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Daily life for chronically ill oldest old persons
Aud Moe,Ingela Enmarker,Ove Hellzén
Nursing Reports , 2012, DOI: 10.4081/nursrep.2012.e8
Abstract: In the past, the study of old age often focused on the losses and problems associated with ageing. In recent times, the focus has been on the positive aspects, such as quality of life, inner strength, and enjoying life. The aims of this study were to highlight the ways in which chronically ill older persons experience the meaning of daily life and to understand what it means to live at home with chronic disease. In-depth interviews were used to illustrate individual experiences. The sample consisted of 13 chronically ill persons, aged 80 to 94 years, living at home and receiving assistance in the form of home nursing care. Data were analyzed using the phenomenological hermeneutical method. After a na ve reading and a structural analysis of the text, we identified three themes: being insufficient, becoming dependent, and enjoying life. The comprehensive understanding suggested that daily life involved bad days, described as illness with dysfunctions, limited energy, and dependency on others. Daily life also had its positive aspects, described as enjoying life. Dignity was threatened by feelings of being a burden to others and was affirmed by experiencing a will to live. It was concluded that bad days with experiences of suffering and good days that provided the older with experiences of enjoying life could help them meet adversity through qualities of resilience that gave meaning to daily life and helped them to think positively in times of greater difficulty.
The Experience of Nurses Providing Home Nursing Care to Oldest Old Persons Living Alone in Rural Areas—An Interview Study  [PDF]
Tove Mentsen Ness, Ove Hellzen, Ingela Enmarker
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.54036
Abstract: The rapidly increasing population of older persons worldwide, and the fact that the majority of them want to continue living in their own homes, mean there is a growing focus on home based care. Because of this, it is necessary to increase the number of studies, including rural areas, as earlier studies are sparse. Rural areas cannot be seen as a homogeneous phenomenon, meaning more research is needed to increase knowledge about cultural differences in rural areas. The aim of this study was therefore to describe registered nurses’ experiences of providing home nursing care to oldest old persons living alone in rural areas. A sample of 15 registered nurses in rural South Sami areas was chosen for this study, 13 women and 2 men. Narrative interviews were conducted, and qualitative content analysis was used to interpret the data. The analysis revealed four themes and eight subthemes in addition to a core-theme. The latent meaning of the themes “Feeling responsible”, “Trying to accommodate”, “Being challenged” and “Feeling significant” formed the core-theme: contradictions between nurses’ ideals of being professional and the reality faced in rural home nursing care with close social relationships. The findings in this study showed that the experiences of providing home nursing care in rural areas to oldest old persons were multifaceted and altering, as well as emotionally and socially contradictory.
Interdisciplinary Team Collaboration during Discharge of Depressed Older Persons: A Norwegian Qualitative Implementation Study  [PDF]
Anne Lise Holm,Elisabeth Severinsson
Nursing Research and Practice , 2013, DOI: 10.1155/2013/794743
Abstract: In order to deliver effective care, it is necessary to organise interdisciplinary activities for older persons who suffer from depressive disorders. This paper evaluated the interdisciplinary team members’ perceptions of cooperation in the discharge planning of depressed older persons based on the Chronic Care Model (CCM). A qualitative implementation design was used, data were collected by means of multistage focus groups, and a thematic analysis was performed. Three themes emerged: lack of effective team leadership in the community, the need to change the delivery system, and enhancing self-management support for depressed older persons as well as the participation of their families. It was concluded that nurse managers must find ways of supporting the depressed older persons by better structuring the care, increasing cooperation with organisational leadership, and creating an environment characterised by trust and mutual respect. Distrust can have serious implications for discharge planning collaboration. The development of a common vision of transparency in the organization is important as is a policy of change among leadership and in clinical practice. 1. Introduction Depression in older persons is an increasingly complex health problem due to the difficulties involved in distinguishing it from symptoms of physical ill-health, dementia, normal aging, and grief [1, 2]. Older persons with depression are a vulnerable group for whom the transition from hospital to community care is of critical importance. Evidence has demonstrated that effective and safe interventions, delivered in collaboration between hospital and community care, are associated with a reduced rate of readmission [3]. Naylor et al. [4] identified nine interventions that demonstrated positive effects related to hospital readmission, thus constituting a key focus of health reform. According to Choi and Pak [5], interdisciplinary analysis synthesises and harmonises disciplines into a coordinated and coherent whole. Collaboration begins when different disciplines meet to share each other’s knowledge [6]. Every health care professional possesses evidence-based knowledge, that is, of value to the other members of the team [7]. Interest in implementation issues has increased in the health services field in recent decades and can be related to the development of Evidence Based Practice (EBP) and programmes as well as the concern that people will not benefit unless EBP interventions and programmes are correctly implemented [8]. EBP requires that “decisions about healthcare are based on the
