Elder Abuse: A Global Challenge and Canada's Response

Elder abuse is a global call to action. Nurses have a primary role to play in its detection and prevention. Globally, demographic change is creating an increasing number of older adults. Consequently, this increased number of people will be affected by age discrimination and ageism, both of which contribute to elder abuse. Despite the existence of the Universal Declaration of Human Rights, older adults are not recognized explicitly under the international human rights laws that legally oblige governments to address the rights of all people. Drawing initially on global conversations specific to elder abuse and the role of nurses, the current article explores the challenges of recognizing and combating elder abuse. To provide specific gerontological nursing strategies, recognition is given to actions implemented in Canada to address this major health challenge. The desired outcome is an advocacy framework for gerontological nurses to use in working toward the recognition and prevention of elder abuse. [Journal of Gerontological Nursing, 48(4), 21-25.].

The implementation of correctional nursing practice-Caring behind bars: A grounded theory study

AIM

To understand how registered nurses implement their nursing practice in correctional institutions with healthcare governance by a health authority (e.g. Ministry of Health).

DESIGN

Straussian grounded theory.

METHODS

Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison and memo writing. Thirteen registered nurses engaged in semi-structured telephone interviews about implementing their correctional nursing practice including, providing direct care to adult offenders. Data were collected (December 2018 to October 2019) until saturation occurred. Analytic coding (open, axial and final theoretical integration) was performed to identify the core category and subcategories around which the substantive theory was developed.

RESULTS

The theory of Caring Behind Bars refers to the process of how registered nurses implemented their correctional nursing practice to care for offenders. The core category of Caring Behind Bars is comprised of five subcategories: tension between custody and caring, adaptability and advocacy, offender population, provision of care, and challenging and positive elements.

CONCLUSION

Caring Behind Bars required registered nurses to address tension between custody and caring by adapting and advocating to access offenders. The provision of care required registered nurses to use assessment skills and numerous resources to provide a variety of patient focused care to offenders. The consequences of Caring Behind Bars had challenging and positive elements.

IMPACT

The tension provides purposeful space to continue improving teamwork among correctional officers and registered nurses. More research is required about the impact of correctional healthcare governance models on professional practice and health outcomes. Frontline registered nurses can use the theory to make informed choices when providing care. Registered nurses practising in other domains of correctional nursing (i.e. administration, education and research) can also use this theory to advance and inform practice with the goal of promoting offender health.

The Suitability of Grounded Theory Research for Correctional Nursing

The tension between custody and caring is particular to correctional nursing practice, including issues such as the correctional priorities of safety and security that often dominate nursing practice. The evidence that should underlie correctional nursing practice is regrettably sparse. There are two reasons a grounded theory (GT) approach is paramount for building foundational knowledge to advance correctional nursing practice. First, the development of theories regarding correctional nursing practice will provide an in-depth understanding of this subspecialty of nursing and lead to further research endeavors. Second, correctional nursing practice is a process carried out in correctional institutions. The GT approach is "process oriented" and thus is appropriate for exploring the implementation of correctional nursing practice. Two GT approaches have evolved since first described by Glaser and Strauss. We contend that the approach offered by Strauss and Corbin may be more beneficial for studying how correctional nurses implement their practice.

Correctional nursing and transformational leadership

Transformational leadership (TL) is a highly discussed approach in the literature for many professions. Likewise, the TL approach continues to be explored in a myriad of nursing contexts to demonstrate its advantages for practice and client health. The tension between custody and care is particular to correctional nursing practice, such as the correctional priorities of safety and security that often override caring-focused nursing practice. Presented herein, is information relating to correctional nursing leadership as found in the minimal, available literature; and hypothetical examples of how correctional nursing leaders can use TL are provided. Measuring the influence of TL on practice and offender health can assist in determining if this approach is an appropriate "fit" for the correctional nursing context. The dearth of literature regarding correctional nursing leadership must be addressed to advance this subspecialty of nursing and promote offender health. The intent is not to argue that TL is the only applicable leadership approach for this subspecialty of nursing. Rather, introductory insight is offered regarding the suitability of TL in correctional nursing practice.

Nursing and music: Considerations of Nightingale's environmental philosophy and phenomenology

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the use of music within a holistic, caring-healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music-based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well-being of this vulnerable group of older persons.

The ACHRU-CPP versus usual care for older adults with type-2 diabetes and multiple chronic conditions and their family caregivers: study protocol for a randomized controlled trial

BACKGROUND

Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).

METHODS/DESIGN

The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.

DISCUSSION

This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014.

