Veronica F. Engle

The Experience of Living-Dying in a Nursing Home: Self-Reports of Black and White Older Adults

PURPOSE: The purpose of this study was to describe and compare the experiences, needs, priorities, and concerns reported by black and white nursing home residents during the living‐dying interval. The living‐dying interval is defined as the time between the knowledge of ones impending death and death itself.

Self-assessed and functional health of older women

This study examines the contributions made by functional health, age self-concept, and attitudes, and demographic variables toward explaining health self-assessments in a sample of older women. The participants in the study were a simple random sample of white females (114) over age sixty years and who were residents in five apartment complexes for the aged in a large Midwestern city. Significant correlations to self-assessment of health were found among measures of functional health, self-concept and attitudes, and demographic variables. Multiple regression analysis using five variables (self-assessment of speed, emotional behavior, age self-concept, body care and movement, and occupation) explained almost 40 percent of variance in self-assessment of health data.

Study designs of randomized controlled trials not based on Chinese medicine theory are improper.

Current biomedical research methods to evaluate the efficacy of Chinese medicine interventions are often conceptually incompatible with the theory and clinical practice of Chinese medicine. In this commentary, we (1) highlight the theory and principles underlying Chinese medicine clinical practice; (2) use ginseng as an example to describe clinical indications in Chinese medicine; (3) propose a framework guided by Chinese medicine theory for the evaluation of study designs in Chinese medicine research; and (4) evaluate 19 randomized, double-blind, placebo-controlled trials of ginseng. Our analysis indicates that all 19 trials with both positive and negative results confirm the specific effects of ginseng indicated by Chinese medicine theory. Study designs guided by Chinese medicine theory are necessary to validate and improve future randomized controlled clinical trials in Chinese medicine.

Prevalence and Predictors of Regularly Scheduled Prescription Medications of Newly Admitted Nursing Home Residents

The purpose of this study was to identify the prevalence and predictors of commonly prescribed regularly scheduled medications.

Determinants of health-related hardiness among urban older African-American women with chronic illnesses.

A systematic probability sample of 100 community-living older African-American women with chronic illnesses was evaluated during clinic visits to an urban safety-net hospital to explore health and demographic factors predictive of health-related hardiness (HRH). Questionnaires on HRH, function, self-assessed health, morbidity, health behavior, and selected demographics were used for collection of data. Multiple linear regression analyses ascertained that years of education and function explained 20% of the variance in HRH. Findings raise issues regarding validity of HRH prediction models and the cultural appropriateness of current methods of assessing HRH in older African-American women.

Health status gender differences of newly admitted black nursing home residents

OBJECTIVES: To investigate gender differences in health status of newly admitted black nursing home residents on the day following admission.

Admission Health Status Differences of Black and White Indigent Nursing Home Residents

OBJECTIVE: To compare the health status of newly admitted lower socioeconomic status (SES) southern black (n = 81) and white (n = 53) nursing home residents.

Meta-analysis techniques.

The three elements of meta-analysis include exact specification of sources from which primary studies are identified; transformation of primary study findings to a common metric; and statistical analysis of primary study findings. Meta-analysis has several drawbacks, such as dependence on the quality of the reporting of primary analysis findings; dependence on sufficient numbers of eligible studies to justify statistical analysis; a lack of a universal common metric; and a lack of expert agreement about the best form of statistical analysis. As researchers become more familiar with meta-analysis, two effects will be seen: an increased use of meta-analysis elements in all review of literature, and increased attention to reporting important details of research in scientific journals.

NURSING HOME STAFF AS RESEARCH PARTNERS

thinkers, even the most efficacious interventions are doomed from the beginning. Thus, a shift in the focus of intervention research is needed to address both the process of delivering care and the outcomes of care. Resident acceptance of SimPres, like staff acceptance of SimPres, may also be of concern. SimPres is a creative use of noninvasive, simple technology for a personalized intervention that builds on the unique history of the resident and memory characteristics of older adults with Alzheimer’s disease and related dementias. It is low cost and, potentially, requires a minimum amount of staff time. Although 43% of residents accepted the intervention 100% of the time, 9% refused the intervention more than half of the time. What resident characteristics were associated with acceptance, which with refusal? Will future cohorts of nursing home residents be more amenable to wearing headphones because of previous experience with personal stereos? Did the acceptance vary by family member or surrogate on the SimPres tape? Can staff identify for researchers those residents more likely to accept and benefit from SimPres? Unfortunately, all too often the definition of “staff” in published studies is unclear. This lack of specificity in identifying the qualifications of staff may hinder subsequent successful implementation of interventions in the clinical setting. For example, are the staff licensed personnel? If licensed, are they registered nurses or licensed practical nurses? If unlicensed, are they nursing assistants? Each has unique skills and strengths in the clinical setting, and each may require different administrative support to implement and evaluate interventions. EVALUATION OF BEHAVIORS As Camberg et al.’ noted, staff were in the best position to evaluate residents in the immediate day-to-day context of the environment, and trained observers were rarely able to evaluate the entire sequence of care from beginning to end. Consequently, daily staff observation logs (SOL-interest, mood) were the only variables to document consistently the efficacy of SimPres in relation to both placebo and usual care. Of the nine study variables, only one other variable (MOSESinterest) documented the efficacy of SimPres in relation to placebo and usual care, and that variable was also evaluated by staff.

Meta-Analysis for the Refinement of Gerontological Nursing Research and Theory

A meta-analysis review of literature addresses concerns such as inclusion and exclusion criteria for articles in the meta-analysis and seeks potentially biasing effects of sample size and characteristics, measurement of variables, type of design, and analytic techniques. Whereas the narrative review of literature provides direction by identifying potential variables and relationships of concern, meta-analysis quantifies those relationships by integrating findings and providing explicit direction for research, practice, and theory development. Despite its strengths for quantitatively integrating study results, meta-analysis is time consuming, labor intensive, and may omit other sources such as case studies, historical and qualitative research, and clinical decision making.