Sherry Dahlke

Caring for hospitalized older adults at risk for delirium: the silent, unspoken piece of nursing practice.

More than half of hospitalized older adults will experience delirium, which--if left untreated--can lead to detrimental outcomes. Despite the prevalence and severity of delirium, nurses recognize less than one third of cases. Because little is known about how nurses manage this problem, a qualitative study was conducted to explore how nurses care for hospitalized older adults at risk for delirium. The data revealed that nurses care for older adults byTaking a Quick Look, Keeping an Eye on Them, and Controlling the Situation. The context in which nurses choose their priorities and interventions was reflected in the themes of the Care Environment and Negative Beliefs and Attitudes about older adults. Nurses are caring for an older population whose care requirements are different than those of younger people and in a context where this challenging work is rarely addressed. To improve care, the older population must be acknowledged, and nurses must possess the knowledge and resources needed to meet this populations unique needs.

Shifting Patterns of Everyday Activity in Early Dementia: Experiences of Men and Their Families

In this article we draw from a larger study to examine experiences of two men and their families as they negotiate changing patterns of everyday activity in the months after receiving a diagnosis of dementia. We conducted in-depth interpretive phenomenological analysis of interview and observational data that were gathered from the men and various members of their families (n = 7) over a period several months. Findings are presented as three themes: The best kind of man (highlighting participants’ historical positioning); It’s a little different now (recognizing challenges posed by the dementia); and You have to do something (showing how the men and their families responded to and accommodated these challenges). We discuss these findings in terms of how everyday activity is not only important for supporting personhood in dementia, but it also contributes to sustaining family identity, and does so in a way that is deeply influenced by gender and masculinity.

Examining nursing practice with older adults through a historical lens.

Scholars have suggested that negative views toward older individuals are prevalent in Western society and that health care practices with older adults are influenced by these beliefs. In this article, a historical lens is used to examine health practices and social ideas about aging to provide a clearer understanding of the current challenges to nursing practice with an aging population. Parallels between nursing practices of the past and present are discussed. It is suggested that negative beliefs about older adults are related to social ideas that originated in antiquity and yet continue to influence social institutions and practices with an older population.

Maximizing Theoretical Contributions of Participant Observation While Managing Challenges

Participant observation (PO) is an important method of data collection used in a variety of research methodologies. PO can inform theory development by providing understanding of participants’ behaviors and the contexts that influence their behaviors. Because theory development is important in grounded theory studies, we emphasize theoretical contributions of PO while interrogating the challenges of using PO, in particular, attending to informed consent. We use the exemplar of a mid-range theory about nursing practice with hospitalized older adults to highlight contributions of PO to category development. While acknowledging theoretical contributions, we explore challenges entailed in observations where consenting participants interact with vulnerable patients and a changing cast of health care professionals in dynamic contexts. Reflexivity about interactions with vulnerable individuals, as well as other actions to avoid compromising voluntary consent, enhances contributions of PO.

Understanding clinical nursing education: An exploratory study

Clinical experiences are recognized as a critical aspect of nursing education, highlighting the importance of the perspectives of those providing clinical instruction. The aim of this mixed methods descriptive study was to discover the knowledge and guidance needs of preceptors and clinical faculty who provide clinical instruction to Bachelor of Science in Nursing (BSN) students. Fifteen clinical faculty and 17 preceptors were surveyed using a questionnaire developed and piloted by the researchers. Although preceptors and clinical faculty reported a high level of knowledge and confidence in their ability to guide student nurses, they also identified the need for additional support for their teaching roles. Analysis of the qualitative data provided insights into what helped and what hindered clinical instruction, as well as what could enhance clinical instruction. The development, implementation, and evaluation of formal education and mentorship processes for preceptors and clinical faculty are recommended in order to meet these knowledge and guidance gaps. Further research is also needed to explore how to clinical instruction could be tailored to the capacity of those engaged in the experiences and to clinical environments.

