Margaret Black

The effect of natural environments upon agitation and aggression in late stage dementia patients

Agitated aggressive behavior in late stage dementia occurs in 30 to 50 percent of patients. This behavior often results in the use of chemical and physical restraints (which have a high degree of untoward side effects) and caregiver burnout. Interventions for agitated aggressive behavior are needed that do not have these side effects, which are readily available in nursing homes and are effective and acceptable to caregivers. Environmental psychologists have proposed that natural elements within the environment decrease agitation in the nondemented as well as the demented Since the shower bath is often a time of great agitation in dementia patients, natural elements were used to modify care during the shower bath (n = 31). There was a significant decrease in mean difference scores from baseline to treatments one and two, with the treatment group demonstrating an overall decline in agitated aggressive behavior Additional randomized trials of the effects of natural environments upon agitation and aggression in dementia are needed.

Development of professional confidence by post diploma baccalaureate nursing students

Professional confidence should be nurtured in a caring nursing curriculum, however there is a lack of clarity as to what confidence means, how it is perceived by students, and what educators can do to instill professional confidence in nursing students. A qualitative study using focus groups was conducted to explore the components of professional confidence as perceived by diploma-prepared registered nurses enrolled in a two-year student-centered, problem-based baccalaureate degree program. Students identified professional confidence as developing through a two-phase process. During the first phase, Becoming Informed, students reported acquiring knowledge, theory and critical thinking in the supportive environment of small tutorial groups, which in turn enabled them to examine nursing practice and defend decisions with clarity and confidence. In Finding a Voice of My Own they clearly articulated an evidence-based nursing position in both academic and clinical environments with a sense of ownership and congruence with their own values. Each phase was further composed of four processes: feeling, knowing, doing and reflecting. When supported through these phases, students felt prepared (i.e. confident) to assume broader roles in health care. Post diploma programs should acknowledge and build on the skills and abilities nurses bring to the educational setting, yet challenge learners to develop critical self appraisal.

Nursing Roles in End-of-Life Decision Making in Critical Care Settings

This study used a grounded theory approach to formulate a conceptual framework of the nursing role in end-of-life decision making in a critical care setting. Fourteen nurses from an intensive care unit and cardio-respiratory care unit were interviewed. The core concept, Supporting the Journey, became evident in four major themes: Being There, A Voice to Speak Up, Enable Coming to Terms, and Helping to Let Go. Nurses described being present with patients and families to validate feelings and give emotional support. Nursing work, while bridging the journey between life and death, imparted strength and resilience and helped overcome barriers to ensure that patients received holistic care. The conceptual framework challenges nurses to be present with patients and families at the end of life, clarify and interpret information, and help families come to terms with end-of-life decisions and release their loved ones.

Seeking to Understand Telephone Support for Dementia Caregivers

Caregivers of persons with dementia encounter particular challenges in their roles and often experience unmet needs for information and emotional support. This article describes a qualitative descriptive study designed to explore the intervention of telephone support for such caregivers. Data were collected from both caregivers and telephone support providers. Results revealed that telephone support met four specific needs of dementia caregivers: the need for (a) information and education, (b) referral and/or assistance required to navigate through the system, (c) emotional support, and (d) caregiver support that is convenient and hassle free. Caregivers’ main experience with the intervention was the sense of companionship, whereas service providers experienced mixed feelings of helplessness and an opportunity to empower caregivers.

Older Women and Mammography Screening Behavior: Do Possible Selves Contribute?:

This study sought to explore the contribution of the self-concept to older women’s adherence to regular mammography screening behavior. The PRECEDE and health belief model concepts were incorporated with a measure of the women’s future selves to determine whether the self-concept adds to our ability to predict screening. A self-administered questionnaire was completed by 210 community-dwelling women ages 50 to 75 years, recruited from urban and rural women’s groups. Logistic regression analyses revealed that predictors of adherence were clinical breast examination, physician recommendation, age, barriers, benefits, feared health-related possible self, and self-efficacy in the feared domain. The addition of the self measures significantly improved the overall fit of the model. Implications for theory development, practice, and future research are discussed.

Living alone with dementia: An interpretive phenomenological study with older women

AIM This paper is a report of a study of the meaning of living alone from the perspective of older people with dementia. BACKGROUND Risks and problems experienced by older women living alone have been investigated mostly through quantitative research. Balancing their safety and autonomy is a serious international community care dilemma. Older peoples perspectives have been muted in qualitative research on living alone with dementia. METHOD Using an interpretive phenomenological approach and van Manens method, 14 interviews were conducted in Ontario, Canada from January 2004 to April 2005 with eight older women diagnosed with Alzheimer disease or a related dementia. FINDINGS The theme holding back time expressed the temporal meaning of living alone. Pharmacological treatments represented stored time, offering the opportunity to hold back future dreaded time. Past experience with others with dementia was a context for holding on to now and facing some risks of living alone with memory loss. The women acknowledged the limited time remaining for, and identified endpoints to, living alone. CONCLUSION Insight into the impact of past experience with others with dementia could inform nursing assessment and advocacy for health/social services that are sensitive to the potential emotional impact of mixing people with varied levels of dementia in the same programme.

