Prevalence of Cognitively Intact Individuals Residing in Extended Care Nursing Facilities

There appears to be a relative absence of studies that have examined the prevalence of cognitively intact individuals who reside in extended care facilities. Prevalence data were collected on 296 persons who resided in 3 extended care nursing facilities in Central Virginia. Cognitive intactness was evaluated via the Minimum Data Set Cognitive Performance Scale (CPS) and an author-generated survey (i.e., Cognitively Intact Survey [CI Survey]) of select nursing staff members at each facility. The Mini-Mental State Examination (MMSE) was utilized to examine the accuracy of the two measures in identifying cognitive intactness. Findings indicated that prevalence rates of cognitively intact residents varied as a function of the measures utilized to assess intactness. Specifically, a significantly greater proportion of the total sample of residents was judged to be cognitively intact via the CI Survey (34.12%) as compared to the CPS (26.01%). The level of interjudge agreement between the two measures was found to be moderately high (K = 0.68). When the MMSE was employed to verify individuals' levels of intactness, the percentages of residents predicted to actually be cognitively intact were somewhat lower for each measure. Specifically, based on the data obtained via the CI Survey, 22.75% of the total sample were predicted to actually be cognitively intact, whereas 17.85% of the sample were predicted to be intact based on the CPS results. Findings are discussed in light of factors that may have contributed to the differential prevalence rates of cognitively intact individuals obtained across the measures utilized in this study. Concerns regarding the utilization of the MMSE as a criterion measure of cognitive intactness in persons residing in extended care nursing facilities are provided, along with data on the living environments/roommate statuses of those residents judged to be intact via the CI Survey. Implications for the design of future extended care nursing units, as well as future research, are also included.     

A Prospective Comparison Study of Different Methods of Gathering Self-Reported Family History Information for Breast Cancer Risk Assessment

Currently there is much debate regarding the ability of mathematical models incorporating epidemiological information or mutation-based risk algorithms to accurately predict a woman's risk of developing breast cancer. Without access to accurate family history information these models have limited use. This study compares different methods of gathering family history information and the impact on subsequent risk assessment. These methods were compared to the gold standard interview with a trained genetics' professional. The amount and accuracy of information provided by primary care doctors' letters was found to be poor and better information was obtained by sending a postal questionnaire directly to the patient. Because of the high number of low-risk women referred to clinic a questionnaire (the FCAT) was designed to provide reassurance and piloted as part of this study. This paper highlights the importance of using appropriate methods to gather the family history information. It presents evidence for the importance of a skilled assessor and the need to allow time for women to discuss the importance of this information with their family.     

心理护理程序和方法的研究

护理理论认为护理是对人的生理、心理、社会的整体护理。心理护理是护理工作的重要组成部分。本文分别用ＳＤＳ、ＳＡＳ等量表为材料,对心理护理程序和方法的建立作了一个临床试验研究。并以理论和实践的意义为线索,论述心理护理的分化、应用性研究的现实性和前瞻性意义。结果发现：丑）建构心理护理程序必须以主客观指标为基础。２）心理护理的方法应为综合的,形式以集体和个案护理为主。３）建构的心理护理程序和方法在理论上积极促进护理学科的分化研究。在实践上具有易于推广应用,行之有效的价值。４）实施心理护理后,病人的ＳＤＳ、ＳＡＳ分值有显著降低的趋势。心理问题也明显减少。     

The Nursing Stress Scale: Development of an instrument

Despite increased recognition of the stress experienced by hospital nursing staffs and its effects on burnout, job satisfaction, turnover, and patient care, few instruments exist that can be used to measure stress. This paper describes the development of an instrument, the Nursing Stress Scale (NSS). It consists of 34 items that describe situations that have been identified as causing stress for nurses in the performance of their duties. It provides a total stress score as well as scores on each of seven subscales that measure the frequency of stress experienced by nurses in the hospital environment. The Nursing Stress Scale was administered to 122 nurses on five hospital units. Factor analysis indicated seven major sources of stress that closely paralleled the conceptual categories of stress on which the scale was based. Test-retest reliability as well as four measures of internal consistency indicated that the Nursing Stress Scale and its seven subscales are reliable. Validity was determined by correlating the total score from the Nursing Stress Scale with measures of trait anxiety, job satisfaction, and nursing turnover hypothesized to be related to stress. In addition, the ability of the scale to differentiate hospital units and groups of nurses known to experience high levels of stress resulting in staff turnover was examined.     

