Smoking in nursing homes: conflicts and challenges

Nursing home social workers were surveyed to determine nursing home smoking policies and the effect these policies may have on resident and staff interaction. Data analyses suggest that in the past five years there has been a trend toward facilities becoming smoke-free. Facilities that permit smoking face greater conflicts between residents and staff. Social workers are expected to be resident advocates as well as mediators in such areas of conflict. This difficult position is further complicated by the social workers' personal views regarding smoking and "guest" standing in medical settings.     

Coping strategies of enrolled nurses in nursing homes: shifting between organizational imperatives and residents'' needs

An in vitro perifusion system for bovine hypothalamic tissue was used to determine if growth hormone-releasing hormone (GHRH) and somatostatin (SRIF) modulate each other's release, and whether SRIF mediates D1-agonist-induced suppression of GHRH in cattle. Up to three sagittal slices (600 microns) of bovine hypothalamus, immediately parallel++ to the midline, were cut in an oxygenated balanced salt solution at 4 degrees C, placed in 5 cc syringe barrels, and perifused at 37 degrees C with oxygenated minimum essential medium-alpha at a flow rate of 0.15 ml/min. Three experiments were conducted, and medium effluent was collected every 20 min before (two samples), during (one or three samples), and after (six samples) treatment. Areas under GHRH and SRIF response curves (AUC), adjusted by covariance for pretreatment values, were calculated from samples collected during the treatment/post-treatment period. Perifusion of SRIF at 10(-6) M and 10(-4) M decreased AUC for GHRH from 86.3 (control) to 65.4 and 59.5 +/- 6.3 ng.ml-1 min, but 10(-8) M SRIF was ineffective. Relative to controls, 10(-8).10(-6), and 10(-4) M GHRH increased release of SRIF 190, 675, and 1,135%, respectively. Activation of D1 receptors with 10(-6) M SKF 38393 increased AUC for SRIF from 12.5 ng.ml-1 min (control) to 484.9 ng.ml-1 min and decreased AUC for GHRH from 36.4 ng.ml-1 min (control) to 18.2 ng.ml-1 min. Blockade of SRIF action with a SRIF antagonist, cyclo-[7-aminoheptanoyl-phe-D-trp-lys-thr(bzl)], increased release of GHRH 1.9-fold. In addition, the SRIF antagonist blocked SKF 38393-induced suppression of GHRH. We concluded that GHRH and SRIF interact within the bovine hypothalamus/pituitary stalk to modulate the release of the other. Moreover, SRIF mediates the inhibitory effects of activation of D1 receptors on release of GHRH in cattle.     

Maintaining ambulation in the frail nursing home resident: a nursing administered walking program

This article describes a walking program that was implemented at a 550-bed long-term care facility. The program was developed in order to promote functional mobility in the frail nursing home population. The aim of the program is to establish a nursing procedure that focuses on the individual resident's need to walk, and to improve or maintain the ambulatory status of the frail elderly. Twenty nursing home residents from the first three units on which the program was implemented were evaluated before and after the implementation of the program. The data show that the participants improved their ambulatory status after participating in the walking program. This improvement was accompanied by a decrease in the proportion of residents falling.     

Fecal incontinence in Wisconsin nursing homes: prevalence and associations

INTRODUCTION: This report determines the characteristics and health histories that are associated with fecal incontinence in a nursing home population. METHODS: A cross-sectional survey is reported comprised of data from the Health Care Finance Administration's Minimum Data Set submitted by Wisconsin skilled nursing facilities to the Wisconsin Center for Health Statistics' Annual Nursing Home Survey in 1992 and 1993. Demographic characteristics, functional status, and disease history were correlated with the dependent variable, fecal incontinence. RESULTS: In both 1992 and 1993, significant positive associations with fecal incontinence included the following, in order of adjusted odds ratios: urinary incontinence, tube feeding, any loss of activities of daily living, diarrhea, truncal restraints, pressure ulcers, dementia, impaired vision, fecal impaction, constipation, male gender, age, and increasing body mass index. Significant inverse associations were noted for heart disease and depression in one of the years and arthritis in both years. In both years, diabetes was not associated with fecal incontinence. CONCLUSION: Urinary incontinence frequently coexists with fecal incontinence. The treatment of fecal incontinence may depend more on awareness of these significant associations, such as tube feeding, impaction, diarrhea, and loss of activities of daily living, which might exacerbate fecal incontinence, than on the condition of the anal sphincter.     

The elderly in nursing homes: a special population

The ear-xiphisternum distance (EXD, the distance from the low edge of the ear to the xiphisternal basis in supine position) was used as a reference value for esophageal catheter insertion. ECGs recorded in the esophagus with bipolar electrocardiography using standard limb lead (ESLL) and conventional unipolar lead (ECUL) were compared. 112 patients with sinus rhythm and 76 patients during paroxysmal supraventricular tachycardia (PSVT) whose P-wave and QRS complex did not overlap were studied. The results suggested that in sinus rhythm the amplitude of the P-wave in ESLL was larger and the T-wave was smaller than in ECUL. During PSVT, the P-wave was much clear and higher in each lead of ESLL than that in ECUL. The ideal range of esophageal ECG recording was situated between the end of EXD and 6.5 cm proximal to it.     

