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This article provides an overview of family involvement in care intervention and its implementation with African American and Caucasian family members of persons with dementia in nursing home settings.

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1 With placement of a family member with Alzheimer's disease on a SCU, the family does not relinquish the caregiving role, rather they take on different roles in relation to the residents. 2 Family visitation of the residents on the SCU is an integral part of family involvement in care of individuals with Alzheimer's disease, as well as SCU functioning. 3 Within the context of changing relationships with the residents, family members visited the residents as a sense of duty to "be faithful," to monitor care by "being their eyes and ears," and to foster a sense of family through ongoing relationships and family rituals. 4 Nurses have critical roles in promoting physical, emotional, and interactive environments which foster family visitation on SCUs.

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Concerns about the "elder care crisis" and changes in the provision of health care are fostering expectations that families should be responsible for taking care of their elderly members. The assumptions that families (1) are not providing enough care, (2) know how to provide care, and (3) have access to resources for the provision of care are embedded in the social expectation of family care for elderly persons with dementia. However, research shows that these assumptions are not based on fact.

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Advanced practice nurses (APNs) are challenged to evaluate their practice in light of goals guided by nursing theory. In this specific case study, a nurse consultant, using Parse's theory of human becoming, evaluated changes in the quality of life from the perspective of the person for patients suffering from genital herpes. The nurse consultant met with the group before (presession) and after (postsession) an APN's 10-week series of seven sessions (person/group-perspective intervention). Analysis of pre- and postsession data uncovered three patterns. These are described with implications for research and practice.

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Past-present-future messages for nursing leadership were derived from the personal perspectives of contemporary outstanding nurses in the United States. Based on professional life histories provided by 40 participating members of the American Academy of Nursing in its early years, a composite profile of these contemporary nurse leaders emerged. From their stories, rich in discovery of meaning, past-present-future messages are posited with futuristic hints to guide the education of nursing leaders into the 21st century.

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The author, a nurse guided by Parse's theory of human becoming, describes one way to focus on quality of life in person-centered practice with a group in the community, in contrast to traditional nursing practice with groups in which the focus is on problems, learning, and socially-defined responsibility. The author describes living true presence over a 10-week period in accord with Parse's practice method with a group of persons with genital herpes. Emerging patterns of health of the group are reported along with a loose agenda for community-based practice.

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The purpose of this study was to identify and validate specific activities considered important in the implementation of three non-pharmacologic pain management interventions--relaxation, distraction and guided imagery. Using a two-round Delphi survey, nurses selected for their expertise in pain management were asked to validate definitions and activities considered important in the implementation of each of these strategies. Data were analyzed using a modification of Fehring's diagnostic content validity method. From this process, a list of activities for each intervention evolved that has implications for nursing research, practice and education.

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Nurses working with the elderly encounter many complex and potentially stressful care situations. Nowhere is this more true than for nursing home staff who work in highly demanding, labor- and client-intensive jobs. A number of factors contribute to the high levels of stress found among nurses who work with the elderly, including continual exposure to physical and emotional pathology and death, and conflict with families, co-workers, supervisors, and representatives from other departments or professions (Goldin, 1985; Klus, 1980). When the stress level in a long-term care facility becomes overwhelming, role conflict, ambiguity, poor self-esteem, and burnout may ensue (Goldin, 1985; Heine, 1986; Klus, 1980; Morrow-Winn, 1985). The process of burnout is characterized by a progressive loss of idealism, energy, and purpose that eventually leads to emotional overextension and exhaustion (Price, 1984).

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Risk factors that contribute to pressure ulcer formation include immobility and inactivity, age, malnutrition, fecal and urinary incontinence, and a decreased level of consciousness. Gerontological nurses should collaborate with other health disciplines (eg, the physician, physical therapist, and dietitian) to plan and provide preventive treatment measures for the elderly person with potential for impaired skin integrity: pressure ulcers. Gerontological nurses must continue the development and refinement of tools with which to predict the degree of risk for impaired skin integrity, as well as use a consistent method of grading pressure ulcers.

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Mobility of elderly patients is a consequence of the interaction between factors including biological health, sensory-perceptual capacity, motor skills, cognitive capacity, and ego-strength; and environmental resources including physical and architectural features, medical regimens, institutional policies, resident and staff characteristics, and social support availability. Impaired mobility, whether self- or other-imposed, places the elderly at risk for a multitude of negative physiological and psychological consequences that can affect health, well-being, and quality of life. Understanding the basic mechanisms underlying the physiological and psychological consequences of immobility, the relative time-frame in which they can develop, and the concomitant changes associated with aging provides the basis for interventions aimed at preventing or minimizing them. A multitude of factors that influence the elderly's state of mobility are within nursing's realm of practice. Although elderly patients may present a special challenge, the negative consequences of immobility can be avoided, to a significant extent, with astute and vigilant nursing management.

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The phenomenon central to this study is, "struggling with going along in a situation you do not believe in." It emerged as a predominant universal lived experience within the lives of outstanding nurses in the United States studied earlier by the author. The purpose of the research reported in this article was to generate a structure of the lived experience of "struggling with going along in a situation you do not believe in," using Parse's research methodology. Through the processes of the method: participant selection, dialogical engagement, extraction-synthesis and heuristic interpretation, a structure of the lived experience for persons over 65 years of age was generated. This structure is: struggling with going along in a situation you do not believe in is justifiable yielding, as opposing views intensify personal convictions and compel disclosure while suffering consequences. When linked with the major concepts of Parse's theory, the theoretical definition is: valuing the powering of revealing-concealing. Recommendations for further study are offered.

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With changes in the work force and aging of the population, employees of all ages will be affected by caregiving responsibilities for the elderly. As a counselor, the occupational health nurse is interested in the physical and emotional health of the employee caregiver. As a teacher, the occupational health nurse can assist the employee with emotional, social, and personal assessments and interventions related to older persons and their environment. The occupational health nurse can influence employers in meeting the needs of the employee caregiver.

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