Sandra P Hirst

Defining Resident Abuse within the Culture of Long-Term Care Institutions:

Although researchers have identified the presence of resident abuse within long-term care facilities, it has not come under the same scrutiny as have other aspects of abuse against older adults. This is due, in part, to the difficulty in defining the phenomenon. The purpose of this study was to articulate a definition of resident abuse as perceived by registered nurses working in long-term care institutions. Ethnoscience was the method used to answer this question. The five categories of resident abuse characteristics—perception of hurt felt by older residents, acts of omission or commission, context of care, intentional or unintentional, and behavioral clusters—that emerged through semistructured interviews and focus groups reflect the descriptions given by participants. Identifying a common definition of resident abuse suggests that assessment and intervention to reduce episodes of it are more likely to be effective.

Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon

AIMS AND OBJECTIVES In order to obtain more information regarding this phenomenon, a scoping review of the literature was undertaken to analyse current research on the recognition of delirium by registered nurses in acute care settings. BACKGROUND Delirium is often manifested as a sign of an underlying undiagnosed condition that requires immediate intervention and is frequently manifested in acute care settings. Unfortunately, registered nurses often do not recognise delirium and its occurrence goes under-reported. DESIGN/METHODS Based on six inclusion criteria, a search in numerous databases using terms such as delirium detection, recognition and diagnosis by registered nurses was undertaken. Eight quantitative studies were deemed relevant and analysed for this scoping review. RESULTS Seven major categories emerged: the fluctuating nature of delirium, the impact of delirium education on its recognition, communication barriers, inadequate use of delirium assessment tools, lack of conceptual understanding of delirium, delirium as a burden and the likeness of delirium and dementia. A brief summary of the findings in each category is reported here. CONCLUSIONS The scoping review revealed that delirium remains underrecognised by registered nurses, which potentially contributes to reduced quality of nursing care for clients experiencing this condition. Further research on delirium and the processes that registered nurses use to recognise it is timely and will facilitate the development of evidence-based interventions to manage it. RELEVANCE TO CLINICAL PRACTICE While acute care registered nurses have historically reported dramatic changes in cognitive and neuro-biological functions in ill older adults, the literature highlighted in this scoping review revealed the following: (1) the need for further research to validate delirium assessment tools and, (2) the need for education and training for registered nurses on the use of these assessment tools to promote early recognition and thereby decrease the incidence of delirium in older adults.

Institutional abuse of older adults: what we know, what we need to know

Although Canadian policies support “aging in place,” there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

Gerontological Content in Canadian Nursing and Social Work Programs

Method A survey of gerontological content in nursing and social work programs across Canada (English speaking) was conducted. The survey tool was the competencies list developed for interprofessional gerontological education by the National Initiative for the Care of the Elderly (NICE). Deans or designates of English-speaking nursing and social work programs across Canada were contacted by e-mail. Data was collected by Zoomerang.com. Results Findings indicate that clear progress is being made in ensuring that students have the knowledge and skills needed to provide the care required by older adults in a variety of settings.

I hated those darn chickens...: The Power in Stories for Older Adults and Nurses

Attention to stories provides a holistic view of an older adult and offers the potential for quality nursing intervention. Explored in this article is the power of stories to advance the well being of older adults and the implications for gerontological nurses of a commitment to support storytelling in this population.

The emergence of gerontological nursing education in Canada

Summary Changing demographics and greater demands for nursing expertise in caring for the aged are increasing the support in Canada for gerontological nursing education. However, gerontological nursing is not yet an area of focus receiving high priority in many Canadian nursing education programs. Gerontological nursing education is in its infancy in Canada, and numerous questions remain unanswered. For example, what was the influence of geriatric medical education on the historical development of gerontological nursing education? Findings of our preliminary research into articulating and understanding the history of Canadian gerontological nursing education may enhance the professional identity of gerontological nurses. Awareness of milestones in the development of gerontological nursing education in Canada, and of the role of its leaders, provides insight into the historical context underlying current issues. Finally, awareness and comprehension elucidates, and gives value to, individual and collective achievement within this nursing specialty. Our voyage of historical discovery will continue to be filled with excitement and challenge as we further explore this new frontier.

The ACHRU-CPP versus usual care for older adults with type-2 diabetes and multiple chronic conditions and their family caregivers: study protocol for a randomized controlled trial

BackgroundMany community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).Methods/designThe study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.DiscussionThis study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.Trial registrationClinicalTrials.gov, Identifier: NCT02158741. Registered on 3 June 2014.

How Do Nursing Students Perceive the Needs of Older Clients? Addressing a Knowledge Gap

Background. Many nurse educators understand that students need to embrace the challenges and rewards of working with older clients. Yet, they might wonder how they can help students to develop and what is the specialized knowledge necessary to care for older clients. Question. How do students perceive the nursing needs of older adults? Method. A qualitative descriptive study was undertaken. Data collection occurred through semistructured interviews (9 students) and one focus group (8 students) using a photoelicitation technique. The researchers used a descriptive approach to analyze the data. Findings. Six themes emerged from the data: ask the older client!; physiology rules; personal, not professional; who can validate?; hierarchy of needs; and help us learn. Conclusion. Participants relied upon previous patterns of learning, primarily experiential, and on the views of health care colleagues in clinical practice to make decisions about the health needs of older clients. Participants clearly recognized the need to and significance of understanding the health care requirements of older clients. Findings have implications for how the care of older clients is introduced into nursing education programs.

Expanding the Technology Safety Envelope for Older Adults to Include Disaster Resilience

The concept of resilience is central to understanding how technology might have a role to play in reducing the disproportionate vulnerability of older adults in natural and human-made disasters. Resilience has been defined in various ways by different theorists and researchers, but the common thread is the idea of adaptive capacity and the ability to recover from adversity (Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008). Resilience is not simply a personality style or a characteristic of individuals but a product of the interplay among various determinants of population health: income and social status, social support, education, employment, social and physical environments, health practices and coping skills, developmental factors, biological and genetic endowment, health services, gender, and culture (Public Health Agency of Canada [PHAC], 2003). Disasters are large-scale disturbances or sources of adversity that tax the resilience not only of individuals but of whole communities and broader societies. All members of a population can be at risk depending on the nature of the crisis (InterInter-Agency Standing Committee [IASC], 2006). As would be expected given the multiple interacting determinants that come into play, the pathways from risk vulnerability to disaster resilience are complex (International Federation of Red Cross and Red Crescent Societies [IFRC], 2004). Similar to other population health challenges, the availability of appropriate resources, effectively implemented, is likely to contribute to more desirable outcomes for individuals and groups who are responding to and attempting to recover from disasters (Lindsay, 2003). Disaster resilience is increasingly in the public eye as the number of catastrophic natural and human-made events continues to rise. This chapter examines the potential for technology to promote disaster resilience among older adults. They are a population subgroup with increased vulnerability in emergencies not because of age per se, but because they are more likely to live with a constellation of risk factors for increased vulnerability, including health problems, dependence on healthcare and social services, lower socioeconomic status, and restricted social networks. In addition, with increasing age, higher proportions of older adults are women, a population subgroup with heightened vulnerability across the life course (Powell, 2009).