Nursing-home staff perception of behavior disturbance and management of confused residents

The practical, methodological and ethical dilemmas of conducting focus groups with vulnerable clients

AIM

This paper presents some of the practical, methodological and ethical dilemmas that were encountered in a study that used focus groups to elicit the views of women with serious and enduring mental health problems about the services they were receiving.

FINDINGS

The dilemmas identified included the time and effort taken to gain access to the women, the role of the researcher as facilitator, communication and interaction in the focus group, accepting the women's reality, and the thin divide between research and therapy.

CONCLUSION

The paper concludes with some recommendations for researchers who are planning to use focus groups to elicit the views of vulnerable clients.

A pilot study of the relationship between discomfort and agitation in patients with dementia

People with dementia often have painful conditions that go unnoticed because of their communication problems. Signs of pain in this population may include agitation and observable behaviors associated with discomfort. Agitation, discomfort, and severity of dementia were evaluated in 33 Veterans Affairs nursing home patients using the Cohen-Mansfield Agitation Inventory, the Discomfort Scale, and the Global Deterioration Scale, respectively. Findings revealed statistically significant positive relationships between agitation and severity of dementia (r = 0.34, P = 0.01), discomfort and severity of dementia (r = 0.44, P = 0.01), and agitation and discomfort (r = 0.50, P = 0.003). In a multiple regression analysis, agitation was significantly associated with discomfort (R(2) =.14, P = 0.02) after controlling for dementia severity. These preliminary findings suggest that discomfort may be a source of agitation.

Development, implementation, and evaluation of a confusion protocol

Because the phenomena of managing and therapeutically responding to confused elderly hospitalized patients is complex and difficult, a group of advanced practice nurses, supported by a pharmacist, nursing administration, and a School of Nursing professor, was commissioned to explore the research-based literature and provide practice recommendations for these patients. This article identifies one process undertaken for synthesizing and grounding an immense body of literature related to confused elderly patients. The literature review served to begin clarifying the differences between the diagnosis and required interventions for managing either acute or chronic confusion. These interventions were articulated within a protocol format (Marker model) familiar to staff members at our institution. The development, implementation, and evaluation of the protocol is presented, as well as suggestions for further research.

Coping with difficult resident behaviors takes time

1. Studies suggest that from 23% to 79% of residents manifest behaviors that are problematic for their caregivers, families, and at times, themselves. 2. The acronym, TIME, was developed to describe the components required of caregivers when working with residents: Together: Investigate, Measure, and Empathize. 3. Nurses can invite behavior change through encouraging, teaching and mentoring, but only the resident can truly manage the behavior.

Psychiatric nursing outcome research: the state of the science

A review of the nursing literature from 1989 to 1994 indicates that few psychiatric nursing studies are published in the major nursing research journals. The psychiatric specialization literature includes a large number of studies that are classified as either outcome studies or could serve as building blocks for future outcome studies. Few studies build on prior research, resulting in a weak scientific basis for evaluating the outcomes of psychiatric nursing care. Strategies for increasing the quantity and quality of psychiatric nursing outcome research are presented.