Susan J. Loeb

Reframing person-centered nursing care for persons with dementia.

Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia.

Supporting Older Adults Living With Multiple Chronic Conditions

This qualitative study was conducted using focus groups to explore the strategies commonly employed by older adults (N = 37) to manage multiple chronic conditions. Key strategies identified were relating with health care providers, medicating, exercising, changing dietary patterns, seeking information, relying on spirituality and∕or religion, and engaging in life. Although social support was not mentioned as a discrete strategy, the participants’ social networks were embedded in all of the categories. This study supports building a partnership of care in which nurses and other health care professionals function in supportive and educative roles to enhance the older person’s lifelong self-care management and ability to stay in control of multiple chronic health conditions.

An integrative literature review of lifestyle interventions for the prevention of type II diabetes mellitus

AIMS AND OBJECTIVES An integrative literature review was undertaken to determine what type II diabetes prevention programmes have been evaluated, what type of programme is the most effective and how adherent to lifestyle changes adults are after participating in a prevention programme. BACKGROUND Type II diabetes is important because the disease is affecting millions of people worldwide. Obesity and sedentary lifestyles are preventable risk factors for type II diabetes, leading many researchers from around the world to examine different programmes that are focussed on prevention of the disease. DESIGN Integrative literature review. METHOD Search of electronic databases. RESULTS Diet, exercise, counselling and diet plus exercise were the types of prevention programmes, with the diet plus exercise being the most efficacious. Although many studies demonstrated excellent results initially, maintaining the effects of the lifestyle behaviour change proved to be difficult for participants, with only one study demonstrating the persistence of results after six years. CONCLUSION Future research should focus on long-term maintenance programmes, rather than just short-term prevention programmes to determine the need for booster interventions or other means to ultimately decrease the incidence of type II diabetes. RELEVANCE TO CLINICAL PRACTICE As front-line healthcare providers working across a broad array of settings, nurses are particularly well-suited to play an integral part in future applications of diabetes prevention programmes. Lifestyle interventions are being delivered in a variety of settings and venues such as the workplace, the Internet and places of worship. In addition, at-risk populations also can be targeted, particularly overweight and obese persons, with at least one parent having type II diabetes or persons with gestational diabetes.

Comparing incarcerated and community-dwelling older men's health.

The purpose of this study is to compare incarcerated and community-dwelling older mens self-efficacy for health management, health-promotion behaviors, and health status. Social cognitive theory was the guiding framework. A sample of 51 incarcerated and 33 community men (age 50 and older) were surveyed. Frequencies and independent samples t tests were computed. Inmates reported significantly less participation in health-promotion behaviors (p < .01) and attended fewer programs (p < .05). The two groups did not demonstrate significant differences in self-efficacy or health status. The latter finding is important because the community men were on average 15 years older. Finding that prisoners attended significantly fewer programs and engaged less often in health-promoting behaviors may be because of lack of availability or awareness of programs to build self-care skills, perceptions that there is not much they can do about their health, a knowledge deficit in regard to health, or insufficient motivation.

African American older adults coping with chronic health conditions.

This study’s purpose is to identify strategies used by community-dwelling African American elders to cope with their chronic health conditions. A focus group study of 28 African American elders with multiple chronic conditions was conducted. Data collection occurred during the last 4 months of 2003. The five focus groups were audiotaped and transcribed verbatim. Content analysis was performed on the data to ascertain coping strategies employed to manage daily life with chronic conditions. Categories of coping strategies identified are (a) dealing with it, (b) engaging in life, (c) exercising, (d) seeking information, (e) relying on God, (f) changing dietary patterns, (g) medicating, (h) self-monitoring, and (i) self-advocacy. This study expands nurses’ knowledge of the repertoire of coping strategies used by African American elders to ameliorate the effects of their chronic health conditions. Study findings will be valuable for planning intervention studies aimed at promoting successful coping.

The primary care nurse practitioner and cancer survivorship care

Purpose: To examine the important role that primary care nurse practitioners (NPs) have in providing long‐term surveillance and health maintenance for breast, prostate, and colorectal cancer survivors throughout the continuum of cancer care. Data sources: MEDLINE, CINAHL, MD‐Consult, and Cochranes databases were utilized with the inclusion of primary research and critical research reviews from January 1995 through March 2008. Select organizational websites were also cited. Conclusions: Cancer patients experience changes in the focus of their care when management shifts from the treatment of cancer to management of treatment side effects and outcomes, to survivorship care, and to secondary cancer treatment. NPs have a strong impact on cancer survivorship care by serving in various roles and settings throughout the cancer trajectory to improve patient outcomes. Implications for practice: Cancer survivorship care expands beyond specialty settings, into primary care. NPs have a key role in ensuring continuity of care for patients with cancer. Models of care that promote continuity and high quality of care for patients with cancer include the shared‐care and nurse‐managed health center models. The formal collaborative plan of care is essential in long‐term cancer survivorship care.

