Elders' perceptions of formal and informal care: aspects of getting and receiving help for their activities of daily living

A purposive and convenience sample of 16 women and four men receiving informal and formal care for their activities of daily living either at home or institutions in Southeast Washington, USA was interviewed. Qualitative findings related to asking for help, getting and receiving help, interpersonal aspects of receiving help, and met and unmet needs are reported. Some seniors found it more difficult to ask for and accept help and there were gender differences, with men tending to adopt a more logical and pragmatic approach while women viewed receiving help as a loss of independence and an invasion of privacy. Intimacy and nudity were also threats for women. Three styles of adjustment and acceptance were identified within the data and related to positive acceptance, resigned acceptance and passive acceptance. There appeared to be a relationship between independence and control, with elders losing some independence but retaining control through choice, payment and involvement in decision making. Reciprocity was found to bring added value to relationships between care providers and elders, with a rhythm and symmetry developing in relationships where needs were known, anticipated and met. Seniors should be encouraged to plan for their future and to find out about local help and services available to them in advance of their requiring any assistance.

Elders' needs and experiences of receiving formal and informal care for their activities of daily living

Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. Findings related to personal and instrumental activities of daily living are reported and include elders' experiences and views relating to the help and assistance they receive. The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency.

Broad-spectrum group treatment for parents bereaved by the violent deaths of their 12- to 28-year-old children: a randomized controlled trial

This study assessed the efficacy of a 10-week broad-spectrum intervention offered to bereaved parents about 4 months after the deaths of their 12--28-year-old children due to accidents, homicide, or suicide. For three outcomes of distress there was a significant interaction between treatment and baseline values for each outcome for mothers both immediately posttreatment and 6 months later. The intervention appeared to be the most beneficial for mothers most distressed at baseline. Fathers showed no immediate benefits of treatment. Further research is needed to investigate these unexpected results for fathers and to further characterize those who benefit from similar programs.

Falls: are rural elders at greater risk?

1. Advocating that elderly clients engage exclusively in behaviors that are free of risks may not always advance the goals of independence, autonomy, and a maximal level of functioning. 2. Falls in the elderly may not be primary events, but indicators of an as yet undetected decline in health, suggesting that the health care provider tailor fall prevention information to the specific lifestyle of the older adult. 3. There may be a range of safe and acceptable risk depending on the lifestyles and the demands of daily living.

Reliability, construct validity, and subscale norms of the Brief Symptom Inventory when administered to bereaved parents

The Brief Symptom Inventory (BSI) was administered to parents (N = 260; 171 mothers and 89 fathers) whose adolescent and young adult children died unexpectedly and violently by accident, homicide, or suicide. Summary statistics and reliability coefficients (Cronbach's alpha) for the nine subscales and the Global Severity Index were calculated. A comparison of means and standard deviations confirmed the expectation that this sample is dramatically different from the normative American community standard. Raw scores for the subscales were transformed into standardized T scores and critical values for a screening heuristic presented. An attempt to obtain construct validity using factor analysis suggested that a five-factor solution provided a description of this population of bereaved parents that is more insightful than the nine standard subscales of the BSI. Implications for both clinicians and future research are discussed.

Understanding depression in bereaved older adults

Depression is a common outcome of spousal bereavement. Concurrent life events may contribute to the intensity of depression following spousal bereavement in older adults and, if not identified, may interfere with therapeutic plans for the management of depression. Taped interviews, conducted six times over two years, were analyzed for ten subjects, five whose depression scores were low, and five whose scores were high. In addition, a detailed case comparison analysis of two subjects was done. Four recurring types of life events, reported by the bereaved spouses, were illness (of self or others), deaths of family or friends, residential relocation, and changes in interpersonal relationships. Significantly depressed spouses were more likely to report these events. Implications for nursing practice and for integrating qualitative and quantitative research methods are addressed.

Toward a theory of helpfulness for the elderly bereaved: an invitation to a new life

The purpose of this study was to generate a theory of helpfulness for the elderly bereaved. The theory is grounded in data from responses of 30 participants concerning the advice they would give others who have lost a spouse and how others were helpful to them. Participants responded during six interviews following death of their spouses. A content analysis of responses was the basis of a dialectical theory of helpfulness: An Invitation to a New Life.

Treatment of axillary burn scar contracture using an arterialized scapular island flap

A case of an axillary burn scar contracture treated with a scapular island flap is presented. We believe that this will be a useful addition to the treatment of burn scar contractures of the axilla.

Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment

A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.

Family Theory and Family Therapy Models: Comparative Review with Implications for Nursing Practice

Although theories of the family and theories of family therapy have different origins and purposes, both provide the basis for a family focused nursing approach. Family theory is a practice theory with a focus on health while family therapy is a practice theory with a focus on pathology. Thus, the contributions of each are different. For nurses to adapt and apply the principles of the two theories correctly, they first must understand whether application of a basic theory with a focus on health or a practice theory with a focus on pathology is appropriate in the particular nursing situation. For example, if a husband is hospitalized, recovering from a myocardial infarction, a family focused nursing approach is mandatory in providing optimal nursing care. Assessment of the family situation will provide clues for the functional or dysfunctional state of the family and the appropriateness of utilizing family theory or family therapy principles. If the current state of family relationships is optimal, application of family theory principles than can be applied to guide health promotion on a family level is appropriate. Organizational and dynamic aspects of the family promoting the husband's recovery can be accentuated, supported, and emphasized in the nursing care. However, if the current state of family relationships is pathological, application of family therapy principles is appropriate. Here the goal of the nursing care is restoration of functional organizational patterns and interactive processes between family members.

Bereavement and the elderly: a critical review with implications for nursing practice and research

Loss is a common occurrence in the lives of the elderly. One of the most profound losses is the death of a spouse. Yet, infrequent and predictable as this event is for older adults, we know very little about the grieving process or the resolution of grief among this age group. For nurses who care for older clients an understanding of loss and bereavement is important in order to provide appropriate and timely support. In this paper the nature of grief and bereavement behaviour is discussed beginning with the earliest empirical work done in 1930 and including a synopsis of six major variations of grief. A comprehensive review and critique of current investigations provides the basis for suggesting that, because of flaws in conceptualization and design, there are substantial limits on the relevance of existing knowledge of grief for an understanding of this phenomenon among the aged bereaved. A beginning theoretical integration and discussion of key concepts related to bereavement and the elderly is provided. This discussion is summarized in a proposed model. This paper concludes with suggestions for nursing research and practice.

Concomitant pneumococcal appendicitis, peritonitis, and meningitis

A 9-year-old boy developed pneumococcal meningitis and peritonitis following appendectomy. Subsequent pathologic examination showed Gram-positive diplococci in the appendix. Cultures of the peritoneal fluid, blood, and spinal fluid showed Diplococcus pneumoniae. The experience illustrates the danger of assuming that all pneumococcus peritonitis is the primary variety and the advisability of routine Gram stain of the peritoneal fluid at operation in order to select the appropriate antibiotic.