The chronically ill patients’ quality of counselling in the hospital  [cached]
Pirjo Kaakinen,Maria K??ri?inen,Helvi Kyng?s
Journal of Nursing Education and Practice , 2012, DOI: 10.5430/jnep.v2n4p114
Abstract: Background: Patient counseling is one of the core elements in healthcare. The number of chronically ill people is increasing, whilst the number of additional stays in hospital that are required has dropped. Thus, there is less time to deliver good-quality patient counseling when they are in hospital. The aim of this study was to describe quality of patient counseling chronically ill patients’ in the hospital. Methods: This study used a cross-sectional design. A convenience sample (n=106) of patients, who had suffered ischemic attack, COPD or cardiac disease was employed. Data were collected using the Counseling Quality Instrument (CQI) questionnaire. Results: Most chronically ill people received patient counseling about their disease symptoms, but there was lack of content of counseling about social support and the disease prediction. Half of the patients reported that their counseling had been implemented in planned manner and that they had experienced positive interaction during that counseling. Sixty percent of chronically ill patients had perceived patient counseling about the result of investigations, but half of respondents did not receive patient-centered counseling. Patient counseling had a positive benefit on the treatment of the chronically ill and their attitudes. Eighty percent of the patients were satisfied with the counseling materials and methods. Those over 60 years old and those who lived alone were the most dissatisfied with patient counseling. Conclusion: The findings indicate that chronically ill patients’ counseling on social support and disease prediction require development. In addition, implementation of patient counseling should be more patient-centered and based on care plan.
The association between resilience and survival among Chinese elderly  [cached]
Ke Shen,Yi Zeng
Demographic Research , 2010,
Abstract: Based on the unique longitudinal data of the elderly aged 65+ with a sufficiently large sub-sample of the oldest-old aged 85+ from the Chinese Longitudinal Healthy Longevity Survey, we construct a resilience scale with 7 indicators for the Chinese elderly, based on the framework of the Connor-Davidson Resilience Scale. Cox proportional hazards regression model estimates show that, after controlling for socio-demographic characteristics and initial health status, the total resilience score and most factors of the resilience scale are significantly associated with reduced mortality risk among the young-old and oldest-old. Although the causal mechanisms remain to be investigated, effective measures to promote resilience are likely to have a positive effect on longevity of the elderly in China.
Counseling chronically ill adults in the healthcare setting: An integrative literature review  [cached]
Pirjo Kaakinen,Patala-Pudas Leena,K??ri?inen Maria,Kyng?s Helvi
Journal of Nursing Education and Practice , 2012, DOI: 10.5430/jnep.v2n3p185
Abstract: Background: Chronic diseases among the adult population have increased rapidly worldwide. Chronically ill adults use health services more frequently; they are hospitalized more often and for a longer time than the average. Although counseling is an essential part of the care of chronically ill adults, there is no clear conception of counseling elements in healthcare settings. The aim of this integrative review is to describe the key elements of counseling of adults with chronic diseases. Methods: This integrative literature review describes elements of the counseling of chronically ill adults. The study was conducted by means of a systematic search of CINAHL (1981 to April 2010), Medline (1973 to March 2010) and Medic (1978 to April 2010) databases. Three reviewers selected the studies and two reviewers independently assessed the quality of studies. 31 studies were included in the data extraction and narrative synthesis. Results: The review identifies the following typical elements in the counseling of adults with chronic disease: the counseling needs of chronically ill adults; the implementation of counseling; and the impact of counseling. The counseling needs of chronically ill adults included 1) gaining an understanding of the disease and treatment in relation to everyday life, 2) handling of emotions, 3) social support. The implementation of counseling concerned 1) need-based and goal-oriented counseling, 2) the content of counseling, 3) the nature of interaction and atmosphere of counseling, 4) counseling time, 5) counseling methods and materials, and 6) challenges of implementation. The impact of counseling included increased 1) compliance with medication, 2) ability to cope with feelings, 3) understanding of the disease, and 4) quality of life. Conclusions: This study found that effective counseling should be based on the individual needs of chronically ill adults and it should include more knowledge about social services and provide support in handling emotions. The study also revealed it is important to plan counseling and to set goals in conjunction with chronically ill adults. The results of this review are useful for the development of counseling of chronically ill adults in a variety of healthcare settings.
