Family Caregivers' Characterization of Conversations Following an ACP Event.

Background: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers.

Objective: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers.

Participants: Patients with advanced illness and family caregivers.

Pilot Study of a Two-Step Delirium Detection Protocol Administered By Certified Nursing Assistants, Physicians, and Registered Nurses.

The feasibility and acceptability of a two-step screening protocol for delirium identification was pilot tested. Step 1, a screening tool, comprises two items: "Please tell me the day of the week," and "Please tell me the months of the year backwards starting with December." If either/both items are incorrect, Step 2, a 3-minute diagnostic assessment, follows.

A Toolkit for Enhancing End-of-Life Care: An Examination of Implementation and Impact.

The purpose of this study was to examine the infusion of a Toolkit for Enhancing End-of-Life Care in prisons, as well as the outcome and impact on the quality of prison end-of-life care. A total of 74 front-line staff and administrators were in attendance across two post-Toolkit-infusion evaluation visits. Applying qualitative analysis, co-researcher outcome findings were related to activities, community outreach and relations, multidisciplinary team, quality improvement approach, and participatory action research team effects.

Enhancing Care of Aged and Dying Prisoners: Is e-Learning a Feasible Approach?

Background: Prisons and jails are facing sharply increased demands in caring for aged and dying inmates. Our Toolkit for Enhancing End-of-life Care in Prisons effectively addressed end-of-life (EOL) care; however, geriatric content was limited, and the product was not formatted for broad dissemination. Prior research adapted best practices in EOL care and aging; but, delivery methods lacked emerging technology-focused learning and interactivity.

A Discourse Analysis: One Caregiver's Voice in End-of-Life Care.

Informal family caregivers make a significant contribution to the U.S. health care system, and the need for caregivers will likely increase.

Empowering Change Agents in Hierarchical Organizations: Participatory Action Research in Prisons.

Participatory action research (PAR) approaches harness collaborative partnerships to stimulate change in defined communities. The purpose of this article is to illustrate key methodological strategies used in the application of PAR methods in the particularly challenging environment of a hierarchical organization. A study designed to promote sustainable, insider-generated system-level changes in the provision of end-of-life (EOL) care in the restrictive setting of six state prisons is used as an exemplar of the application of three cardinal principles of PAR.

"Wish we would have known that!" Communication Breakdown Impedes Person-Centered Care.

Purpose: To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored.

Design And Methods: Participants were 59 staff from two nursing homes.

Efficiency of health care in state correctional institutions.

Little is known about the efficiency of health care in correction settings. This article reports an efficiency analysis of health care in state correctional institutions (SCIs) in a single, mid-Atlantic state from 2003 to 2006. A two-stage data envelopment analysis was used to estimate the technical efficiency of prison health care and determine inmate and institutional characteristics that were associated with efficiency.

Merging person-centered care with translational research to improve the lives of older adults: creating community-based nursing research networks.

Translational research is a leading trend in science with the aim of bridging the research-practice gap to significantly speed the implementation of effective interventions in clinical practice. Integrating the values and preferences of older adults and their families into this process is critical to the success of translational research. Engaging communities in meaningful research is an important part of advancing translational science in which older adults are partners in developing solutions to the health needs of individuals within communities.

What it takes: perspectives from developing nurse scientists.

The need for nurse scientists has never been greater, given the complexity of health problems facing our world and the rising cost of providing care to prevent and treat them. The development of nurse researchers is critical to preserve and advance the scientific foundation of the discipline. In this article, two successful doctoral students present their personal views about the cognitive and behavioral transformation they experienced during their program of study, highlighting what they believe to be important resources that enhance doctoral education and sharing how they overcame the challenges encountered.

Administrators' perspectives on changing practice in end-of-life care in a state prison system.

Objective: Sentencing trends have created a demographic shift in prison populations. Greater numbers of inmates are aging and dying in prison, creating a demand for enhanced end-of-life (EOL) care. Changing practice to meet escalating care demands in correction settings is complicated by economic constraints, attitudinal barriers, and organizational features.

Care and companionship in an isolating environment: inmates attending to dying peers.