Improving early detection of breast and cervical cancer in Chinese and Vietnamese immigrant women.

Margaret E.A. Black, RN, PhD, is an associate professor in the School of Nursing at McMaster University and a public health consultant at the Healthy Lifestyles and Youth Branch of the City of Hamilton Public Health Services, Angela Frisina, RN, MHSc, is a public health nurse at the Healthy Lifestyles and Youth Branch of the City of Hamilton Public Health Services, Trisha Hack, RN, BScN, is a public health nurse at the Healthy Lifestyles and Youth Branch of the City of Hamilton Public Health Services, and Barbara Carpio, RN, MScN, MScT, is an associate professor in the School of Nursing at McMaster University, all in Ontario, Canada.

Development of an instrument to assess individual student performance in small group tutorials.

Recognizing the need for a valid and reliable method to assess individual tutorial performance in a problem-based learning curriculum, we developed a 31-item instrument from theoretical frameworks and items used elsewhere. A scale was developed for each of three broad learning domains: self-directed learning (SDL), critical thinking (CT), and group process (GP). The instrument demonstrated high internal consistency (SDL = .88, CT = .90, GP = .83) on a sample of 18 tutors and 167 students. Tutor-student interrater reliability coefficients were estimated to be low (SDL = .16, CT = .18, GP = .14) due to lack of variance on the response scale. The instrument showed high correlation (r = .82) with other forms of summative evaluation. In its current form, this standardized and validated instrument is unreliable in differentiating strong from weak tutorial performance but can have a steering effect on student tutorial behaviors. The process of instrument development has general application to other educational programs.

A descriptive analysis of the impact of moral distress on the evaluation of unsatisfactory nursing students.

Background Nurse educators assume a difficult role when evaluating unsatisfactory students, including those at risk for failure in clinical and classroom settings. While the decisional dilemma inherent in evaluating unsatisfactory students has been well documented in literature, little is known about how moral distress impacts the nurse educators′ decisions regarding whether to pass or to fail unsatisfactory students. Purpose This article aims to provide a descriptive analysis of the moral dilemmas and the potential impact of moral distress experienced by nurse educators when evaluating the performance of unsatisfactory students in clinical and classroom courses. Methods Nathaniels theory of moral reckoning guided the descriptive analysis of six studies to understand how nurse educators work through moral dilemmas, make decisions, and provide justification for their decisions when evaluating the performance of unsatisfactory students. Findings Nathaniels theory has been shown to be helpful in discussing the dilemma of evaluating unsatisfactory students, and it is a suitable framework for nurse educators in working through their dilemmas as a form of structured reflection. Practice Implications The outcomes of this descriptive analysis highlight the need for educational administrators to provide support to undergraduate nurse educators experiencing moral distress in this type of situation.

Competence trust among providers as fundamental to a culturally competent primary healthcare system for immigrant families.

AIM To explore how an organizations trust in the cultural competency of other service providers (competence trust) can influence the effectiveness of a services network in meeting the needs of recent immigrant families. BACKGROUND Primary health care for recent immigrants arriving in Canada is delivered through a network of community-based services. To ensure the functioning of the network and its ability to facilitate access to needed services for new arrivals, network members need to be able to work together collaboratively. A case study involving services for an urban community in Atlantic Canada was undertaken in 2009 to explore how service organizations worked together to address the needs of recent immigrant families with young children. This paper focuses on provider perceptions of cultural competency among local service organizations and how this influenced trust and desire to work together for the benefit of families. METHODS The case study utilized both social network analysis and qualitative inquiry methodology. Twenty-one of 27 selected organizations responded to the online social network survey, and 14 key informant interviews were conducted. Social network measures and network mapping were used to demonstrate trusting relationships and associated interactions, while interview data were used to explain the relationships observed. FINDINGS Perceived cultural competency affected the degree of trust and collaboration within the services network when addressing the needs of recent immigrant families. Competence trust toward other providers increased the desire and commitment to work together, while lack of competence trust created avoidance. Non-government organizations were identified among the most culturally competent. The perceived positive and negative experiences of families with different providers influenced the level of trust among network members. The development of systemic cultural competences within a services network is needed in order to improve collaborations and access to services for immigrant families.