International journal of older people nursing
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Int J Older People Nurs · Mar 2011
CommentPrescribing for older people in nursing homes: challenges for the future.
As the population continues to age, long-term care for older people will be required, although the setting and method of delivery may differ depending on people's needs. We anticipate that nursing homes will continue to be part of the overall long-term care delivery model, but will face a number of challenges if they are to be considered as much sought-after places. This paper highlights three issues in relation to prescribing that have been largely ignored to date, but which need to be considered by practitioners, policy makers and researchers alike: culture; resident-centred decision-making and care at the end of life. ⋯ Culture is important in how it contributes to resident-centred care and this leads to a consideration on how residents may be involved in decision-making, specifically in the area of medicines. Finally, care at the end of life in nursing homes, particularly in those with dementia, has been shown to be poor in quality, and this also encompasses the medicines that are prescribed. Palliative services need to be developed to meet the requirements of some of the most vulnerable residents in this care setting.
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Int J Older People Nurs · Mar 2011
Clinical TrialFocus on communication: increasing the opportunity for successful staff-patient interactions.
This study reports on a pilot study examining the feasibility of a Patient-Centred Communication Intervention. Aims of this study include: assessing the implementation of the communication care plans; identifying staff perceptions of the intervention; exploring changes in patients' perceptions of care and psychosocial functioning; and exploring changes in nurses' knowledge of and attitude towards communication with patients. ⋯ Providing tailored approaches to communication-enhancement education may be necessary for changes in practice to occur.
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Int J Older People Nurs · Sep 2010
Raising the bar of care for older people in Ontario emergency departments.
To describe the role of geriatric emergency management nurses as a catalyst for culture change in emergency department processes with the goal to improve care and outcomes of older people. ⋯ Known strategies that have been effective in improving outcomes for older people within the hospital and residential care setting can be generalized into emergency department care. Further research into the effectiveness of these strategies in this environment is recommended.
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Internationally there is commitment to work towards eradicating the abuse of older people and to develop services that promote their equality, dignity and human rights. The emphasis on service users is gradually increasing and, along with this, the focus within health and social care policy, service provision and professional practice is shifting. In UK health and social care policy the emphasis on service structure and provision is being replaced by a focus on outcomes for service users, including outcomes which patients themselves evaluate. ⋯ The outcomes framework developed through the research is offered, along with a discussion of the advantages of an outcome-focused approach to care and some of the remaining challenges. A case example is offered to illustrate an outcomes-focused approach. Finally, the paper draws conclusions on how shifting the focus of care delivery from traditional problem-orientated approaches and ritualized practice towards the outcomes of care that individual older people choose and evaluate for themselves offers potential towards eradicating abuse and neglect in formal care settings.
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Int J Older People Nurs · Dec 2006
Wandering into the future: reconceptualizing wandering 'A natural and good thing'.
There is still significant scope for improvement in knowledge on wandering in dementia and in the care of persons with dementia who wander. Although progress in research-derived knowledge is evident over the last 15 years, the current state of practice is influenced by an immature research base where the clarification of what wandering is still needs to be achieved. This is fuelled by research which to date, has framed wandering as a problem behaviour and generally starts from the premise that it needs to be prevented or severely controlled. ⋯ In regard to the practice context, it is suggested that there is little evidence to suggest that screening for wandering, assessment of wandering, person-centred and evidence-based care planning and interventions or evaluation are yet the norm for older persons with dementia. Thus, these areas must be the priorities for the immediate future. Whilst at a theoretical level, there are three key issues that require attention in the future: the orientation of research on wandering including reconceptualizing wandering to address the lack of theoretical frameworks to explain wandering, addressing the need some care settings might have with application of research and recognition of the experiential expertise of older persons with dementia.