Juliana C. Cartwright

End-of-life care in assisted living facilities: Perceptions of residents, families, and staffs

Terminally ill residents, their families, and care providers were interviewed and observed in 4 assisted living facilities (ALFs). Families supported the residents’ desires to die “at home,” and dying residents had sustained, caring relationships with some staff. Facilities varied in terms of the services they could provide at the end of life. The staff did not always have sufficient training in care at the end of life, and staffing ratios did not always accommodate the intense care needs of dying people. ALF and hospice staffs did not plan, coordinate, or communicate sufficiently in providing care services. This study suggests that the privacy and autonomy that make ALFs desirable living environments may create challenges when dying residents require increasingly intense monitoring and care.

End-of-life care for rural-dwelling older adults and their primary family caregivers.

Older adults dying from chronic illness in rural areas are understudied and of concern because of their limited access to health services. The purpose of this qualitative descriptive study was to describe the perspectives of primary family caregivers regarding experiences with formal and informal care at the end of life for dying older adults in one rural, agricultural county. Semi-structured interviews were conducted with 23 caregivers following the death of an older relative. Major themes that emerged from the data were the benefits and challenges associated with care services. Benefits included neighbors, friends, and other volunteers who offered household help and provided respite care. Challenges included limited resources for continuity of care, geographical service boundaries, and lack of knowledge about end-of-life care by paid caregivers. Further research that addresses the perspective of rural service providers is needed to better understand the benefits and challenges of end-of-life care in this setting.

Mammography Decision Making in Older Women With a Breast Cancer Family History

Purpose: This studys purpose is to describe and explain how women 55 years of age and older with a family history of breast cancer make screening mammography decisions. Design: A qualitative design based on grounded theory. This purposeful sample consisted of 23 women 55 years of age or older with one more first-degree relatives diagnosed with breast cancer. Method: Open-ended interviews were conducted with 23 women 55 years of age and older with a family history of breast cancer using a semistructured interview guide. Transcribed interview data were analyzed using constant comparative analysis to identify the conditions, actions, and consequences associated with participants screening mammography decision making. Findings: Women reported becoming aware of their breast cancer risk usually due to a triggering event such as having a family member diagnosed with breast cancer, resulting in women “guarding against cancer.” Womens actions included having mammograms, getting health check-ups, having healthy behaviors, and being optimistic. Most women reported extraordinary faith in mammography, often ignoring negative mammogram information. A negative mammogram gave women peace of mind and assurance that breast cancer was not present. Being called back for additional mammograms caused worry, especially with delayed results. Conclusions: The “guarding against cancer” theory needs to be tested in other at-risk populations and ultimately used to test strategies that promote cancer screening decision making and the adoption of screening behaviors in those at increased risk for developing cancer. Clinical Relevance: Women 55 years of age and older with a breast cancer family history need timely mammogram results, mammography reminders, and psychosocial support when undergoing a mammography recall or other follow-up tests.

Strategies to promote safe medication administration in assisted living settings

Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.

Navigating federalwide assurance requirements when conducting research in community-based care settings.

There is an urgent need for research on quality of life and healthcare delivery for older adults living in community‐based care settings, yet implementing current federalwide assurance (FWA) requirements can be a challenge in these settings. This paper discusses FWA requirements for engagement in federally funded research as the requirements pertain to community‐based care settings. Factors that impede community facilities in achieving FWA approval include lack of organizational structure to provide oversight for the ethical conduct of research, administrator concerns regarding potential liability associated with obtaining the FWA, lack of resources to complete required paperwork, and lack of staff knowledge about human subjects protection and federal requirements for participating in research. Effects of the FWA process on investigators include the burden of extra time needed to support community‐based facilities to acquire a FWA and concerns that studies may be limited to only those community facilities with the resources to complete the FWA process. Investigator‐initiated strategies for conducting research in community‐based settings include considering study designs that are exempt from the FWA process and proactively assisting community‐based facilities to acquire FWA status. Investigators need to work with potential research sites and the office for human research protections to ensure that subjects are protected without shifting the burden of protection to ill‐prepared community administrators.

Long-Term Care Nurse Role Models in Clinical Nursing Education: The ECLEPs Experience

This article describes the partnership formed between long-term care (LTC) staff nurses and clinical nursing faculty to provide students with excellent clinical experiences in nursing homes and assisted living facilities. The nurses, called Clinical Education Liaisons, contributed to faculty understanding about LTC and served as resources for students. Faculty provided ongoing mentorship about current trends in clinical education. An in-person interactive training program prepared the nurses and faculty for their new partnership roles. Evaluation results indicate the Enriching Clinical Learning Environments through Partnerships program was successful, with all LTC nurses indicating they would participate in the program again. They also reported that the students had contributed to their organizations and were being well prepared for future practice.

Investigators' successful strategies for working with institutional review boards

This study was designed to identify successful strategies used by investigators for working with their Institutional Review Boards (IRBs) in conducting human subjects research. Telephone interviews were conducted with 46 investigators representing nursing, medicine, and social work. Interview transcripts were analyzed using qualitative descriptive methods. Investigators emphasized the importance of intentionally cultivating positive relationships with IRB staff and members, and managing bureaucracy. A few used evasive measures to avoid conflict with IRBs. Few successful strategies were identified for working with multiple IRBs. Although most investigators developed successful methods for working with IRBs, further research is needed on how differences in IRB culture affect human subjects protection, and on best approaches for obtaining IRB approval of multi-site studies.

Enhancing the capacity to teach gerontological nursing: a faculty development project.

This article describes a faculty development initiative implemented by baccalaureate school of nursing faculty to address the urgent need for education and development in gerontological nursing. The Gerontological Nursing Education Curriculum (G-NEC) project was implemented in five states between 2006 and 2009 to (a) increase faculty knowledge of gerontological nursing, and (b) increase gerontological content in participating schools of nursing. A 4-hour workshop presented at 11 schools introduced key concepts and instructional activities related to care of older adults. Participants rated content and format highly; follow-up reports indicated that many made curriculum changes to incorporate gerontological content. The authors describe workshop content and teaching strategies, curriculum changes participants made to incorporate gerontological content, and implications for faculty development.

Peer-reviewed Web-based gerontological resources for nursing faculty.

Faculty members are expected to integrate content about older adults into undergraduate curricula. Although numerous gerontological education resources exist on the Internet, educators often lack awareness of these resources or the time to explore them. We describe a project that used a peer-review process to organize resources into a searchable, online catalog that includes suggestions for using the content in different courses (http://www.ohsu.edu/son/ecleps). Implications are discussed for developing and maintaining the interactive catalog of Web-based instructional resources.

Administrators' perspectives on ethical issues in long-term care research.

Ethical issues are a significant potential barrier to much-needed research in long-term care settings. LTC stakeholder perspectives are largely absent from the development of regulation and guidelines. Fifteen long-term care administrators were interviewed as part of a study of ethical issues in community-based, long-term care research. Established qualitative procedures for conducting content analysis were used to organize the data. Findings suggest that existing mechanisms to protect human subjects do not take into account important differences between academic and long-term care settings. The full potential of LTC research will not be realized until supportive processes to enhance human subjects protections are developed in a way that is reflective of the LTC environment.