Essentials of nursing leadership and management

Sally A. Weiss, Ruth M. Tappen

Interprofessional education in community-based Alzheimer's disease diagnosis and treatment

As the population ages and understanding of Alzheimer's disease (AD) improves, the number of older adults diagnosed and treated for AD and related dementias is projected to increase. Dementia diagnosis, treatment and patient and family education are complex processes best done through collaboration among healthcare professions. The educational program described in this article aimed to create an interprofessional team approach to the diagnosis and treatment of dementia involving medical and family nurse practitioner students. A two-group treatment/control pretest posttest design was used to measure changes in knowledge, attitudes and appreciation for an interprofessional team approach to patient care. Findings from this interprofessional program demonstrated that nurse practitioner students gained higher levels of knowledge regarding AD, and medical students gained more positive attitudes toward these patients and their caregivers. Comments from students indicated that both medical and nursing students found the experience valuable. Understanding the roles that various providers play will help healthcare professional meet the challenge of caring for the increasing number of patients with memory loss and for their families

Integration or Separation for Gerontological Nursing Education?

Nursing educators have been slow in recognizing the need to include gerontological nursing content into the curricula. Questions over where or how to include content have not been previously addressed through research. This comparison study of two programs, one with a blocked curriculum and one with an integrated curriculum, found students from the former had significantly higher cognitive scores but not as positive attitudinal or choice to work with the elderly. The need for interested, knowledgeable faculty continues to be the more salient issue

Digital Health Information Disparities in Older Adults: a Mixed Methods Study

Important health information including disease prevention and chronic disease self-management is increasingly packaged for digital use. The purpose of this sequential explanatory mixed methods study was to describe the extent of computer ownership, Internet access, and digital health information use in an ethnically diverse sample of older adults, comparing ownership, access, and use of digital health information (DHI) across ethnic groups and identifying the factors associated with them quantitatively. Significant differences in computer ownership, Internet access, and DHI use were found across ethnic groups (African American, Afro-Caribbean, Hispanic American, and European American). Logistic regression identified older age, less education, lower income, and minority group membership as significant predictors of limited DHI use. Older African Americans were one-fifth as likely to own a computer than were European Americans; Hispanic Americans were one-half as likely to have access to the Internet. We then conducted a series of focus groups which highlighted differences across ethnic groups. Participants in the African American/Afro-Caribbean group expressed frustration with lack of access to DHI but appreciation for alternative sources of information. Hispanic Americans critiqued information received from providers and drug inserts, some suggesting that a positive attitude and trust in God also contributed to getting well. European American participants evaluated various DHI websites, looking to providers for help in applying information to their personal situation. As the development and use of DHI continue, parallel efforts to increase access to DHI among economically disadvantaged and minority older adults are critical to prevent further disfranchisement

Effect of a Combined Walking and Conversation Intervention on Functional Mobility of Nursing Home Residents With Alzheimer Disease

Assisted walking and walking combined with conversation were compared to a conversation-only intervention in nursing home residents with Alzheimer disease. Sixty-five subjects randomly assigned to treatment group were tested at baseline and end of treatment. Subjects mean Mini-Mental State Examination score was 10.83; mean age was 87. Treatment was given for 30 minutes three times a week for 16 weeks. Subjects in the assisted walking group declined 20.9% in functional mobility; the conversation group declined 18.8%. The combined walking and conversation treatment group declined only 2.5%. These differences in outcome were significant and appear to have been affected by differences in treatment fidelity. Subjects in the conversation treatment group completed 90% of intended treatment compared with 75% in the combined group and only 57% in the assisted walking group. Failure to treat was due to subject refusal and physical illness. The conversation component of the combined walking and conversation treatment intervention appears to have improved compliance with the intervention, thereby improving treatment outcome. Results indicate that assisted walking with conversation can contribute to maintenance of functional mobility in institutionalized populations with Alzheimer disease. Staff assigned to this task should be prepared to use effective communication strategies to gain acceptance of the intervention

Reliability of Physical Performance Measures in Nursing Home Residents With Alzheimer’s Disease

BACKGROUND: Investigation of the effects of exercise on frail, institutionalized individuals with dementia has been impeded by concerns about the reliability of physical performance measures when used in this population. METHODS: The physical performance of 33 institutionalized subjects with Alzheimer’s disease was measured during both the morning and afternoon of day 1 by rater 1 and during both the morning and afternoon of day 2, one week later, by rater 1 and rater 2. Intraclass correlation coefficients (ICCs) were calculated to examine the inter-and intrarater reliability of “sit to stand,” “25-foot walk,” and “the distance walked in 6 minutes” and walking speed over 25 feet and for 6 minutes. An analysis of variance was performed to determine the components of variance for each test. RESULTS: ICCs for “distance walked in 6 minutes” ranged from .80 to .99 with 77% of the variance explained by inter-subject differences. The ICCs for “time to walk 25 feet” ranged from .57 to .97 with 25% of the variance explained by inter-subject differences. In contrast, the “sit to stand” measure produced ICCs ranging from −.07 to .85 with only 7% of the variance explained by inter-subject differences in this impaired population. CONCLUSION: Our results support the contention that some physical performance measures can be used to test individuals in the later stages of Alzheimer’s disease given appropriate modification. Although subjects with Alzheimer’s disease may have difficulty following commands and/or require physical assistance, this does not prohibit the reliable assessment of physical performance if measurements are made over longer (6-minute walk) rather than shorter periods (25-foot walk)

Factors Associated with Physical Activity in a Diverse Older Population

Physical activity is important for healthy aging, but few older adults achieve the goal of 150 min per week of moderate activity. The purpose of this study was to employ a robust statistical approach in the analysis of the factors related to physical activity in a diverse sample of older adults. A secondary analysis of factors associated with calculated MET-h/week was conducted in a sample of 601 African Americans, Afro-Caribbeans, European Americans, and Hispanic Americans age 59 to 96 living independently in the community. Age, education, social network, pain, and depression were the five variables that accounted for a statistically significant proportion of unique variance in the model. The strongest correlation to total MET-h/week was with depression. Directionality of the relationship between these variables and physical activity is complex: while pain and depression can reduce physical activity, activity may also help to reduce pain and depression. Additionally, of note is that many of these factors may be modified, calling for the design and testing of individual, group, and community level interventions to increase physical activity in the older population