Nancy Fleming Courts

Thriving: A Life Span Theory

There is a need for aging theories to become holistic and multidisciplinary with a life span focus. A theory is the construction of explicit explanations in accounting for empirical findings. A good gerontological theory integrates knowledge, tells how and why phenomena are related, leads to prediction, and provides process and understanding. In addition, a good theory must be holistic and take into account all that impacts on a person throughout a lifetime of aging. Based on these criteria, the authors created the Theory of Thriving, with a holistic life span perspective for studying people in their environments as they age. This article proposes a theory for studying people over time in a holistic, encompassing manner.

Psychosocial Adjustment of Patients on Home Hemodialysis and Their Dialysis Partners

When hemodialysis (HD) became practical as an intervention for patients with end-stage renal disease, most were on home HD. The numbers of patients requiring dialysis are increasing as the resources for them are decreasing. Simultaneously, there is a move toward home health care. This study investigated the psychosocial reactions of patients on home HD and their dialysis partners, how decisions were made to choose home HD, and the patients’ perception of HD stressors. The participants were 14 patients on home HD and their dialysis partners; 7 were husband-wife pairs, 2 mother-daughter pairs, 1 sister pair, and 1 friend pair. Instruments included the Clinical Anxiety Scale, the Generalized Contentment Scale, the Psychosocial Adjustment to Illness Scale Self-Report, the Spielberger State-Trait Anxiety Scale, and the Hemodialysis Stressor Scale. Interview data and the psychosocial adjustment levels of patients and partners support the effectiveness of HHD. Further research with a larger sample is needed.

Psychosocial adjustment of males on three types of dialysis.

End-stage renal disease (ESRD) is a chronic illness that challenges the coping ability of patients and their families, demanding behavioral and emotional lifestyle changes. The purposes of this comparative descriptive study were to explore the anxiety, depression, and psychosocial adjustment of male patients on three types of dialysis-home hemodialysis (home HD), in-center hemodialysis (in-center HD), and peritoneal dialysis (PD)-and to identify perception of hemodialysis stressors for those on home HD and in-center HD. Five subjects in each of the three groups (N = 15), matched for age, gender, education, and dialysis type, participated in the study. Although the convenience sample size is too small to generalize, subjects on home HD demonstrated higher psychosocial adjustment The study supports further research with larger, randomized samples. Information about psychosocial adjustment of patients on each type of dialysis provides information for nurses as they guide patients in choosing dialysis type.

Characteristics of nursing homes adopting environmental transformations

During the past few years, many nursing homes in North Carolina have formulated plans to transform or enhance their environments to make the facilities more desirable places to live and work. The purpose of this study was to compare characteristics of facilities adopting one specific model for environmental transformation. The Eden Alternative; with those adopting other environmental transformations or making no changes. Surveys were mailed to administrators of all (n = 378) certified nursing facilities in NC. A total of 167 surveys were returned, for a return rate of 44%. Of these, almost three fourths were planning or implementing some sort of environmental transformation. Thirty-seven facilities (22%) indicated they were currently adopting the Eden Alternative, and 47 (28%) were planning to adopt it. Twenty-six facilities (16%) reported they were currently adopting an environmental transformation other than the Eden Alternative, and another 9 (5%) were planning to adopt another environmental transformation. The facilities adopting or planning environmental transformation other than the Eden Alternative reported adopting (or planning to adopt) various components of the Eden Alternative. Forty-six facilities (28%) indicated they had no plans for environmental transformation. Facilities making environmental transformations were found to be similar to those making no changes on most variables examined, supporting the conclusion that environmental transformation is feasible for facilities with a wide range of characteristics.

Care of the traumatized older adult

Older adults are experiencing excellent health and maintaining active lifestyles. They continue to engage in the activities they have enjoyed throughout their lives, but as they grow older they are at increased risk for injury related to these activities. Older adults suffer injuries of equivalent severity as those of younger patients; however, the consequences are much more severe. The older adult presents a unique and complex scenario that requires nurses to understand the normal physiological changes of aging and the effects of chronic disease. This article provides guidelines for the emergency care of the older adult patient with trauma and emphasizes areas that require special considerations.

Salicylism in the elderly: “A little aspirin never hurt anybody!”

Mrs. F. was an 85 year old who not only read widely but also prepared book reports and programs for a variety of local groups. Her only health problems were hypertension and severe osteoporosis with kyphosis. The previous summer she had broken her left hip, had a prosthesis inserted, and moved into the retirement home in her community. After 7 months, Mrs. F. arranged for daytime help and sitters for the night and moved back into her house. Four months later she had a lumbar compression fracture and began to self-treat the pain with 500 mg aspirin with calcium carbonate, magnesium oxide, and magnesium carbonate (Extra Strength Bufferin). She had had several fractures in the past that she had successfully treated with aspirin. This time, however, about 2 months after beginning the self-treatment, she began to have difficulty hearing, and this loss of hearing was interpreted as being the cause for her occasional confused responses. Her physician had a small amount of wax removed from her ears and substituted choline magnesium trisalicylate (Trilisate) tablets for the buffered aspirin. Mrs. F. did not consider the Trilisate tablets effective, so she began taking the buffered aspirin tablets again. Over the next 7 days her condition deteriorated. Her mental confusion was now obvious, and she was experiencing hallucinations. Her physician insisted on an immediate computed axial tomographic (CAT) scan. Mrs. F. had to be transported by ambulance to a hospital in another town for the CAT scan. Her symptoms included confusion, rapid respirations and heart rate, diaphoresis, severe hand tremors, anorexia, and lethargy. It was at this point that salicylism was first suspected, and her use of the buffered aspirin was discontinued. Unfortunately, no blood work was done to test for salicylate intoxication.

Psychoneuroimmunological aspects of nursing: a course sampler.

Health care consumers are searching for ways to enhance health. Bookstores are filled with self-help literature about mental, physical, and emotional connections and ways to manage these relationships. In an innovative and challenging course, the authors discuss mind-brain-body interactions and illustrate the application of alternative modalities in nursing practice.