Elizabeth Andersen

Implementing team based learning in large classes: nurse educators' experiences.

Team-based learning (TBL) is an interactive teaching method promoted as an alternative to traditional lectures. TBL was implemented in four large second year classes in a baccalaureate nursing program but the implementation process was found to require much more effort than indicated in the literature. A predominant theme during the implementation phase was the importance of collegial support. Faculty workload increased significantly and they were challenged by occasional student confrontations and technological difficulties. The benefits for students included reduced attrition, reading workloads, and enhanced preparedness for classes, which allowed for more time to be spent in class discussing complex realistic nursing problems. Although TBL was not enthusiastically embraced by all of the students, the majority indicated that they liked and valued TBL, hence commitment to continuing to teach using the TBL method remains.

Reasons to Accumulate Excess: Older Adults Who Hoard Possessions

ABSTRACT This article is directed towards a deeper understanding of emotional issues that underpin hoarding behaviors by older people. A focused ethnographic research design was used as the method of exploration. The sample consisted of eight older adults who received home care and who were identified as exhibiting compulsive hoarding behaviors. The act of acquiring excess was found to be reassuring for older hoarders because stockpiled possessions relieved their anxieties and helped them to feel proud and productive, needed by others, connected, socially engaged, and in control. The hoarded possessions had value that was embedded but undeclared. Older hoarders were likely to have a positive view of themselves and their hoarding habits. For those who were not in imminent danger, hoarding constituted a certain quality of life.

Alone in Eden Care Aides’ Perceptions of Consistent Assignments

The Eden Alternative® is a philosophy of care and transformational model aimed at increasing quality of life for nursing home residents by enhancing institutional environments and restructuring delivery of care. Restructured care consists of three fundamental components: resident care provided primarily by care aides, enhanced responsibilities for care aides, and consistent assignment of residents to care aides. Researchers have focused on resident and family satisfaction with the model, but there is limited research evaluating the impact of the model on nursing home employees. This article is focused on their experiences. Convenience and purposive sampling were used to recruit 22 care aides from five nursing homes in a western Canadian city. Experiential interview data were collected and analyzed utilizing constant comparison to identify common themes. Although care aides initially welcomed the restructuring, they described gradually becoming overwhelmed by the work, confined by consistent assignments, and isolated from colleagues and other residents.

Being Below the Horizon: The Dwelling Place of the Nurse Aide

Nurse aides are the unregulated caregivers who perform the bulk of the physical and emotional care-giving work for residents in long-term care facilities. Hierarchies of nursing work in some long-term care institutions and the marginalization of some nurse aides in these institutions are revealed through quotes retrieved from existing literature. These quotes illustrate the ways in which these nurse aides are on earth – their ways of “dwelling.” The author calls for support and empathy from registered nurses for struggling nurse aides by integrating Martin Heidegger’s philosophies of space and dwelling with the ways in which nurse aides “dwell” in their places of work.

Participant Retention in Randomized, Controlled Trials: The Value of Relational Engagement

Although participant retention is critically important for the conduct of randomized controlled trials, relatively little is known about factors that lead to attrition. I argue that commonly used retention strategies are not cost effective in large trials because most participants do not value them. Attrition in experimental research occurs because we rely on conventional retention strategies and we neglect the unspoken values and beliefs of our participants. The most important of these is the value of relational engagement. Relational engagement does pose a potential threat to internal validity in trials with small sample sizes. This threat is discussed. In conclusion, I suggest that large trials should consider supporting relational engagement rather than spending money on conventional retention strategies.

Measuring relational care in nursing homes: psychometric evaluation of the Relational Care Scale.

Background and Purpose: The Relational Care Scale (RCS) is a Canadian evaluative instrument designed to measure nursing home residents’ perceptions of care aides’ relational abilities. Care aides’ abilities to be reliable and empathetic with nursing home residents are very important determinants of quality of care, but few instruments are designed specifically for residents or focus exclusively on these determinants. Initially developed and tested in metropolitan teaching-affiliated nursing homes in Ontario, we expanded testing by reevaluating the psychometric properties of the RCS in 5 rural nursing homes in British Columbia. Method: There were 62 residents living in 5 rural nursing homes who completed 3 instruments: the RCS under investigation, the Experiences in Close Relationships-Relationship Structures (ECR-RS) questionnaire to test for convergent validity, and the Lubben Social Network Scale-6 (LSNS-6) to test for discriminant validity. Results: The reliability of the RCS was strongly supported (Cronbach’s alpha = .90, item–total correlation > .77). Consistent with previous testing, a unidimensional internal structure was extracted. A moderate to strong correlation between the RCS and the Anxiety and Avoidance subscales of the ECR-RS supported convergent validity of the instrument. Last, partial support was obtained for the discriminant validity of the RCS. Conclusions: The RCS was easy to use for both residents and researchers. Expanded testing demonstrated its recurring reliability and validity.

Gaining awareness: Cultivating clinical reflection in nursing students

Earlier this year, in an article published in Nurse Education in Practice, a nurse educator in our school of nursing described an activity designed to refresh and inspire undergraduate nursing students who feel fatigued at the end of the day, and/or anxious, pressured, or overwhelmed during their clinical practice experiences (Andersen, 2016). We are some of those students who participated in this activity during some of our therapeutic debriefing and reflective discussions and we would like to respond by describing our experiences.

