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The recognition of caregivers working with elderly people with neuro-evolutionary diseases is a fact. The caregivers interviewed for this study reported that they felt recognized and identified by these elderly people, who were considered to be prosopagnosic. The caregivers were even able to show that this recognition was possible, even during changes in appearance.

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Caring for older patients with neurocognitive disorders can be challenging, especially when family members disagree regarding optimal care. This article explores the role and utilization of mediators in the healthcare setting.

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OBJECTIVE: The goal of this review is to analyse articles on the experience of surrogates who find themselves making end-of-life decisions for a relative with a major neurocognitive disorder in a nursing home. DESIGN: An integrative review of the literature based on Whittemore and Knafl's method. DATA SOURCES: This review used the CINAHL, PubMed, PsycInfo, Embase and Web of Science databases. A complementary search was also conducted via citation pearl searching, and the reference lists from the selected articles were manually verified. REVIEW METHOD: The quality of the selected articles was assessed using the Crow Critical Appraisal Tool, and the data were extracted systematically and were then organised according to Mishel's uncertainty in illness theory. The data that did not correspond to any concept of the theory were excluded at this stage. Analysis was conducted using the method put forward by Miles, Huberman and Saldaña. RESULTS: A total of 18 articles were selected: 11 qualitative, 5 quantitative and 1 using a mixed method, as well as 1 ethical argument. The subjects arising from the analysis of the articles were the types of decisions made, the support available for the surrogates, the role and involvement of the surrogates in the process and the factors that influence the decisions. CONCLUSION: The results of this integrative review stimulate reflection on the needs of family members involved in making decisions, as well as on the nursing practice and research. Published literature is mainly from North America, and thus, more research is needed to better understand the impact of cultural and ethnic differences in the process, which was poorly covered by the existing literature. Also, exploring nurses' involvement in supporting surrogates may eventually better equip nurses for their interventions with surrogates. IMPLICATIONS FOR PRACTICE: Describing the illness progression and the signification of palliative care to the resident with a NCD and their surrogate decision makers, as well as discussing end-of-life care preferences as early as possible are all nursing interventions that could potentially enhance surrogates' end-of-life decision-making process.

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AIMS AND OBJECTIVES: (a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. BACKGROUND: Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. DESIGN: Three-stage, mixed-methods, process and outcome evaluation. METHODS: The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. RESULTS: The App included three components: cognition and risk assessment; tailored evidence-based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors. CONCLUSIONS: The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. RELEVANCE TO CLINICAL PRACTICE: Co-development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real-time access to assessment tools and tailored knowledge supported nurses' clinical decision-making; workload and unfamiliarity were barriers to use.

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This study examines the need for, and outcomes of, a psychotherapeutic skills training programme, within an acute psychogeriatric unit. Nursing staff were surveyed to explore their training needs in psychotherapeutic skills with inpatients diagnosed with depressive, anxiety, or neurocognitive disorders. Staff were then invited to participate in a focus group (n = 6) to identify content of such training, possible barriers, and an implementation strategy. Next, to ascertain the feasibility and acceptability of such training, materials and schedules were developed and piloted with a small group of nurses (n = 8), before being administered to nurses across the unit (n = 23). Impacts of training on the confidence and competence of nurses to use such skills were investigated. Of nurses surveyed (n = 20), 80% wanted to use psychotherapeutic skills in routine practice, but only 35% had received training in such skills in the last 5 years. Focus group results identified that nurses wanted training in skills related to engaging patients, responding to resistance from patients, problem solving, reminiscence, relaxation, and cognitive behaviour therapy. Nurses who underwent the pilot training reported increases in confidence and competence in using such skills. These findings were replicated in the unit-wide training programme and were found to be durable across a 3-month follow-up period. This study highlighted the training needs of nurses working in an inpatient psychogeriatric setting, approaches to implementing new skills, and benefits of training for nurses' levels of confidence and competence in using psychotherapeutic skills.

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INTRODUCCIÓN: El papel de enfermería en el cribado del delirium resulta fundamental. Pocos trabajos analizan la validez de herramientas de pregunta única. OBJETIVOS: Comprobar la validez de una «pregunta única» como herramienta de cribado de delirium en una unidad de hospitalización de oncología médica y analizar los factores relacionados con la presencia de cribado positivo. METODOLOGÍA: Estudio descriptivo transversal de validez de una prueba de cribado. CRITERIOS DE INCLUSIÓN: mayores de 18 años, con presencia de un tumor sólido y que estuvieran ingresados al menos 3 días. Se comparó una pregunta única por parte de enfermería con un patrón oro a través del CAM y los criterios de DSM-IV por parte de medicina, midiendo la relación con otras variables. RESULTADOS: Incluidos 42 pacientes. Varón de 61 años con localización digestiva con intención paliativa como más frecuente. Prevalencia de un 14% de delirium según CAM (26% cribado positivo), con alta concordancia, sensibilidad, especificidad y valor predictivo negativo. Asociación con uso de opioides. CONCLUSIÓN: Una herramienta de «pregunta única» sería útil para el cribado del delirium

INTRODUCTION: The role of nursing in the process of delirium screening is fundamental. Few studies analyze the validity of the single question tool. OBJECTIVES: To verify the validity of the single question as a delirium screening tool in a Medical Oncology inpatient unit and analyze the factors linked to the presence of a positive screening. METHODOLOGY: Cross-sectional descriptive study of the single question screening validity. Inclusion criteria: Older than 18 years old, with presence of a solid tumour and hospitalized for at least 3 days. The single question by the nursing team was compared with a gold standard through CAM and DMS-IV criteria by the medical team, measuring the relation to other variables. RESULTS: 42 patients included. Sixty-one-year-old male with a digestive tract location treated with palliative intention as the most frequent. Prevalence of 14% of delirium by CAM (26% positive screening), with high concordance, sensitivity, specificity and negative predictive value. Association with opioid usage. CONCLUSIONS: A single question tool would be useful in the delirium screening

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Occupational therapy practitioners play a significant role in supporting adults with Alzheimer's disease and related major neurocognitive disorders, as well as their caregivers, through all phases of the disease process. This editorial highlights the systematic reviews completed in collaboration with the American Occupational Therapy Association's Evidence-Based Practice Project that summarize the evidence for the effectiveness of interventions within the scope of occupational therapy practice for this population. Readers are encouraged to translate and integrate this updated knowledge into everyday practice.

