December 04, 2014

Journal of Gerontological Nursing - November 2014

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au

Guest Editorial 

Nursing Leadership in Skilled Nursing: A Journey to Clinical Excellence

The use of advanced practice nurses (APNs) in long-term care has been well documented in the literature. Lyons, Specht, Karlman, and Maas (2008) introduced an evidence-based framework (i.e., “Everyday Excellence: A Framework for Professional Nursing Practice in Long-Term Care”), which focused on the following eight guiding principles for nurses in long-term care: value, envisioning, peopling, securing, learning, empowering, leading, and excellence. This framework stresses the importance of the professional nurse in long-term care, with an emphasis on generating a process for creating, implementing, and sustaining a professional practice model that provides nurses with a sense of commitment, enthusiasm, and belief in the value of nursing. The purpose of the current editorial will be to describe the authors’ journey to clinical excellence using some of the framework principles and to provide resources for others to take a similar journey.
p. 3-5 

News
FTD Included for the First Time in National Plan to Cure Alzheimer’s
The Association of Frontotemporal Degeneration (AFTD) has announced that frontotemporal degeneration (FTD) has been formally included in national research priorities to cure Alzheimer’s disease (AD) and other dementias by 2025.
Slow Gait Speed May Indicate Dementia
A study published online in Neurology found that approximately 1 in 10 older adults met criteria for predementia based on a simple test that measures how fast individuals walk and whether they have cognitive complaints. Those who tested positive for predementia were twice as likely as others to develop dementia within 12 years.
Study Examines Relationship Between Depression and Dementia
A study published online in Neurology indicates that the association of depression with dementia is independent of dementia-related changes.
p. 7-8 

Diagnosis: Dementia 
Sensory and Nurturing Nonpharmacological Interventions for Behavioral and Psychological Symptoms of Dementia
This article is part three of a four-part series addressing the use of nonphar-macological interventions in place of or in conjunction with psychotropic medications in older adults with cognitive impairment. Acquiring a better understanding of the mechanics for how each intervention works makes selection of an intervention easier at the time it is needed. Selection of the appropriate nonpharmacological intervention is based on person-centered care and how to adapt and implement it for each individual. Selection also depends on target behavior, behavior triggers, and the physical and cognitive functioning of the individual with the behavioral and psychological symptoms of dementia. Nonpharmacological interventions can be implemented by all staff members, not just recreational and activity personnel. The Centers for Medicare & Medicaid Services initiative would like to see all staff involved with these interventions, which can be implemented on the spot, as they are needed, to prevent, reduce, or stop a particular behavior. The current article will describe sensory and nurturing interventions, present the evidence supporting their use, and provide information on effective implementation.
 
 
 
 
 
p.  9–15
Evidence-Based Practice Guideline 

Wandering

Wandering can be problematic for both caregivers and individuals with dementia, particularly when wandering behaviour disrupts an individual’s sleep, eating habits, socialization, or safety, or a caregiver’s ability to provide care. The purpose of the current evidence- based guideline is to help caregivers identify and manage wandering behaviour in community- dwelling or institutionalized older adults with dementia.
p. 16-23 
AGS Update 

Updated and Expanded: AGS’ Geriatric Nursing Review Syllabus

The American Geriatrics Society (AGS) develops a range of publications to ensure that current, evidence-based geriatrics information is available to all health care practitioners who care for older adults, as well as those who teach the care of older adults to health professional trainees. The Geriatric Nursing Review Syllabus (GNRS), tailored to advanced practice nurses (APNs), is among AGS’ most important publications. First published in 2003, the new 4th edition of GNRS (GNRS-4) was updated earlier this year.
p. 24-25 
CNE Article 

A Patient-Centered Approach to Addressing Physical Activity in Older Adults: Motivational Interviewing

Regular physical activity reduces the burden of chronic diseases in older adults, but the majority of this population is relatively sedentary. Individuals considering a change in behavior, such as increasing exercise, often experience a mental state of ambivalence, which can lead to inaction. Ambivalence is resistant to traditional counseling methods used in medical settings, such as patient education. Motivational interviewing (MI) is a conversational style that has been shown to help overcome ambivalence by guiding patients to voice their personal reasons for change. Nurse practitioners are uniquely positioned to use MI with older adults to address ambivalence toward increasing physical activity.
p.  26–32. 
Feature Article 

Exergames-Based Intervention for Assisted Living Residents: A Pilot Study

The physical and psychosocial benefits of exergames have been reported in various literature. A pre-posttest, single-group design was used to test the effects of an exergames-based intervention on cognition, depression, and health-related quality of life (QOL) in assisted living residents. Bandura’s self-efficacy theory was applied. Seven residents (mean age = 86, SD = 5 years) participated in the program two times per week for 8 weeks. Outcome measures included cognition, depression, and health-related QOL. No statistically significant differences were found in any of the outcomes after the intervention. A tendency toward improved cognition occurred, but the outcomes of depression and health-related QOL did not follow a similar trend. However, improved socialization and motivation to exercise were reported. Continued research is needed to investigate the cognitive and psychosocial effects of exergames on this population. Nurses can collaborate with other health care professionals to engage residents in exercise and thus improve residents’ QOL.
p.  36–43
Feature Article 

Is Elderspeak Appropriate? A Survey of Certified Nursing Assistants

Elderspeak is a form of patronizing speech that is sometimes used with older adults and can result in unintended negative consequences. Certified nursing assistants (CNAs) working in long-term care facilities may be particularly prone to using elderspeak because they frequently interact with vulnerable and frail older adults who require assistance with activities of daily living. The purpose of the current study was to assess contextual variables that may prompt the use of elderspeak by CNAs. One hundred thirty-four CNAs completed a 36-item questionnaire intended to determine their evaluations of the appropriateness of elderspeak in a variety of contexts. Results indicated that specific resident-related variables (e.g., age, cognitive impairment) and situational variables (e.g., the absence of others during a CNA–resident interaction) were associated with higher ratings of appropriateness of elderspeak. These findings may have implications for improving communication training for CNAs.
p.  44–52
 
 

 

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