RESUMEN
The purpose of this research was to evaluate the effectiveness of an individualized scheduled toileting (IST) program on incontinent, memory-impaired elders being cared for at home. Using a 2 x 2 mixed design analysis of variance (group by time), 118 patients were randomly assigned to experimental or control groups. Caregivers in the experimental group were taught the IST procedure. Urinary incontinence (UI) was measured at baseline and at 6 months. Weeklong voiding records were kept by caregivers and were used to calculate the percentage of times the incontinence occurred. UI significantly decreased in the experimental group, whereas in the control group it did not. The baseline cognitive ability, mobility, and consistency of implementing IST were entered into a discriminant function equation and significantly predicted patients who would improve with IST. Cognitive ability was the best predictor, with mobility also emerging as a meaningful predictor. Candidates for IST should be selected based on elders' cognitive ability and their ability to cooperate with toileting. Moderately cognitively impaired elders and ones able to cooperate with toileting protocols are prime candidates for IST.
Asunto(s)
Evaluación Geriátrica , Trastornos de la Memoria/complicaciones , Evaluación en Enfermería/métodos , Planificación de Atención al Paciente/organización & administración , Selección de Paciente , Control de Esfínteres , Incontinencia Urinaria/etiología , Incontinencia Urinaria/enfermería , Actividades Cotidianas , Anciano , Análisis de Varianza , Cuidadores/educación , Análisis Discriminante , Familia , Femenino , Servicios de Atención de Salud a Domicilio , Atención Domiciliaria de Salud/educación , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Persona de Mediana Edad , Investigación en Evaluación de Enfermería , Registros de Enfermería , Cooperación del Paciente/psicología , Valor Predictivo de las Pruebas , Factores de Riesgo , Incontinencia Urinaria/clasificación , Incontinencia Urinaria/fisiopatología , Incontinencia Urinaria/psicologíaRESUMEN
The purpose of this pilot study was to explore elderly Mexican women's readiness to exercise, and their multiple roles. Fifty older women were sampled from two separate neighborhoods of low socio-economic status. Readiness to exercise was examined using the Stages of Change - Exercise instrument with six categories: precontemplation nonbelievers, precontemplation believers, contemplation, preparation, action, and maintenance. Time devoted to the following functional roles was explored: wife, household, grandmother, personal care, and recreational. Women fell mainly under the first three stages of change both, precontemplation nonbelievers and believers, and the contemplation stage. The stages of change scale and role commitments were not significantly related. Nevertheless, precontemplators devoted less time in all the roles than the women in the other categories of stage of change.
Asunto(s)
Anciano/psicología , Actitud Frente a la Salud/etnología , Conflicto Psicológico , Ejercicio Físico/psicología , Identidad de Género , Mujeres/psicología , Anciano de 80 o más Años , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , México , Investigación Metodológica en Enfermería , Proyectos Piloto , Pobreza/psicología , Autocuidado/psicología , Encuestas y Cuestionarios , Administración del Tiempo , Mujeres/educación , Salud de la Mujer , Carga de TrabajoRESUMEN
The urine control theory, a middle range theory substructed from Roy's adaptation model, is presented to explicate the phenomenon of urine control. Urine in the bladder is identified as the focal stimulus, and the impact of the cognator subsystem in relation to urine control is described. The role of contextual stimuli related to mobility and the environment is also described. Relationships between concepts are explained and supported with individual case studies. The case findings are used to exemplify the interrelationships in the model. The urine control theory can be used by practitioners to inform practice and by researchers to guide research designs.
Asunto(s)
Adaptación Psicológica , Modelos de Enfermería , Modelos Psicológicos , Teoría de Enfermería , Incontinencia Urinaria/prevención & control , Incontinencia Urinaria/psicología , Urodinámica , Actividades Cotidianas , Anciano , Cuidadores/educación , Conducta de Ingestión de Líquido , Terapia por Ejercicio , Familia , Femenino , Humanos , Masculino , Trastornos de la Memoria/complicaciones , Planificación de Atención al Paciente , Rol , Autoimagen , Control de Esfínteres , Incontinencia Urinaria/etiología , Incontinencia Urinaria/fisiopatologíaRESUMEN
This article is a report of a task force formed from a discussion group hosted by the American Nurses Association on the AHCPR Guidelines on Urinary Incontinence. The need to standardize content related to bladder incontinence to be used in curriculums was identified as an initial step in implementing the guidelines. A task force was formed to develop educational competencies to be used by schools in identifying content that should be addressed at various levels of preparation. Although special training is needed when continence care is a significant part of a nurse's practice, it is expected that by using the educational competencies, schools will produce graduates at the basic level able to provide beginning continence care and graduate nurses able to address advanced incontinence problems.
