J Gerontol Nurs
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Expansion and diversification of the older adult demographic group is a key indication that nurses need to be aware of current recommended practice related to the most common mental health diagnoses in this age group. Such conditions include depression, anxiety, dementia, delirium, and substance abuse/dependence. This article, the second in a two-part series, focuses on key assessment components and suggested interventions for dementia, delirium, and substance abuse/dependence.
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Multicenter Study
Family satisfaction with care of a dying loved one in nursing homes: what makes the difference?
As part of a larger study examining end-of-life care in nursing homes, qualitative focus groups were conducted with bereaved family members to explicate those factors contributing to satisfaction and dissatisfaction with end-of-life care in the nursing home setting. Content analysis of focus group data revealed two overarching themes that influenced family members' satisfaction with care. ⋯ Family members dissatisfied with their relative's end-of-life care expressed feelings of guilt, anger, and frustration, both while the resident was alive and in the bereavement period. The findings of this study have implications for clinicians committed to delivering quality end-of-life care to residents and their families and provides the basis for educational interventions and quality care improvement initiatives in the long-term care setting.
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This qualitative study identified certified nursing assistants' (CNAs') perspectives of nursing home residents and how these perspectives translate into care practices. Data included observations of and interviews with 27 CNAs in three dissimilar nursing homes. All participants were people of color, and all but 3 were immigrants. ⋯ Although individual CNAs held one primary view of residents in general, select residents were viewed from an alternative perspective, resulting in variations in care practices. These findings suggest that such distinctions, in tandem with structural, organizational, and cultural differences in nursing homes, present opportunities for nursing leadership to affect the visible, everyday practice of nursing CNAs. To target interventions, further research is needed on how CNAs come to differentially view residents and how these differences influence CNAs' care relationships with residents.
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A do-not-resuscitate (DNR) order is a written medical order that documents a patient's wishes regarding resuscitation and, more specifically, the patient's desire to avoid cardiopulmonary resuscitation (CPR). A DNR order is one of the most important patient care directives that can be issued because it has dramatic and irreversible consequences. A portable DNR order is a do-not-resuscitate directive that travels with the patient. One way to improve continuity among providers and organizations is to develop statewide portable DNR and end-of-life orders that ensure patients' wishes are followed regardless of setting.
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Delirium is a prevalent, costly, and global problem in older adults. This article is a systematic review of the literature on nurse recognition of delirium. ⋯ The most compelling finding is that although related, the notions of nurse knowledge of delirium, nurse recognition of delirium, and nurses' assessment and documentation of delirium in older adults are different. Recommendations for practice are suggested at several levels, including education, guidelines, communication, health care system, and use of informatics.