The impact of mode of assignment on relational care in nursing homes

I Canada, over the past decade, care aides’ assistive and caring roles have expanded considerably due to dramatic shifts in staffing patterns in nursing homes. These shifts are due in part to tremendous health care cost pressures faced by federal and provincial governments and in part to new approaches to health care delivery. In contemporary approaches, the presence of Registered Nurses in long-term care facilities has diminished, while care aides are employed in escalating numbers. Care aides have become the most central or the most accessible/available service providers to residents. In many facilities, teams of care aides who used provided care to all residents have been abolished. Newer approaches favor consistent (non-rotating) assignment of residents to care aides. In theory, consistent assignments foster closer, more intimate relationships between care aides and nursing home residents and facilitate familiarity between care aides and families of residents. This ethnographic study is a portrayal of care aides’ thoughts and feelings about their consistent assignments. Experiential data were collected from 22 care aides working in five nursing homes in a western Canadian city. The data were analyzed utilizing constant comparison to identify common themes. Care aides who were consistently assigned to residents described working without reference to each other. Some described losing contact with residents/families not assigned to them. Others described feeling overwhelmed, isolated, and confined by this mode of assignment and described a strong need for collegial fellowship and friendship. Experienced care aides stressed the importance of shared tasks, interchangeable tasks, and joint decisions, and indicated that a return to teamwork would help them to moderate or buffer the effects of stressful events and/or work environments.I Brazil there are more than 20 million people aged 60 or over and estimates indicate that the number will triple in the next 40 years. In this context, the aim of this study was to analyze the evolutionary trend of STDs among the elderly in Brazil and around the world. The study consisted of a systematic review (PRISMA) in LILACS, IBECS, Cochrane, MEDLINE, PubMed and SciELO. In total, 979 articles were identified, 44 of which met the inclusion criteria for this study. Among the works selected, 77% of the research related to HIV/AIDS and only 23% to other STDs. It was found that currently seniors remain sexually active into their later years, a fact related to the advent of drugs for erectile dysfunction. It was also found that a notable characteristic of this age group was the practice of sex without protection, which is reflected in the increase in STDs in this population. Other relevant data found in this review refers to the failure to diagnose STDs in elderly patients due to the fact that health professionals are unaware of, or ignore, the sexual practices of the elderly population, confusing the symptoms with comorbidities associated with old age. Furthermore, it was found that the elderly are generally excluded from public policy promoting health and the prevention of STDs. It is concluded that there is a need for awareness among health professionals of STD and geriatric services about changes in the behavior and epidemiological profile of this population.H professionals practicing in geriatric units routinely assess their patients with dementia prior to hospital discharge for their ability to perform safely their daily living activities. The aim of this assessment is to know what type of home care services are needed when they will return in their living environment. Because of a home visit cannot usually be done prior to discharge, this assessment is performed in hospital. This situation raised two questions: One is to what extent the risks assessed and the home care services recommended in hospital setting prior to discharge truly reflect and predict home safety; and second is how can we improve home safety in people with dementia following hospital discharge. Based on a systematic review and an international panel of experts, our data suggest that some risks (such as fire) may be overestimated while others (such inappropriate medication intake) may be underestimated before hospital discharge. These results may be explained by the characteristics of the assessment setting (unfamiliarity of the context), differences in clinicians, patients and caregivers’ perceptions and values toward ethical challenges (safety vs. autonomy) and difficult to predict how safety issues will change in the months following hospital discharge (progression of the disease, reduction of delirium). Developing a clinical decision tool to support assessment and management of risks by health professionals as well as optimizing transitions of care (through case manager and technological aid) may help to improve home safety in people with dementia following hospital discharge.

Nursing home models and modes of service delivery: Review of outcomes

Within contemporary approaches to nursing home care, the staff composition and task allocation influence paid caregiver experiences, and in turn affect the quality of care provided to residents. In this scoping review, we profile several different models of nursing home care with their associated modes of service delivery, and summarize the varied reports of effectiveness of these models and modes of service delivery. While anecdotal evidence supports the Eden Alternative® Neighbourhood or Household models, empirical support for the consistent assignment mode of service delivery within the Eden Neighbourhood or Household models is not extensive. More persuasive evidence supports the more advanced Eden Greenhouse model with its embedded flexible assignment policies and self-managed teams of care aides. Flexible assignments are a design element of the Alzheimer’s Disease and Related Disorders Society (ADARDS) model as well. Although consistent assignments for paid caregivers continue to be targeted by organizations, self-managed teams and flexible assignments may be more ideal modes of nursing home service delivery, especially now, as the average age, frailty level, and acuity level of nursing home residents is increasing.

Do They Think I Am a Pack Rat

This case study presents details of the life of one older man who lived in seclusion and squalor, surrounded by hoarded possessions. This man was one participant of a focused ethnography of eight older adults who received home care. All participants in the original ethnography were identified by their community care coordinators as exhibiting hoarding behaviors. The case study presented here provides rich narrative and photographic detail in order to add strength to what has already been presented in previous research articles about compulsive acquisition. The narratives reveal examples of debilitating dysfunction, distress associated with decision making, broad acquisition of free things, compulsive buying, and ritualistic discarding. Quotes included in the case study stem from the original ethnography.