Donna L. Wells

Falling Short of the Mark Tales of Life After Hospital Discharge

The purpose of this qualitative study was to explore the everyday issues, challenges, struggles, and needs of elderly, community-dwelling women in the first weeks posthospital discharge. Fourteen elderly women were interviewed in their homes 6 to 8 weeks following hospitalization. In addition, using a process based on photo novella or photovoice, 4 of the women took photographs of their everyday lives. The photos were used as triggers during the interviews. The interviews were analyzed to identify the themes of the women’s experiences. The overarching theme was that hospital discharge plans “fall short of the mark” because they failed to reflect the complexity of the posthospitalization experience by focusing primarily on very basic physical and medically related needs rather than on the reality of the women’s recovery. These findings are alarming given the aging population. The implications for hospital discharge planners, home care service providers, and policy decision makers are discussed.

The effects of language used by caregivers on agitation in residents with dementia.

In this study, We addressed the problem of whether residents with a diagnosis of dementia would become agitated if given verbal commands at a level of language complexity above their comprehension ability. The study used an A-B-A research design. The convenience sample of 15 subjects was comprised of 11 men and 4 women who resided in a long-term care institution. Their mean age was 86.6 years, and their average length of stay in the institution was 317.3 days. The results lent support to the hypothesis that exposing residents with dementia to language beyond their comprehension ability could result in agitated behavior. The predominant manifestations of agitation were general restlessness, strange noises, and negativism. An important implication for nursing practice is that the language used by caregivers should match the comprehension ability of residents. Caregiving can thereby facilitate communication and, potentially, prevent agitation.

Use of a content methodology process to enhance feeding abilities threatened by ideational apraxia in people with alzheimer's-type dementia

Self-feeding behavior is often the first of a chain of self-maintenance skills to deteriorate in people with Alzheimers-type dementia and is a major determinant of institutionalization. Moreover, nurses working in geriatric settings report the feeding of patients as a most difficult management problem. Of the various features of Alzheimers-type dementia that can affect a persons ability to feed him- or herself, ideational apraxia can explain the loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects necessary for feeding. In this article, a systematic process is used to review the research literature to develop substantive content for nurses caring for people with feeding problems related to ideational apraxia. Ideational apraxia is a condition in which an individual is unable to plan movement related to an object because he or she has lost the perception of the objects purpose. The specific abilities necessary for feeding that are threatened by ideational apraxia are identified. A tool to assess these abilities is described, and nursing interventions aimed at enhancing or preserving existing abilities, preventing excess disability, or compensating for lost abilities are presented.

Description of retained abilities in older persons with dementia

There have been suggestions in the literature that the care of people with dementia must be focused on abilities as opposed to disabilities. However, this approach has not been carefully defined in terms of what constitutes remaining abilities. This article provides a description of the abilities in people with dementia, which is based on a descriptive analysis of data derived from a larger study regarding the psychometric evaluation of an abilities assessment instrument. The sample comprised 112 male veterans with dementia who were living in a long-term care facility. Their mean age was 75 years. Data were collected in the areas of self-care, social, interactional, and interpretive abilities. Abilities were retained in all four areas. Furthermore, abilities were differently affected and varied considerably across subjects, which is consistent with evidence pertaining to cognitive changes in dementia. Our results provide support for an individualized, abilities-focused approach to the care of people with dementia.

Voiding Dysfunction in Geriatric Patients with Hip Fracture: Prevalence Rate and Tentative Nursing Interventions

Our clinical experience indicates that voiding dysfunction is common in geriatric patients with hip fracture. Therefore, we conducted a prevalence survey and found that voiding dysfunction occurred in 47% of these patients, indicating a significant clinical problem. This article describes the survey and outlines tentative nursing actions that are aimed at reducing voiding problems in this patient population. We are currently designing an explicit nursing protocol that will be tested in a prospective study involving geriatric hip-fracture patients.

An abilities assessment instrument for elderly persons with cognitive impairment: psychometric properties and clinical utility.

In this article the psychometric properties of an Abilities Assessment Instrument (AAI), developed to assess the self-care, social, interactional and interpretive abilities of older people with cognitive impairment (CI) related to dementia, are described. The sample consisted of 112 institutionalized older men with CI and 60 institutionalized older men without CI. The psychometric evaluation of the AAI indicated that: (a) it is reliable in terms of test-retest (Pearson’s r range .93-.99), interrater (Pearson’s r range .95-.99), and internal consistency evaluations (Cronbach’s alpha .90-.98), as well as through confirmatory factor analysis; and (b) that it is valid with respect to content validity (CVI 87.3%), concurrent validity (Pearson’s r correlations ranging from -.67-.80 on the London Psychogeriatric Rating Scale [LPRS], and from -.76-.85 on the Functional Assessment Stages Scale [FAST]), and construct validity with significant differences between subjects with and without CI (t values ranging from 5.13 -9.30). The AAI is a reliable and valid instrument that can be used to provide assessment data.

A Content Methodology for Advancing Gerontological Nursing Practice

THE CONTENT METHODOLOGY process is a method of observation, research, and application that refines the caregiving practice. An application of the content methodology process with cognitively-impaired individuals with dementia is explored, and correlations drawn to language abilities of older patients.

A Systematic Approach to the Nursing Care of Acutely Ill Geriatric Patients with Cognitive Impairment

This afternoon I am going to discuss two examples of clinical nursing research related to the care of geriatric patients who suffer both an acute illness and irreversible cognitive impairment. Cognitive impairment refers to alteration in orientation, memory, language, insight, judgment, attention, perception, and thought content.