Asunto(s)
Competencia Clínica/normas , Curriculum , Educación en Enfermería/métodos , Guías de Práctica Clínica como Asunto , Incontinencia Urinaria/enfermería , American Nurses' Association , Humanos , Sociedades de Enfermería , Estados Unidos , United States Agency for Healthcare Research and QualityRESUMEN
As prospective pay systems are created, many sources of home care information are being considered. This study examines items on the HCFA Form 485 for their ability to accurately predict home healthcare costs. The researchers deduced that the current information available on the HCFA Form 485 was not useful in anticipating, planning for, and, ultimately, controlling costs.
Asunto(s)
Centers for Medicare and Medicaid Services, U.S. , Grupos Diagnósticos Relacionados/economía , Costos de la Atención en Salud , Servicios de Atención de Salud a Domicilio/economía , Sistema de Pago Prospectivo , Enfermería en Salud Pública/economía , Anciano , Predicción , Control de Formularios y Registros , Humanos , Persona de Mediana Edad , Investigación en Administración de Enfermería , Estados UnidosRESUMEN
Data on prevalence of diabetes mellitus in Switzerland are scarce. In connection with a EURODIAB project the prevalence of diabetes was assessed in a standardized form, based on sales data for antidiabetic drugs. The prevalence of diabetes treated by specific drugs was calculated on the basis of Swiss sales data for antidiabetic drugs (corrected for combination therapies), the average prescribed daily dosages of insulin and oral antidiabetic drugs (OAD) defined by an inquiry in 38 pharmacies, and the mean annual population of Switzerland. The following prevalence rates were obtained (patients per 1000 inhabitants): [table: see text] Prevalence data obtained by the same, standardized method are higher in France (1.3%), Belgium (1.64%), Sweden (1.7%), and much higher in Italy (2.2%). Calculation based on drug sales data is an easy method of obtaining prevalence rates of diabetes mellitus. In comparison with field studies, discompliance and non-inclusion of diabetics treated only with diet do admittedly lead to low prevalence rates. Nevertheless, the chosen method is very useful for longitudinal observations and for international comparisons.
Asunto(s)
Diabetes Mellitus/epidemiología , Utilización de Medicamentos , Métodos Epidemiológicos , Hipoglucemiantes/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Humanos , Insulina/uso terapéutico , Prevalencia , Suiza/epidemiologíaRESUMEN
1. Nursing home residents have the right to be involved in decision making relative to their care, which researchers have demonstrated has a positive effect on residents. 2. The authors designed a study to explore discrepancies between residents' perceptions of choice and the amount of choice preferred and their relationship to self-care abilities and functional abilities in nursing home residents. 3. The results indicate that residents desired more choice than they felt they were given, but that this difference was not related to their perceptions of their self-care abilities. As residents' functional abilities increased, actual choice as well as desired choice increased slightly. 4. Nurses should structure the nursing home's approach to residents so that choice is maximized within the constraints of the institution.
Asunto(s)
Actividades Cotidianas , Conducta de Elección , Hogares para Ancianos , Casas de Salud , Participación del Paciente , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Control Interno-Externo , Masculino , Persona de Mediana Edad , MoralRESUMEN
This study describes the relationship between caregiver and elder behavior in institutionalized, cognitively impaired, elderly persons. A repeated-measures design was used to observe interactive behaviors between caregivers and demented elders within three caregiving situations (dressing, toileting, and bathing) and an interpersonal contact in two long-term care facilities. During observations, the caregiver's behaviors were rated using the Interaction Behavior Measure and Health Professional's-Geriatric Patient Behavior Rating scale, whereas the elder's behaviors were rated using a modified version of the Interaction Behavior Measure. The study included 116 subjects (58 elders and 58 caregivers), with each unique caregiver/elder pair being observed in the four situations. All elder behaviors varied according to situation type, with the most difficult elder behaviors occurring during bathing. Ten of the 12 caregiver behaviors included in the analysis varied by situation type. Significant relationships were systematically found between the caregiver's relaxed and smiling behavior and the elder's calm/functional behaviors, r = .42 (dressing) to r = .46 (toileting) for caregiver relaxed behavior and r = .34 (bathing) to r = .58 (dressing) for smiling. The elder's behavior did not vary by type of nursing unit (special dementia unit or general nursing unit), or interruptions to the interaction.
