experiences, relationships, and condition. Intervention implementation was evaluated using Lichsteins criteria of delivery, receipt, and enactment. ResultsSix spouse caregivers of persons with dementia participated in the pilot study. The education and support intervention was delivered as intended (delivery). Participants reported understanding session content (receipt), and planned to use the information (enactment). Participants also reported an increased awareness about self-care practices and offered specific examples of how they intended to practice better self-care. DiscussionThe theory-based Self-Care Talk intervention can be implemented as intended and is ready for use in future randomized clinical trials with older spouse caregivers of persons with dementia.

The Role of the Environment in Fostering Independence: Conceptual and Methodological Issues in Developing an Instrument

Although rehabilitation professionals are increasingly aware that environments can support or interfere with an individuals ability to function, environmental factors are not emphasized in assessment and intervention planning across rehabilitation disciplines. Conceptual and methodological issues related to creating a measure for assessing the rehabilitation environment, in either institutional or home settings, as it relates to fostering an individuals independence are presented. Reflecting a multidimensional conceptual base, the Environment-Independence Interaction Scale has subscales for temporal, physical, social, and cultural dimensions of the environment. The measure is primarily intended for research in evaluating effects of various rehabilitation environments on selected outcomes.

A theory-based Self-Care Talk intervention for family caregiver-nurse partnerships.

Family caregivers need assistance with information, support, and advice from nurses and other health care professionals to successfully meet the demands of caregiving. Self-Care TALK (SCT) is a theory-based nursing intervention designed to improve the health and well-being of older adult spouse caregivers. The Self-Care for Health Promotion in Aging Model (S-CHPA) provides a framework for development of SCT. Key to implementation of the SCT intervention is partnership building between nurses and caregivers, which is fostered through relational conversations. In this article, the model and intervention are described, and an individual example is provided to show the application of the model in practice. Implications for practice and research are explored.

Building and Critiquing Qualitative Research Websites: A Cyberspace Project to Connect Undergraduate Nursing Students in Canada and the United States

This project had a dual purpose: 1) to facilitate student learning about qualitative research methods, and 2) to promote collegiality and professional development among senior nursing students in Canada and the United States through the use of distance technology. In each of three project years, students at St. Francis Xavier University (STFX) in Nova Scotia initiated the experience by working in small groups to develop websites about different methodological approaches in qualitative research. Site information included an overview of the selected approach, discussion of trustworthiness issues, citation of journal articles in which authors used the approach, additional references, and some personal information about the student developers. Also working in small groups, University of Kansas students identified and read related research articles, reviewed website information, and responded to the STFX groups about the usefulness of site information in increasing understanding of qualitative methods and using the information for evaluation of research. The experience promoted active use of qualitative research concepts and facilitated the development of skills in evaluating research article content and website content. Participation in the activity fostered positive perceptions about the value and use of research and helped students appreciate the similarities in courses, programs, and professional requirements and values among international peers.