Navigating Relationships: Nursing Teamwork in the Care of Older Adults

Increasingly, internationally educated nurses (IENs) from developing countries are seeking RN licensure and employment in Canada. Despite efforts to support their integration into the nursing workforce, a significant number never achieve integration. To explore this phenomenon, the authors use ethnographic methods informed by postcolonial feminism and relational ethical theory to examine the experiences of nurses educated in the Philippines as they seek Canadian RN licensure and employment. The studys focus on a journey that begins in the Philippines and continues in Canada adds an important temporal dimension located in tensions within and between the contexts of regulatory and immigration policies. The findings illuminate the dual challenge of being a new arrival in the country and being an IEN pursuing the Canadian RN credential. Additionally, the findings deepen our understanding of the dominant political, ideological, and social values, both in the Philippines and in Canada, that shape this experience.

Older people and their families’ perceptions about their experiences with interprofessional teams

To examine older people and their families’ perceptions about their experiences with interprofessional teams.

The Care of Older Adults Experiencing Cognitive Challenges: How Interprofessional Teams Collaborate

ABSTRACT: We conducted a scoping study to examine how interprofessional health care teams improve the outcomes of older adults experiencing cognitive challenges. We searched Ovid, Medline 1946, and MEDLINE In-Process and other non-indexed citations, using the concepts multi or interdisciplinary care teams, confusion or cognitive impairment, and elderly adults. Of 4,554 articles the review yielded, 34 relevant to our inquiry, using Arksey and O’Malley’s methodological framework. Twenty-nine per cent of authors reported on the processes interprofessional teams use to achieve positive outcomes for older adults. They highlighted the importance of communication, staff strategies, and education interventions in achieving outcomes with older adults and in supporting interprofessional collaboration. The review revealed knowledge gaps about the processes teams use to collaborate in caring for older adults experiencing cognitive challenges, and how to best incorporate older adults and their families’ perspectives in team decisions. More research to understand processes interprofessional teams use is needed. RÉSUMÉ: Nous avons réalisé un examen de portée pour évaluer comment les équipes interprofessionnelles en santé permettent d’améliorer l’état de santé de personnes âgées affectées par des défis cognitifs. Nous avons effectué notre recherche dans les bases Ovid, Medline 1946 et MEDLINE In-Process & other non-indexed citations, en utilisant trois principaux concepts : équipes de soins multidisciplinaires ou interdisciplinaires, confusion ou trouble cognitif, personnes âgées. L’examen de portée a rassemblé 4554 articles. Le cadre méthodologique d’Arksey et O’Malley’s a été utilisé pour examiner 34 articles jugés pertinents pour le sujet à l’étude. Bien que 71 % des auteurs n’ont pas rapporté les processus utilisés par les équipes interprofessionnelles pour atteindre des résultats positifs chez les personnes âgées affectées par des défis cognitifs, cela a été réalisé par 29 % des auteurs, qui ont souligné l’importance de la communication, des stratégies d’implication du personnel et des formations pour appuyer la réussite des soins sur le plan des résultats escomptés chez les personnes âgées et pour fournir un soutien adéquat pour la collaboration interprofessionnelle. L’examen de portée a mis en évidence des lacunes dans les connaissances actuelles concernant les processus utilisés par les équipes interprofessionnelles pour collaborer en vue de la prestation de soins aux personnes âgées affectées par des défis cognitifs, et les défis de l’incorporation optimale des perspectives des personnes âgées et de leur famille dans les décisions d’équipe. Davantage d’études sont nécessaires pour comprendre les processus utilisés par les équipes interprofessionnelles dans le cadre de la communication entre les membres de l’équipe, mais aussi pour celle liée aux autres cliniciens, aux personnes âgées et à leur famille.

Influence of Teamwork on Health Care Workers' Perceptions About Care Delivery and Job Satisfaction

The aim of the current study was to examine the nature of teamwork in care facilities and its impact on the effectiveness of care delivery to older adults and job satisfaction among health care workers. A focused ethnography was conducted at two care facilities where older adults reside. Analysis of interviews with 22 participants revealed perceptions of teamwork and understandings about facilitators of and barriers to effective teamwork. Participants indicated that team relationships impacted care provided and job satisfaction. Participants also identified trust and reciprocity, communication, and sharing a common goal as critical factors in effective teamwork. In addition, participants identified the role of management as important in setting the tone for teamwork. Future research is needed to understand the complexity of supporting teamwork in residential settings given the challenges of culture, diversity, and individuals working multiple jobs. [Journal of Gerontological Nursing, 44(4), 37-44.].