Asunto(s)
Anciano , Conducta , Cuidadores/psicología , Demencia/psicología , Demencia/enfermería , Humanos , Relaciones Interpersonales , Casas de SaludRESUMEN
The purpose of this intervention study was to examine the impact of a daily exercise regimen on the mobility, balance, and urine control of a sample of cognitively impaired elderly nursing home residents. A quasi-experimental pretest-posttest design was used with 15 elderly, cognitively impaired, incontinent nursing home residents. Data were collected regarding walking distance, speed of walking, balance ability, ability to rise from a chair unassisted, ability to walk unassisted, and incidence of urinary incontinence before and after a month of daily assisted walking. Subjects were able to walk significantly greater distances before tiring after the exercise regimen. In addition, the incidence of urinary incontinence was significantly decreased.
Asunto(s)
Trastornos del Conocimiento/complicaciones , Ejercicio Físico , Hogares para Ancianos , Casas de Salud , Equilibrio Postural , Incontinencia Urinaria/prevención & control , Caminata , Anciano , Anciano de 80 o más Años , Ejercicio Físico/fisiología , Femenino , Humanos , Masculino , Factores de Tiempo , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/enfermeríaRESUMEN
The Popovich Scale holds great promise for use in home healthcare. Having established reliability and validity makes the tool valuable in promoting high quality nursing care at home. It is applicable to all older adults and their caregivers regardless of medical problems, nursing diagnoses, and regulatory agencies.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Evaluación en Enfermería/métodos , Anciano , Enfermería Geriátrica/métodos , HumanosRESUMEN
The relationship between environmental and personal factors on self-appraised self-care agency of nursing home residents was examined. Data were collected from 83 nursing home residents in relation to self-care abilities, environmental constraints, and selected demographic factors. Race and previous occupation were related to self-care agency with residents who were black or previously self-employed evidencing higher scores. In addition, residents who viewed the home as overly restrictive or fostering dependence had lower perceptions of their self-care abilities. The results are discussed in terms of Orem's theory of self-care, social learning theory, and implications for restructuring care within nursing homes.
Asunto(s)
Ambiente , Casas de Salud , Autocuidado , Anciano , Anciano de 80 o más Años , Actitud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ocupaciones , Autoevaluación (Psicología) , Encuestas y CuestionariosRESUMEN
The purpose of the study was to evaluate patient factors associated with urinary incontinence in nursing homes to identify the relative importance of these factors in predicting urinary incontinence. Cognitive ability and patient mobility were measured for 61 patients residing in a nursing home. Twenty-nine of the patients were incontinent and 32 continent. Cognitive ability and mobility were found to differ significantly between continent and incontinent patients. When the variables were examined together, mobility emerged as the best predictor of the patient's urine control, followed by cognitive impairment. The findings highlight the importance of addressing patient mobility issues when dealing with urinary incontinence in nursing homes.
Asunto(s)
Actividades Cotidianas , Trastornos del Conocimiento/complicaciones , Incontinencia Urinaria/etiología , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/diagnóstico , Femenino , Evaluación Geriátrica , Hogares para Ancianos , Humanos , Masculino , Escala del Estado Mental , Casas de Salud , Incontinencia Urinaria/enfermeríaRESUMEN
Thorough assessment is essential in caring for the institutionalized elderly who have difficulty with urine control. The assessment should include a physical examination, a functional assessment, and an evaluation of the environment. The physical examination should be completed in a timely fashion after incontinence develops in order to rule out treatable causes of urine loss. The examination includes a health history and physical examination, with special attention being given to the genitourinary system. A urine specimen should be obtained during the examination to rule out bladder infection. The functional assessment of the patient is one of the most important aspects of the patient assessment. This is particularly true for elderly inpatients because much of the incontinence found in nursing homes is attributable to functional deficits. The functional assessment should address the history of the patient's incontinence, the patient's cognitive abilities and potential for participating in continence care, the patient's mobility, and the patient's abilities related to activities of daily living. Deficits in any of these areas may contribute to or cause urinary incontinence. In addition to the physical examination and functional assessment of the patient, the environment should be evaluated. The visibility, location, and structure of the toileting facilities can serve to either promote or impair urine control. In addition to the physical facilities provided, the overall nursing care approach may foster or hinder the patient's ability to maintain urinary continence. Nursing assessment that addresses these three areas will provide information that is needed to develop a nursing care plan that will maximize the patient's potential for urine control.