The purpose of this study was to examine the values, beliefs, and perceptions of end-of-life (EOL) care held by inmates caring for peers approaching the end of their lives. The study is part of a broader participatory action research project to infuse enhanced EOL care into state prisons. Face-to-face interviews using a semistructured discussion guide were conducted with 17 male prisoners who were providing care for peers with advanced chronic illness and approaching end of life.

End-of-life caregiving: challenges faced by older adult women.

In the United States, the number of people older than 60 is expected to triple over the next 50 years, and as the population ages so do family caregivers. Increased levels of depression and low ratings of subjective well-being in caregivers are consistently associated with older age, the spousal relationship, and female caregiver gender. Less well known is the effect care delivery models have on the older adult as his or her spouse approaches the end of life.

Pilot testing of the function focused care intervention on an acute care trauma unit.

The purpose of this pilot study was to test the feasibility and preliminary effectiveness of Function Focused Care for Acute Care (FFC-AC) on acute care trauma nurses. A single group pre/post repeated measure design was used with measurements completed at baseline, 3 and 9 months post implementation of the intervention. FFC-AC was implemented by a function focused care nurse champion and includes 3 components: (I) Environmental and Policy Assessments; (II) Education; and (III) Mentoring and Motivating.

The influence of the culture of care on informal caregivers' experiences.

The environment of care can have a profound impact on caregiving experiences of families caring for loved ones with a life-limiting illness. Care is often delivered through disease-specific specialty clinics that are shaped by the illness trajectory. In this study, the following 3 distinct cultures of care were identified: interdisciplinary, provider dominant, and cooperative network.

End-of-life care and barriers for female inmates.

The number of female inmates is growing, and their average age is increasing. As a result, end-of-life care is situated in a highly restrictive environment with a focus on security rather than comfort. We describe the need for and potential barriers to humane care and provide care strategies that can be useful in a complex organizational system.

A model of caregiving through the end of life: seeking normal.

Informal family caregivers provide significant contributions to end-of-life (EOL) care. A theoretical model of the phases and transitions of EOL caregiving was explicated using grounded theory methods to explore the experiences of 46 family caregivers of adults suffering a variety of life-limiting conditions. The derived model describes four phases of caregiving spanning prediagnosis through bereavement.

End-of-life caregiving trajectories.

The purpose of this study is to illustrate variations in caregiving trajectories as described by informal family caregivers providing end-of-life care. Instrumental case study methodology is used to contrast the nature, course, and duration of the phases of caregiving across three distinct end-of-life trajectories: expected death trajectory, mixed death trajectory, and unexpected death trajectory. The sample includes informal family caregivers (n = 46) providing unpaid end-of-life care to others suffering varied conditions (e.

It's about time: use of nonpharmacological interventions in the nursing home.

Purpose: To provide a stronger evidence base for cultural change in the nursing home, this study elicited nursing, recreational therapy, and medical staff perceptions of barriers to the implementation of nonpharmacological interventions for the behavioral and psychological symptoms of dementia (BPSD).

Design: Thirty-five staff members (registered nurses, licensed practical nurses, nurses' aides, recreational therapists, activity personnel, and medical directors) from six nursing homes located in Pennsylvania and North Carolina participated in the qualitative study.

Methods: A focus group methodology was used to capture discussions that were audio-recorded and transcribed verbatim.

Achieving medical stability: Wives' experiences with heart failure.

The incidence of heart failure continues to rise as innovative treatments are developed. Despite life-prolonging interventions, morbidity and mortality in patients younger than 65 remain high. Few studies have focused on this younger cohort and/or their family caregivers as they navigate the complex illness trajectories manifested in heart failure.

Missed opportunities: under-detection of trauma in elderly adults involved in motor vehicle crashes.

Introduction: Geriatric trauma, mainly as a result of motor vehicle crashes (MVCs), has been a persistent and serious problem for those older than 65 years of age. Because of physiological changes and pre-existing disease, older adults present a unique clinical challenge to emergency nurses and staff. "Are older adults involved in MVCs appropriately assessed and treated?"

Methods: A review of the research literature, including 17 articles from 2003 to 2009, on the topic of geriatric trauma, specifically trauma that resulted from MVCs will be explored.