Nursing older people最新文献

While impaired cognitive dysfunction is a primary feature of dementia, an individual's ability to make decisions is either allowed or denied according to the level of support and advocacy they are afforded. When undergoing rehabilitation following a health event, recovery can be complicated and protracted for an older person with dementia, and they may be deprived of opportunities to determine their rehabilitation goals and express preferences throughout their rehabilitation programme. Furthermore, nurses may face challenges in proactively supporting the person's self-determination in choosing rehabilitation goals, as well as in advocating for and enabling the person to make decisions about their rehabilitation programme. This article provides guidance on how nurses can create an enabling environment by using person-centred communication techniques to assess an individual's capacity for making choices, building their confidence and supporting them to make decisions about rehabilitation goals and activities. These approaches aim to place each person at the centre of decision-making during their rehabilitation journey.

Rationale and key points: Moving into a care home is a major life event, and for people with dementia and their families it can be particularly stressful and challenging. This article outlines how nurses working in care homes can support family carers of residents with dementia during the transition into the care home and throughout the person's stay. • Family carers may experience feelings of loss, guilt and loneliness when they relinquish care. They have their own information and support needs, separate from those of the person with dementia. • A positive relationship between the family carer and the new care provider can improve outcomes for the resident, the family carer and care home staff. • Family carers feel less anxious when the responsibility of caring for the person with dementia is shared between themselves and care home staff and when they have confidence in staff. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when supporting the family carers of care home residents with dementia in the transition phase and throughout the person's stay at the care home. • How you could use this information to educate nursing students or colleagues on supporting family carers of care home residents with dementia.

Multimorbidity is common in older people and makes their care more challenging, for example in terms of adherence to prescribed medicines. Nurses have a pivotal role in supporting patients to adhere to their drug regimen. This article reports the findings of an integrative review of the literature on the influence of personal beliefs on adherence to medicines in older people with multimorbidity. Adherence to medicines was influenced by personal beliefs, such as people's views on the efficacy of medicines, fear of dependency, concerns about polypharmacy, illness perception, beliefs regarding alternative therapies, religious beliefs, social responsibilities and routines. Integrating biopsychosocial insights into nursing practice and providing person-centred and holistic care to older people with multimorbidity can support their adherence to treatment and therefore improve their health outcomes.

Interest in gerontological nursing among nursing students remains low, with few choosing to work in this specialty on registration. The Master of Nursing (MNurs) preregistration programme at King's College London, England, includes a module that incorporates a gerontological nursing theme which aims to enhance students' teaching, learning and clinical placement experiences, as well as their attitudes towards gerontological nursing as a career option. This article details an evaluation that aimed to understand students' attitudes towards working with older adults and pursuing a career in gerontological nursing following completion of the gerontological nursing theme. Two focus groups were held with 18 students, and the data were thematically analysed. Overall, the findings suggest that targeted educational initiatives can strengthen students' engagement with gerontological nursing and foster more positive attitudes towards this field of practice. Nurse education leaders should prioritise the integration of gerontological content into preregistration curricula and support students to consider gerontological nursing as a valued and viable career pathway.

Overcrowding in emergency departments (EDs) result in longer hospital stays, higher rates of adverse events and increased mortality. In overcrowded EDs, older people with learning disabilities are particularly at risk of negative outcomes, partly due to a lack of awareness and knowledge of their needs among staff. This article examines the unique health challenges experienced by people with learning disabilities and discusses systemic issues in EDs which can lead to poor care for this vulnerable patient group. The authors provide some essential nursing considerations when caring for this patient group in the ED, including adapted communication, shared decision-making and reasonable adjustments that can ensure effective, person-centred care.

This systematised literature review explored the challenges faced by healthcare professionals when assessing pain in people with dementia. A comprehensive search of six databases for qualitative studies published between 2018 and 2023, followed by a rigorous study selection, enabled the author to identify six relevant studies. The main challenges identified included communication issues arising from cognitive impairment; difficulties stemming from a lack of experience in dementia care and lack of familiarity with individual patients; and limited awareness and inconsistent use of pain assessment tools. Addressing these barriers through enhanced education and training, clear guidelines and a strengthened commitment to person-centred care is crucial for improving the accuracy of pain assessments in people with dementia and therefore enhancing quality of life in this vulnerable population group.

Rationale and key points: Family carers have a vital role in supporting people with dementia, often taking on significant responsibilities in relation to personal care. The physical, emotional and financial effects on family carers are considerable, and the challenges associated with providing personal care often precipitate admission to a care home or hospital. This article outlines the procedure for undertaking a holistic person-centred assessment of a person with dementia and their family carer, then developing a plan of care for them. It also explains how nurses can use a series of resources that have been designed to support family carers with providing personal care for people with dementia. • Nurses have a crucial role in providing, leading and coordinating care that is compassionate, evidence-based and person-centred. Therefore, they should have the knowledge and skills necessary to provide support for family carers. • Nurses should explore the experiences of family carers as part of a holistic person-centred assessment, to help identify actual and potential challenges. • Many family carers find it challenging to access appropriate services and feel unheard by professionals. Nurses need to ensure that information, services and multidisciplinary team support are accessible and responsive to family carers' needs. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when supporting family carers of people with dementia, and how you could adapt your current approach to better meet their needs. • How you could use this information to educate nursing students or your colleagues about the needs of family carers.

Dementia is a life-limiting condition and a leading cause of death in the UK and globally. Advance care planning (ACP) is of particular relevance to people living with dementia due to the gradual loss of decision-making capacity and ability to communicate that they typically experience. However, many people living with dementia are not given the opportunity to undertake ACP. As a consequence, their end of life care needs often remain unmet. As part of the multidisciplinary team, nurses are well placed to engage people living with dementia and those close to them in timely ACP conversations so that the person's future care aligns with their expressed values, wishes and preferences. Collaborative healthcare services that normalise ACP as part of routine dementia care and provide staff with ACP training and mentoring are essential for supporting nurses to undertake ACP with people living with dementia and their families.

Sexuality is a fundamental aspect of human life, and sexual healthcare and sexual well-being support are relevant and important across the lifespan. However, internalised and externalised ageism can adversely affect the sexual health of older people; it is important, therefore, that nurses are able to recognise and challenge ageist ideas and practices to facilitate effective sexual healthcare. This article provides an overview of sexuality and ageism and discusses the importance of, and some barriers to, effective sexual healthcare and sexual well-being support in older adults. The author also provides guidance for nurses in reflecting on and challenging ageism in this context and in initiating and responding to discussions with older adults about sexual health.

Rationale and key points: Depression is the most common mental health condition in older age but often goes undetected and untreated, which can negatively affect health, well-being and quality of life. This article highlights how nurses can improve the identification of depression in older people, including by being aware of risk factors and signs and symptoms; by using proactive questioning and an individualised approach; and by encouraging older people who may have depression to discuss their mental health as part of a person-centred assessment. •Older people are highly susceptible to many of the physical and psychosocial risk factors associated with depression. •In older people, symptoms of depression can be wrongly attributed to dementia or considered a normal part of ageing. •Older people with depression may not recognise it or be reluctant to discuss it for fear of being stigmatised. •Improving the identification of depression in older people requires challenging assumptions about their mental health. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: •How this article might improve your practice when identifying an older person who may have depression. •How you could use this information to educate nursing students or colleagues about identifying an older person who may have depression.