Resource allocation and context utilization in the reading process.

Two experiments with 294 undergraduates studied the relationship between lower level code availability and top–down contextual processing in word recognition. The utility of context information was measured by a word boundary task, which required Ss to rapidly separate words from a uniformly spaced array of letters. Context was manipulated in terms of coherent vs random passage organization and the presence or absence of prior thematic framework information. Low-level code availability was impaired in a reversed orthographic condition as indicated by reduced performance rates compared with normal presentations. Results show that the increment in performance resulting from coherent organization relative to the random passage was equivalent in both normal and reversed orthographic forms. It appears that framework information can operate as an additional knowledge source to increase performance. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In the worst rather than the best of times: Effects of salient intergroup ideology in threatening intergroup interactions.

Three studies demonstrated that a salient multicultural ideology increases hostile treatment of threatening outgroup interaction partners. The effect of multiculturalism on hostile behavior was evident regardless of whether threat was operationalized in terms of disagreement with an outgroup partner on important social issues (Studies 1 and 3) or rejection by the partner (Study 2). Moreover, the results clearly point to the learning orientation fostered by multiculturalism—as opposed to other factors such as enhanced other-focus, group-level attributions, or focus on differences—as the critical mediator of its effect on hostile behavior under threat. Thus, it appears that multiculturalism enhances the expression of hostility because it prompts individuals to really engage with and attach meaning and importance to threatening behaviors exhibited by outgroup members. The effects of multiculturalism were distinct from those of anti-racism and color-blindness, which set in motion processes that in many respects are directly opposite to those instantiated by multiculturalism. The findings highlight that the behavioral implications of multiculturalism may be quite different in conflictual interactions than they have previously been demonstrated to be in less threatening exchanges. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Physician's attitudes toward the ill aged and nursing homes

A survey of physicians in private practice (exclusive of pediatricians) was conducted in a medium sized suburban city in the New York metropolitan area, to determine whether physicians' attitudes toward the ill aged and nursing homes were predictors of the quality of medical care available to area nursing home patients. Questionnaires were circulated to 302 practitioners. Of the 28 percent who responded, 32 percent were psychiatrists, 15 percent primary care physicians and 8 percent orthopedists. Physicians felt competent to manage the ill aged, although 50 percent had had no significant degree of exposure to geriatric medicine in their medical education, and 70 percent of the primary care group had had none. Primary care and older physicians were more likely to treat patients in nursing homes. Almost 40 percent viewed the nursing home as a place to die. Although 85 percent studied that physicians should be involved in the nursing home displacement process, only 21 percent believed that they continued to be in charge of their patients after placement. The findings demonstrate generalized medical disinterest in the care of ill aged patients in institutions. The persons responsible for awarding government grants and those involved in planning medical school curricula should pay more attention to the needs of the chronically ill aged.     

Top management team characteristics and innovation in nursing homes

This study examines how the demographic characteristics of the top management team in 236 nursing homes can affect the adoption of innovations. The computerization of the Minimum Data Set (MDS) is the innovation we examine, and tenure, education, and involvement in a professional society are the demographic characteristics investigated. Controlling for 10 organizational and environmental factors, the results are generally significant for each of these demographic factors. However, the results for top managers of nonchain nursing homes show a greater association between these demographic factors and innovation than the results for top managers of nursing homes belonging to a chain. We discuss these results in terms of their significance for innovation research, nursing homes, and top management.     

Loneliness among the oldest old, a comparison between residents living in nursing homes and residents living in the community

To ascertain whether membrane signal transduction is induced by bullous pemphigoid (BP) antibody and whether cell lysis is induced by its complement activation, we assessed the intracellular Ca2+ concentration ([Ca2+]i), intracellular pH, membrane potential and morphology of living cells by following the time course of fluorescence intensity of Fluo-3/AM, Snaff-1/AM, Dioc-5 and Luciffer yellow, respectively. A transient increase of Fluo-3 fluorescence intensity in DJM-1 cells (a squamous cell carcinoma line) was revealed when the cells were incubated with 2 of five IgG1 BP antibodies. However, no transient increase of Fluo-3 fluorescence intensity was revealed when the cells were incubated with IgG2 and IgG4 BP antibodies. A transient increase of Fluo-3 fluorescence intensity was revealed in DJM-1 cells incubated with 3 of seven IgG1 and 1 of four IgG2 BP antibodies in an EGTA-containing low-Ca2+ medium. On the other hand, the Dioc-5 fluorescence intensity did not change significantly, though the increase of Fluo-3 fluorescence intensity was observed. The increase of Snarf-1 fluorescence intensity was revealed in DJM-1 cells incubated with 2 of five IgG1 BP antibodies, but was not revealed in the cells incubated with IgG2 or IgG4 of BP antibodies. Study of complement activation by BP IgG1 showed a transient increase of Fluo-3 fluorescence intensity of with 3 of five IgG1 BP antibodies when DJM-1 cells were incubated with complement-supplemented normal-Ca2+ medium. At the same time, however, endocytosis and cell lysis were not observed with 2 IgG1 BP antibodies which did induce an increase of Fluo-3 fluorescence intensity when Lucifer-yellow-loaded DJM-1 cells were incubated with complement-supplemented normal-Ca2+ medium. We examined next whether anti-180 kD BP antigen monoclonal antibodies (mAbs R-223 and 233) induce an increase of Fluo-3 fluorescence intensity. MAb R-223 did not induce any increase of Fluo-3 fluorescence intensity in DJM-1 cells, when incubated with normal- and low-Ca2+ media However, mAb R-223 induced a transient increase of Fluo-3 fluorescence intensity in DJM-1 cells when incubated with complement-supplemented normal-Ca2+ medium. MAb 233 did not induced an increase of Fluo-3 fluorescence intensity in DJM-1 cells when incubated with normal- and low-Ca2+ media. These results suggest that the BP IgG1 induces Ca2+ release from intracellular storage sites, however, the complement activated by BP IgG1 does not induce cell lysis. It could not be confirmed that anti-180 kD BP antigen antibody induced Ca2+ release from intracellular storage sites.     

Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study

This article discusses a longitudinal study of change in disruptive behaviors among nursing home residents treated with neuroleptics compared with those not treated with neuroleptics. Observations were made of 201 participants on admission to and after 1 year in eight skilled nursing facilities. Nine disruptive behaviors were measured using the Psychogeriatric Dependency Rating Scale with nursing assistants. Neuroleptic use was documented from medication records. Odds ratios are reported for the association of behavior at baseline and use of neuroleptics on nine problem behaviors. For those who received neuroleptics during the year, there was greater change in both developing and resolving disruptive behaviors than for those not receiving neuroleptics. For both groups, restless or pacing behavior and belligerent behavior manifested by refusing instructions changed the most, both in developing and in apparently resolving. Our results show that change in disruptive behaviors occurs among nursing home residents regardless of neuroleptic use, but it occurs more frequently among those who receive neuroleptic medication. Knowledge of which disruptive behaviors are most likely to resolve or develop is important in training nursing home staff to cope with the behaviors as well as in planning interventions that may modify such behaviors.     

The best of times, the worst of times: The place of close relationships in psychology and our daily lives.

This article examines the place of relationships in our daily lives and in the field of psychology. The first section of the article offers reasons why relationships are central for humans. Next, the place of relationships in the history, institutional aspects, and subfields of psychology is presented. Then a paradox about relationships is presented: They are both among the most positive, uplifting of life's experiences and yet they can also be among life's darkest aspects. Despite the negative aspects of relationships, most people are very happy in their intimate relations. The paper ends with possible explanations for why satisfaction may be so high. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retention of administrators in nursing homes: what can management do?

Annual turnover among nursing home administrators may be 40% or higher. To investigate the factors that could lead to greater administrator retention, responses to a survey (53% response rate) were analyzed using factor analysis and multiple regression models. Results show that higher retention is observed when administrators are allowed to function independently, are involved in decision making, are treated fairly, and are given reasonable goals to achieve. Organizations must hire administrators whose values match theirs. Multifacility chain organizations and for-profit facilities appear to have a greater need to embrace organizational principles that lead to greater job satisfaction.     

The nursing outcomes taxonomy: development and coding

Interest in the theoretical knowledgebase of nursing has increased over the last 25 years and has led to the current interest in middle-range theory development to describe the essence of nursing. This article describes the creation of a three-level taxonomy and coding structure for the Nursing Outcomes Classification (NOC) based on methods developed by the Nursing Interventions Classification (NIC) work. A model is presented depicting the importance of standardized nursing diagnoses, interventions, and outcomes in the development of the substantive component of nursing practice and to enable nurses to be accountable for care of their clients.     

Behavioral therapy: its application to reduce disruptive behaviors of the elderly in nursing homes

Nurses who care for the elderly in nursing homes and auxiliary hospitals have many goals. They provide for the health, recreational, social and emotional needs of their patients. They also strive to increase their patients' levels of self-care and self-respect. Unfortunately, because many patients exhibit disruptive behaviors--striking staff or other patients, throwing temper tantrums, lying on the floor in corridors, refusing to take medication and so on, these desirable goals cannot always be met. What nurses need, in addition to their specialized, medically oriented training, is training in a consistent strategy for handling these problems. Behavioral therapy provides this strategy.     

Pain prevalence and pain treatments for residents in Oregon nursing homes

The Client Care Monitoring Unit of Oregon's Senior and Disabled Services Division developed and conducted a study with survey-generated information to describe the prevalence of pain and the effectiveness of pain interventions for residents of Oregon nursing home facilities. Forty-four percent of sampled residents who were identified as having pain management needs were found to have problematic treatment regimens. Reports of surveyors' experiences during information collection and review of the Medicare/Medicaid recertification reports of the sampled facilities revealed that lack of assessment, and reevaluation of the effectiveness of treatment for pain were the chief contributing factors that led to these findings.