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As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous. The patient and family are not consistently listened to, or integrated, into the clinical team. We recount our experiences of one hospitalization and how we addressed the recurring obstacles we faced. Our training and experience gave us a firm understanding of the hazards of hospitalizing an elderly person and the need to be present, engaged, attentive, active, and vigilant. We caught and corrected major mistakes: failure to follow-up abnormal test results, multiple medication errors, undertreatment of pain, poor fall prevention, and inappropriate assessment and placement for rehabilitation. In a dysfunctional health care system, the family is, and must be, the ultimate fail-safe mechanism. We identify potentially effective solutions for the problems we encountered: adoption of dementia-sensitive and patient- and family-centered care, improved communication, better management of information (including better systems for monitoring lab results and for dispensing and reconciling medications), expediting care, changing reimbursement and regulation, and improving discharge planning and placement.

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Se realiza una revisión bibliográfica de la literatura en las principales bases biomédicas para identificar cuáles son los factores de riesgo modificables o controlables en ancianos hospitalizados con fractura de cadera, susceptible de padecer delirium, y crear un Plan de Actuación de Recomendaciones de Enfermería desde el ingreso hasta el alta en la unidad, basándonos en la prevención, con el propósito de fomentar el descenso en la frecuencia y consecuencias desfavorables del delirium. Son pocos y con gran disparidad numérica en los resultados obtenidos entre los diferentes trabajos que estudian la eficacia de adoptar medidas ambientales como estrategias en la prevención del delirium. Las acciones llevadas a fin, en as de la prevención, son primordialmente las que controlan los factores de riesgo como: el deterioro cognitivo y físico, inmovilidad, discapacidad visual y auditiva, deshidratación, desnutrición, desorientación, privación del sueño, polifarmacia y dolor. Al delirum no se le presta la importancia que requiere, a pesar de su alta frecuencia e impacto bio-psico-socio-económico en el paciente y su entorno. La prevención es la medida más eficaz y económica de abordar el delirium en su fase inicial y la enfermería contribuye en gran medida en esta labor. El anciano hospitalizado con fractura de cadera es un paciente de alto riesgo debido al gran número de factores de riego agregados a su situación clínica y contexto. Sería interesante en otras investigaciones futuras valorar la eficacia de las recomendaciones ofrecidas en esta revisión (AU)

A bibliographical revision of Literature is done in the main biomedical databases to identify which are the modifiable or controllable risk factors in elderly hospitalized with hip fracture, susceptible to suffer delirium, and to create a Plan of Action of Recommendations of Infirmary from the admission to the discharge in the unit, basing ourselves on the prevention, in order to promote the reduction in the frequency and unfavourable consequences of the delirium. They are few and with great numerical disparity the obtained results between the different works that study the effectiveness to adopt environmental measures like strategies in the prevention of the delirium. The taken actions to aim, in ace of the prevention, are fundamentally those that control the risk factors such as: the mental and physical deterioration, immobility, visual and auditory disability, dehydration, undernourishment, disorientation, deprivation of the dream, polypharmacy and pain. The delirium is not given the importance that requires in spite of its high frequency and the biological, psychological, social and economic impact in the patient and his/her environment. The prevention is the most effective and economic measure to approach the delirium in his/her starting phase and the nursery contributes to a great extent in this work. The elderly hospitalized with hip fracture are patients of high risk due to the great number of risk factors added to its clinical situation and contextIt would be interesting in other future investigations to value the effectiveness of the recommendations offered in this revision (AU)

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The idea of paranoia has existed since Antiquity, but it was only in the 19th centurythat psychiatrists became interested in it and sought to describe it. Delusion and the feeling of persecution are common in all paranoiacs. The origins of the disease can be found in the patient's psychic structure. Establishing and maintaining contact with a caregiver is one way of helping the patient.

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This study documents the nursing of an organically mentally disordered patient with chronic vertigo. The subject suffered a head injury in a traffic accident, resulting in impairments to his cognitive abilities as well as symptoms of recurring vertigo, which hampered his work and family activities. Holistic nursing assessment revealed four areas of nursing concern: risk of falls, impaired self-care ability, caregiver role strain, and powerlessness. Care provided to the subject concentrated on: (1) preventing him from falling again, (2) regaining his ability to care for himself, through gradual training exercises; (3) training his spouse in caring for herself and the subject; (4) establishing his self-assurance by means of cognitive-behavior therapy and vestibular rehabilitation.

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The nature and scope of depression and its relationship to physical symptom distress and functional status were examined in 79 women 3 to 7 months after breast cancer diagnosis. Psychiatric diagnostic criteria for depressive disorders and a depression rating scale were used to measure depression. Nine percent of the sample had depressive disorder, and 24% had elevated depressive symptoms. Women with elevated depressive symptoms had more physical symptom distress (p < .0001) and more impaired functioning (p < .0001) than subjects with depressive disorders and without depression. Multiple regression was used to examine the contribution of key variables to functional status. Two variables accounted for 35% of the variance in functional status: symptom distress (28%) and depressive symptoms (7%).

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