Lori Schindel Martin

Mealtimes and being connected in the community-based dementia context

Mealtimes provide an opportunity for social activity and emotional connection. This grounded theory study focused on the meaning and experience of mealtimes in families living with dementia in the community; 28 partners in care and 27 persons with dementia were interviewed together and separately. Team analysis resulted in the development of a substantive theory which explains how eating together ‘mirrors the way we are’ and reveals the essence of what it is to be human while living with dementia. Mealtimes reflect how these families were being connected, honouring identity and adapting to an evolving life. This article focuses on three ways in which Being Connected occurs at mealtimes: being face to face, participating psychologically, and getting and giving support. Understanding the role that mealtimes play in promoting improved connections and thus relationships within the dementia context has important implications for both formal and family care partners.

Nutrition education needs and resources for dementia care in the community.

Nutrition problems and specificly weight loss are common in older adults with dementia living in the community. Study 1 involved interviews with 14 formal providers to identify the range of nutrition concerns they had experienced. In study 2, 74 Canadian Alzheimer Society chapters were surveyed by e-mail (23% participation rate) to determine nutrition concerns and education resources provided to clients. In all, 26 of these nutrition pamphlets or handouts were rated on content and format by 2 independent researchers using a standardized rating system. Common nutrition concerns identified in older adults with dementia living in the community include safety, weight loss, forgetting or refusing to eat, appetite, dysphagia, and unfavorable eating behaviors. Most resources provided to clients were considered low quality and did not match the nutrition concerns expressed by formal providers. Currently, there is a considerable knowledge translation gap around nutrition and dementia, and this study provides a basis for the future development of nutrition education resources.

Strategies to support engagement and continuity of activity during mealtimes for families living with dementia; a qualitative study.

BackgroundMealtimes are an essential part of living and quality of life for everyone, including persons living with dementia. A longitudinal qualitative study provided understanding of the meaning of mealtimes for persons with dementia and their family care partners. Strategies were specifically described by families to support meaningful mealtimes. The purpose of this manuscript is to describe the strategies devised and used by these families living with dementia.MethodsA longitudinal qualitative study was undertaken to explore the meaning and experience of mealtimes for families living with dementia over a three-year period. 27 families [older person with dementia and at least one family care partner] were originally recruited from the community of South-Western Ontario. Individual and dyad interviews were conducted each year. Digitally recorded transcripts were analyzed using grounded theory methodology. Strategies were identified and categorized.ResultsStrategies to support quality mealtimes were devised by families as they adapted to their evolving lives. General strategies such as living in the moment, as well as strategies specific to maintaining social engagement and continuity of mealtime activities were reported.ConclusionsIn addition to nutritional benefit, family mealtimes provide important opportunities for persons with dementia and their family care partners to socially engage and continue meaningful roles. Strategies identified by participants provide a basis for further education and support to families living with dementia.

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

BackgroundResearch evidence supports the positive impact on resident outcomes of nurse practitioners (NPs) working in long term care (LTC) homes. There are few studies that report the perceptions of residents and family members about the role of the NP in these settings. The purpose of this study was to explore the perceptions of residents and family members regarding the role of the NP in LTC homes.MethodsThe study applied a qualitative descriptive approach. In-depth individual and focus group interviews were conducted with 35 residents and family members from four LTC settings that employed a NP. Conventional content analysis was used to identify themes and sub-themes.ResultsTwo major themes were identified: NPs were seen as providing resident and family-centred care and as providing enhanced quality of care. NPs established caring relationships with residents and families, providing both informational and emotional support, as well as facilitating their participation in decision making. Residents and families perceived the NP as improving availability and timeliness of care and helping to prevent unnecessary hospitalization.ConclusionsThe perceptions of residents and family members of the NP role in LTC are consistent with the concepts of person-centred and relationship-centred care. The relationships NPs develop with residents and families are a central means through which enhanced quality of care occurs. Given the limited use of NPs in LTC settings, there is an opportunity for health care policy and decision makers to address service inadequacies through strategic deployment of NPs in LTC settings. NPs can use their expert knowledge and skill to assist residents and families to make informed choices regarding their health care and maintain a positive care experience.

Theoretical Framing of High-Fidelity Simulation With Carper’s Fundamental Patterns of Knowing in Nursing

Many nursing programs integrate high-fidelity simulation(HFS) into the curriculum. The manikins used are modeled to resemble humans and are programmed to talk and reproduce physiological functions via computer interfaces.When HFS design negates a theoretical framework consistent with the interpersonal and relational nature of nursing,it can problematically focus simulation on psychomotor skills and the physical body. This article highlights a theorized approach to HFS design informed by Carpers seminal work on the fundamental patterns of knowing in nursing(i.e., empirics, esthetics, personal knowing, and ethics). It also describes how a team of Canadian nurse educators adopted these patterns of knowing as a theoretical lens to frame scenarios, learning objectives, and debriefing probes in the context of maternal and newborn assessment. Institutions and practitioners can draw on Carpers work to facilitate focusing on the whole person and expanding the epistemological underpinnings of HFS in nursing and other disciplines.