Measuring Daytime Drowsiness in Nursing Home Residents: The MSLT-NH

A standardized method of assessing daytime drowsiness in frail nursing home residents has not been previously available. We present here the development and test characteristics of an instrument to measure daytime drowsiness in nursing home residents with cognitive and functional impairment, the Multiple Sleep Latency Test-Nursing Home (MSLT-NH). In a standardized manner, the resident is tested three times in one day (at 9 a.m., 11 a.m., and 1 p.m.) to measure the amount of time until the subject falls asleep. The average sleep latency (minutes to fall asleep) is the measure of interest. We tested the MSLT-NH in 95 residents from six community nursing homes in the Los Angeles area (82% of subjects were female; 81% were white, mean age was 86.6 years and mean score on the Mini-Mental State Examination [MMSE] was 9.4). Interrater reliability of the MSLT-NH was quite good (correlations between raters ranged from 0.98 to 0.99; all p values were <.0001). Validity was assessed by comparing MSLT-NH results to simultaneous wrist activity estimation of sleep, and by comparing MSLT-NH findings to results from nighttime sleep estimation by wrist actigraphy the night prior to MSLT-NH. The percent agreement between MSLT-NH and wrist actigraph ranged from 77% to 79% MSLT-NH results were significantly associated with peak duration of nighttime sleep episodes the night prior to testing. The MSLT-NH was also quite acceptable for use in the NH setting. In conclusion, we have developed a promising measure of daytime drowsiness in NH residents. Further testing will help establish whether this test is a clinically useful measure of daytime drowsiness from medications or other conditions in the NH setting.     

用批判性思维方法解决烧伤护理实践中的问题

批判性思维是护理界越来越注重培养并予运用的思维方法。在烧伤护理实践中用批判性思维方法解决临床护理实际问题,护理人员应正确理解批判性思维的概念并培养批判性思维能力、应具备良好的职业道德和敬业精神,最终能将批判性思维正确运用于护理程序的每一个步骤中。     

肿瘤患者心理困扰管理研究现状及本土化思考

心理困扰存在于肿瘤发生、发展的各阶段,是最常见的问题之一,在国外研究日益聚焦的同时,我们从心理困扰起源出发,回顾肿瘤患者心理困扰管理概况、观察性及实验性研究现状,分析心理困扰管理概念内涵、筛查工具、分类标准、干预模式及最佳管理途径等本土化问题,旨在找出困扰管理与我国国情的契合点,探求肿瘤患者心理困扰管理模式的合理化途径。     

Opportunities for development via group psychotherapy in the nursing home

This paper illustrates the benefits of group therapy within the nursing home, and considers the enhancing and problematic factors in conducting groups within this setting. Growth which empowers staff and residents is possible and can be achieved despite significant challenges and social change. A lifespan developmental perspective can assist residents to achieve their maximum developmental maturity and group therapy can be effective in accomplishing that goal. This paper discusses the effect of the nursing home environment and staff on the resident, the task of the therapist in the nursing home, the value of group therapy, therapeutic goals in group therapy, what precipitates the need for group therapy in nursing homes, and the issue of group therapy with the cognitively impaired.     

“What if It’s not Just an Item of Clothing?” – A Narrative Review and Synthesis of the White Coat in the Context of Aged Care

Although increasingly disputed, the white coat uniform is ubiquitous in geriatric care, which may reflect a phenomenon called medicalisation of ageing. This narrative review is the first attempt at integrating several theoretical approaches, such as the “white coat effect” and “enclothed cognition”, in order to gain a comprehensive understanding of the use of this clothing item. Based on extensive empirical evidence, we will examine the consequences of wearing a uniform, not only on patients (in this case, older patients) and healthcare professionals, but also on their relationship. The white coat has powerful symbolic functions for healthcare professionals and is still preferred by older adults. However, the negative repercussions of wearing a uniform require us to question its use, particularly in environments where older persons live, such as nursing homes.