scholarly journals DESCRIBING A CONCEPT OF NURSE INTUITION AND IMPLICATIONS FOR DEMENTIA CARE IN NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S838-S838 ◽  
Author(s):  
Rebekah Perkins ◽  
Katherine Supiano’katherine supiano@hsc utah edu’ kather

Abstract The purpose of this concept analysis was to explore nurse intuition historically and in current literature, appraise the value of nurse intuition to research and practice, and discuss implications for practice in caring for residents with behavioral and psychological symptoms of Dementia (BPSD) in nursing homes. To date, no research has examined the presence or utility of nurse intuition in the nursing home setting. A conceptual analysis using pragmatic utility was chosen and based on the work of Walker and Avant (2005). In the literature, nurse intuition is characterized by attributes of knowledge not preceded by inference, knowledge that is holistic in nature, independent of linear thinking, and drawn from synthesis instead of analysis. Nurse intuition is based on preconditions of experience, empathy, limited information, and limited time to make vital decisions about patient care. Studies on nurse intuition have been criticized for their lack of rigor and empirical evidence of the effect of nurse intuition on positive patient outcomes. The attributes of intuitive nursing practice have important implications in nursing applied to residents with BPSD. The nursing home nurse with extensive educational and experiential knowledge is well-situated to understand the complex, changing needs of residents exhibiting various forms of BPSD in an effort to communicate their needs. Future studies on nurse intuition should focus on early education in dementia care, nurse residency-mentor programs to enhance intuitive thinking in the management of BPSD, and more empirical studies on the use of intuition in the context of dementia care.

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 160
Author(s):  
Jayne E. Kelleher ◽  
Peter Weedle ◽  
Maria D. Donovan

Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusion: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.


2018 ◽  
Vol 39 (6) ◽  
pp. 683-687 ◽  
Author(s):  
Lisa Pineles ◽  
Chris Petruccelli ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
Kalpana Gupta ◽  
...  

OBJECTIVETo directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practiceDESIGNObservational studySETTING AND PARTICIPANTSHealthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and TexasMETHODSOver a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.RESULTSA total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.CONCLUSIONSHealthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.Infect Control Hosp Epidemiol 2018;39:683–687


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S451-S451
Author(s):  
Rebekah Perkins ◽  
Elizabeth Cashdan ◽  
Katherine Supiano

Abstract Nurses draw from their experiences and intuition to detect changes in patient condition, patterns of patient behaviors, and evidence of distress. In the nursing home setting, nurses care for residents with dementia and manage challenging behavioral and psychological symptoms of dementia (BPSD), and may rely on informed intuition to assess and capably respond to such behaviors. To date, no observational method has been developed to discern nurse-resident interactions that identify expert nurses who effectively address BPSD. It is not known if or how nurses in this setting use intuition to make clinical judgments and decisions to manage BPSD events. Using an ethogram approach, we developed an observational tool and spot interview method to discern BPSD events, background and proximal factors and nurse responses to BPSD. Pilot observations took place over three nursing shifts to identify nurse-resident interactions during BPSD events using the observation tool. Nurse-resident interactions were followed by spot interviews with each nurse to clarify their responses to BPSD. Semi-structured interviews were conducted with nurse participants to further develop an interview guide and identify elements of nurse intuition. The pilot study affirmed the feasibility of gaining access to facilities with residents with BPSD, of nurse comfort with field observation and interviews, and established preliminary construct validity of the “expert nurse.” Verification of the utility of this observation and interview method permit further examination of effective nurse engagement with nursing home residents with BPSD, informs our understanding of nurse intuition and permits further exploration of the broader context of BPSD.


Author(s):  
Tannys Helfer ◽  
Kathrin Sommerhalder ◽  
Jos M.G.A. Schols ◽  
Sabine Hahn

Background Nursing homes in many countries continue to follow a traditional medical model of care. This study explored health promotion approaches in the nursing home setting, partly in order to move away from a medical model and to improve the well-being of residents and staff. Methods A scoping study was conducted to review the scientific literature. The Integrated Model of Population Health and Health Promotion was adapted for utilization with the literature analysis. Result A total of 64 publications met the inclusion criteria and were analysed. Five main approaches were shown to have applied health promotion in nursing homes, although gaps were present in the usage of systematically applied health promotion. Conclusion A variety of approaches do exist for the nursing home setting which apply health promotion; however, their usage is fragmented. This study revealed that a framework designed to support nursing homes in the systematic usage of health promotion, could improve the well-being for both residents and staff.


2014 ◽  
Vol 27 (1) ◽  
pp. 49-59 ◽  
Author(s):  
Sofia Vikström ◽  
Per-Olof Sandman ◽  
Ewa Stenwall ◽  
Anne-Marie Boström ◽  
Lotta Saarnio ◽  
...  

ABSTRACTBackground:Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care.Methods:The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis.Results:Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced.Conclusions:One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.


2015 ◽  
Vol 27 (9) ◽  
pp. 1495-1504 ◽  
Author(s):  
Zhicheng Li ◽  
Yun-Hee Jeon ◽  
Lee-Fay Low ◽  
Lynn Chenoweth ◽  
Daniel W. O’Connor ◽  
...  

ABSTRACTBackground:Depression is a common psychiatric disorder in older people. The study aimed to examine the screening accuracy of the Geriatric Depression Scale (GDS) and the Collateral Source version of the Geriatric Depression Scale (CS-GDS) in the nursing home setting.Methods:Eighty-eight residents from 14 nursing homes were assessed for depression using the GDS and the CS-GDS, and validated against clinician diagnosed depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID) for residents without dementia and the Provisional Diagnostic Criteria for Depression in Alzheimer Disease (PDCdAD) for those with dementia. The screening performances of five versions of the GDS (30-, 15-, 10-, 8-, and 4-item) and two versions of the CS-GDS (30- and 15-item) were analyzed using receiver operating characteristic (ROC) curves.Results:Among residents without dementia, both the self-rated (AUC = 0.75–0.79) and proxy-rated (AUC = 0.67) GDS variations performed significantly better than chance in screening for depression. However, neither instrument adequately identified depression among residents with dementia (AUC between 0.57 and 0.70). Among the GDS variations, the 4- and 8-item scales had the highest AUC and the optimal cut-offs were >0 and >3, respectively.Conclusions:The validity of the GDS in detecting depression requires a certain level of cognitive functioning. While the CS-GDS is designed to remedy this issue by using an informant, it did not have adequate validity in detecting depression among residents with dementia. Further research is needed on informant selection and other factors that can potentially influence the validity of proxy-based measures in the nursing home setting.


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