Meaning and experience of “eating out” for families living with dementia

Twenty-eight care partners and 27 persons living with dementia in the community participated in qualitative active interviews to provide their perspectives on the meaning and experience of eating out. Using grounded theory methodology, a substantive theory on eating out as a way of balancing life was developed. Two types of balance were identified: (1) environmental balance through spicing up life and minimizing demands and (2) social balance through binding glue and being part of a peer group. The many changes noted around dementia required families to adopt strategies to help achieve balance and support successful experiences eating away from home.

Transitions to Long-Term Care How Do Families Living With Dementia Experience Mealtimes After Relocating?

Food and mealtimes play a central role in our lives and often hold great meaning. This study is a secondary analysis of a subset of data collected from a 6-year longitudinal qualitative study called Eating Together (ET), which sought to better understand the experiences around food and mealtimes for community dwelling persons with dementia (PWD) and their primary care partners (CP). Several PWD and, in some cases, their spousal CP, relocated to long-term care (LTC) during the conduct of the ET study. To understand how this relocation influenced the meaning of meals, a subset of those who experienced this transition were selected and analysis specific to this issue was undertaken. Seven families were included in this thematic inductive analysis. Findings revealed five themes related to the different mealtime experience in the LTC home, including systemizing the meal, adjusting to dining with others, holding on to home, evolving mealtime roles, and becoming “at home.” Understanding how families adapt to commensal dining in LTC may be relevant to successful relocation. This work furthers this understanding and provides a basis for person-centered mealtime practices that promote adaptation.

Assessment of Agitation in Older Adults

Publisher Summary Accurate and comprehensive assessment of agitation in persons with dementia is critical for clinical, administrative, and research purposes. Clinically, assessment of agitation is relevant to selecting appropriate treatment(s), monitoring treatment effectiveness and making adjustments if necessary, and determining optimal living situations. Administrative issues affected by the assessment of agitation include formulating unit placement plans, staff communication, and quality control of nursing units. Regarding clinical research, the ability to accurately assess agitation is essential to understanding the etiology of agitation and estimating the effectiveness of interventions and prevention programs, and to translating this information into practice. Approaches to assessing agitation include informant ratings, observational methods, and technological devices. Assessment may include identification of the frequency, intensity, and duration of the behavior, as well as determination of a level of risk to oneself and others associated with the behavior. It may involve a behavioral mapping system, which is an observational method that examines the stimulus/response relationship a person has with the environment. Agitation consists of several syndromes, including physically aggressive behaviors, physically non-aggressive behaviors, verbally aggressive behaviors, and verbally non-aggressive behaviors. Because different syndromes are associated with unique etiologies, it is often important to determine the specific syndrome manifested. Some assessments focus only on one type of syndrome or behavior, whereas others identify which syndrome is present, and still others only provide a global score. Given the multitude of assessments available for measuring agitation, the user needs to choose the instrument that will best meet the goal of assessment and will be compatible with the resources available, such as time and cost.

Managing disruptive behaviors with neuroleptics: treatment options for older adults in nursing homes.

Disruptive behaviors are frequent among elderly individuals in long-term care centers. Neuroleptics remain the most common pharmacological treatment for controlling these challenging behavioral manifestations. However, their effectiveness is a subject of controversy and it is unclear what specific behaviors are more likely to be managed with neuroleptic medications. The objective of this study was to identify the types of disruptive behaviors for which neuroleptics are given to elderly individuals in long-term care facilities and determine if the frequency of these behaviors increases the risk of being prescribed neuroleptics. A cross-sectional study was conducted with 2,332 participants ages 65 or older living in 28 long-term care facilities. Among them, 27.8% had taken at least one neuroleptic drug in the prior week. The administration of neuroleptics was not linked to the presence of any one specific disruptive behavior. However, a significant finding was that the greater the frequency of disruptive behavior exhibited by an elderly individual, the greater the risk of them being administered a neuroleptic medication. A multi-dimensional approach to the assessment of disruptive behaviors is recommended to facilitate the identification of the underlying causes of those behaviors. Accordingly, it is suggested that non-pharmacological treatment plans be adapted to each situation and then implemented to potentially reduce the use of neuroleptics.

Urban First Nations Men Narratives of Positive Identity and Implications for Culturally Safe Care

Purpose: Dominant discourse contains negative stereotypical images of First Nations males that are steeped in colonialism. These racialized images can influence First Nations men’s sense of self as well as the care that nurses deliver. The objective was to (a) explore practices that support positive First Nations identity and (b) provide suggestions for practicing culturally safe care. Design: The theory of Two-Eyed Seeing guided this study. Data were collected via two semistructured interviews and Anishnaabe Symbol–Based Reflection from three First Nations men living in Toronto, Canada. Findings: Having mentors, knowing family histories, and connecting with healthy Aboriginal communities fostered positive First Nations identities for participants. Implications: There is potential to advance nursing practice by enacting creative means that may support client’s positive First Nations identity and well-being. Nursing education that focuses on strength-based and decolonizing frameworks, as well as reflexive practices that promote culturally safe care, is needed.