Older Male Prisoners: Health Status, Self-Efficacy Beliefs, and Health-Promoting Behaviors

The fastest-growing prison subgroup is men age 50 years and older, of whom 85% have multiple chronic health conditions. This pilot study examined relationships between health status, self-efficacy beliefs, and behaviors through a convenience sample survey of 51 older male prisoners. Inmates with greater self-efficacy (i.e., confidence) in their health self-management abilities were significantly more likely to rate their health as better, engage in more health-promoting behaviors, and report more improved health since incarceration. Findings, which support Bandura’s social cognitive theory, highlight the need to develop educational interventions aimed at enhancing older male inmates’ health knowledge and self-efficacy for health management to promote greater participation in health-promoting behaviors and better health outcomes.

A Model of Caregiving Through the End of Life: Seeking Normal

Informal family caregivers provide significant contributions to end-of-life (EOL) care. A theoretical model of the phases and transitions of EOL caregiving was explicated using grounded theory methods to explore the experiences of 46 family caregivers of adults suffering a variety of life-limiting conditions. The derived model describes four phases of caregiving spanning prediagnosis through bereavement. Phases are demarcated by key transitions experienced when the illness progression manifestly challenges the established “steady state” achieved by the caregiver. The basic social process was defined as “seeking normal” as caregivers sought reliable patterns of everyday life while meeting the demands of caregiving. Understanding the progression of EOL caregiving enables clinicians to better support family caregivers as both coproviders and corecipients of care.

Predictors of self-efficacy and self-rated health for older male inmates.

AIMS The aims of this study were to examine: (1) the relationships between self-efficacy for health management and (a) health-promoting behaviours, (b) health-monitoring behaviours, and (c) self-rated health status in older male prisoners; and (2) the variations in self-rated health status and self-efficacy for health management by inmate characteristics of older men in prison. BACKGROUND The greying of the inmate population around the globe can be attributed to increases in punitive crime control practices, life expectancy; and the ageing baby boom generation. Older inmates are typically not a healthy group. Therefore, the needs of burgeoning numbers of older, sicker inmates are issues of international significance. METHODS A descriptive, correlational, survey was conducted from late 2007 to mid-2008 with Banduras self-efficacy model as the guiding framework. RESULTS/FINDINGS Participants were 131 male inmates, aged 50 and older. A statistically significant positive relationship was found between self-efficacy for health management and the indexes measuring health-promoting behaviours (r=0.550; P<0.001), health-monitoring behaviours (r=0.323; P=0.001), and the single item rating for self-rated health (τ(b)=0.411; P<0.001). There was a tendency for education to be positively related to self-rated health but not self-efficacy (τ(b)=0.140; P=0.054 and τ(b)=0.105; P=0.122, respectively). Years of incarceration was not significantly related to self-rated health or self-efficacy. CONCLUSION These research findings support Banduras self-efficacy theoretical work and its applicability to health-related research in prisons. Nurses are front line healthcare providers in prison, who are in a key position to implement interventions that promote greater inmate self-efficacy for healthy behaviours and chronic disease management.

End-of-Life Caregiving Trajectories

The purpose of this study is to illustrate variations in caregiving trajectories as described by informal family caregivers providing end-of-life care. Instrumental case study methodology is used to contrast the nature, course, and duration of the phases of caregiving across three distinct end-of-life trajectories: expected death trajectory , mixed death trajectory, and unexpected death trajectory. The sample includes informal family caregivers (n = 46) providing unpaid end-of-life care to others suffering varied conditions (e.g., cancer, organ failure, amyotrophic lateral sclerosis). The unifying theme of end-of-life caregiving is “seeking normal” as family caregivers worked toward achieving a steady state, or sense of normal during their caregiving experiences. Distinct variations in the caregiving experience correspond to the death trajectory. Understanding caregiving trajectories that are manifest in typical cases encountered in clinical practice will guide nurses to better support informal caregivers as they traverse complex trajectories of end-of-life care.