Understanding the Journey Through Homelessness: A Hermeneutic Study of Women Without Children

This study explored the meaning of the experience of homelessness and exiting homelessness among women without children. Convenience and snowball sampling techniques were used to recruit 12 women in an urban centre in Canada. Texts resulting from audiotaped interviews, participant observations, and reflective journal entries constituted data for analysis. Gadamerian hermeneutics informed the interpretive method used for analysis. The analysis yielded 5 subthemes that described the journey: (a) loss of self at home: the trigger; (b) non-feeling of “at-homeness”: dissociation; (c) disconnection and aloneness: homelessness; (d) simulating home: transitional shelter living; and (e) finding oneself: hopefulness. Findings suggest that exiting homelessness for women was a journey in search of hope, and reconnection with the self and others. This perspective suggests a new approach for policy and practice.

Gerontological content in canadian nursing and social work programs

Method

A survey of gerontological content in nursing and social work programs across Canada (English speaking) was conducted. The survey tool was the competencies list developed for interprofessional gerontological education by the National Initiative for the Care of the Elderly (NICE). Deans or designates of English-speaking nursing and social work programs across Canada were contacted by e-mail. Data was collected by Zoomerang.com.

Results

Findings indicate that clear progress is being made in ensuring that students have the knowledge and skills needed to provide the care required by older adults in a variety of settings.

Are gerontological nurses apathetic about apathy in older adults

Despite its serious health consequences, apathy in older adults is often underrecognized by gerontological nurses and other health care professionals. Within this article, we discuss what apathy is and present a review of the literature and research. Two frameworks emerging from the literature search-one regarding rehabilitation and the other illness-are introduced as ways in which apathy may be conceptualized and addressed. Using these frameworks, implications for gerontological nurses are outlined.

Conversations with Holocaust survivor residents

Traumatic events in one's younger years can have an impact on how an individual copes with later life. One traumatic experience for Jewish individuals was the Holocaust. Some of these people are moving into long-term care facilities. It was within this context that the research question emerged: What are Holocaust survivor residents' perceptions of a life lived as they move into a long-term care facility? For this qualitative study, Holocaust survivors were individually interviewed. Findings emphasize that nursing care needs to ensure that Holocaust survivor residents participate in activities, receive timely health care, and receive recognition of their life experiences.

Wanted—committed gerontological nurse preceptors

Good gerontological nurse preceptors can help students feel comfortable working with older adults. They can also provide assistance to students in narrowing the theory-practice gap that sometimes seems to exist. Developed in this article is an understanding of preceptoring students and working with them and academic faculty to promote positive gerontological nursing experiences.

What evidence underlies our practice with alzheimer families?

Registered nurses who base their practice on scientific evidence can justify their decisions and the care they provide to the families of people with Alzheimer disease (AD). The health care literature should provide an evidence base for nurses to draw on. Families care for older members with AD, regardless of whether the setting is a family home, long-term care facility, or day-support program. Sometimes families say they need information to enable them to provide quality care. Their questions may include "What happens next?" "Where do we go from here?" or "How do I stop the wandering?" This study reviewed AD education articles in five journals used by gerontologic health care workers-primarily registered nurses. Findings identified a serious lack of education-specific articles. The implication is whether registered nurses are meeting the education needs of families.

Defining resident abuse within the culture of long-term care institutions

Although researchers have identified the presence of resident abuse within long-term carefacilities, it has not come under the same scrutiny as have other aspects of abuse against older adults. This is due, in part, to the difficulty in defining the phenomenon. The purpose of this study was to articulate a definition of resident abuse as perceived by registered nurses working in long-term care institutions. Ethnoscience was the method used to answer this question. The five categories of resident abuse characteristics--perception of hurtfelt by older residents, acts of omission or commission, context of care, intentional or unintentional, and behavioral clusters--that emerged through semistructured interviews and focus groups reflect the descriptions given by participants. Identifying a common definition of resident abuse suggests that assessment and intervention to reduce episodes of it are more likely to be effective.

"I hated those darn chickens...": the power in stories for older adults and nurses

Attention to stories provides a holistic view of an older adult and offers the potential for quality nursing intervention. Explored in this article is the power of stories to advance the well being of older adults and the implications for gerontological nurses of a commitment to support storytelling in this population.

Resident abuse: an insider's perspective

The purpose of this study was to assess how resident abuse is perceived by members of the long-term care institution. Groups of registered nurses, nonprofessional staff, older residents, and significant others were interviewed individually and participated in focus groups. Resident abuse is perceived by the participants in this study as an experience that causes a perception of hurt in older residents. This perception is voiced by either older residents themselves or other members of the institution on their behalf. Participants' views about resident abuse are always framed within the context of institutional life.

"As a Young Girl, I ..." The Benefits of Narrational Relationships in the Lives of Older Residents

1. Using story telling with the older resident provides an opportunity for the nurse to demonstrate caring, and a common reality between them is developed. 2. Story telling by older residents, far from merely "living in the past," can promote their health and well being. 3. In the narrational relationship between nurse and older resident, story telling is encouraged and supported; for the nurse, this means valuing oneself, older adults, and story telling.