Serenity—Uses in the Care of Chronically Ill Older Patients: A Concept Clarification  [PDF]
Margaretha Norell Pejner
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.51001
Abstract: Serenity is an emotional experience that contributes to the acceptance of a situation. One phenomenon in the care of chronically ill older patients and patients in end of life care is that too much focus is placed on the patient’s disease. This can contribute to anxiety, sadness or sense of isolation. For older people that are chronically ill or in care at the end of life, it is important that the registered nurse can help them to find serenity. Further knowledge is needed about how the concept of serenity is used in relation to the care of older chronically ill patients. Aim: The purpose of this concept analysis was to clarify how serenity is used in nursing and in relation to the care of chronically ill older patients. Method: The study follows Rodgers’ evolutionary method of concept analysis. Findings: Serenity is a state of physical, mental, emotional and spiritual balance when life conditions can be managed or accepted. Through the experience of serenity the chronically ill older patient is able to find or develop the self in order to continue with dignity. The concept is most used at the lowest described levels of the self, including a perception of personal safety. The highest level involves a sense of wholeness and awareness. Conclusion: The concept of serenity is used in relation to chronically ill older patients as a condition where the patient finds balance and thus can manage or accept their situation. Chronically ill older patients will not recover. For that reason it needed a better understanding about what factors to experience serenity are needed. Further research is also needed to examine how registered nurses can support older chronically patients in finding serenity with the help of nursing interventions.
The importance of social support to chronically ill adolescents  [PDF]
Ni?evi? Sanja
Medicinski Pregled , 2006, DOI: 10.2298/mpns0608331n
Abstract: Introduction. Improvements in medicine have significantly prolonged life of chronically ill children and adolescents in the past several decades. There is a great variability in adaptation to illness among chronically ill persons - some of them seem to be very well adapted, with almost no problems. However, research results suggest that chronically ill children are more likely to have psychological problems than their healthy peers. Material and methods. Eighty-four subjects, all elementary school pupils, participated in the study. The first group included adolescents with chronical illness (malignant illness, insulin dependent diabetes mellitus, epilepsy, or asthma), and the second their healthy peers. Depression and social support were evaluated. The Birleson's Depression Scale and Perceived Social Support Scales (forms for friends and for family members) were used. Results and discussion. The results show significant differences for two of the three variables: depression, and perceived social support from family, while there was no significant difference for perceived social support from friends. The results suggest that chronically ill adolescents are more depressed and that they perceive that the social support they receive from their families is lower when compared to their healthy peers. Conclusion. The results of this study showed that chronically ill adolescents are more depressed than their healthy peers. This group of adolescents also perceives that they have less social support from their families than their healthy peers. When it comes to perceived social support from friends, these two groups do not differ. .
NUTRITIONAL SUPPORT IN CHRONICALLY ILL CHILDREN  [cached]
Simi? Du?ica,Budi? Ivana
Acta Facultatis Medicae Naissensis , 2003,
Abstract: Chronically ill children often become malnourished. These children have increased metabolic requirements and increased losses associated with impaired absorption and decreased nutrient usage. In hospitalized children nutritional assessment is rarely performed, increased or modified needs are not recognized, meals are omitted due to analysis or interventions, which lead to a further decline in nutritional status. The consequences of malnutrition are growth retardation and slow development, aggravation of a disease, impaired immunity and decreased resistance to infection. Nutritional support should improve the quality of life in chronically ill children. Adequate nutritional support should provide that the growth of these children corresponds to the growth of the healthy children of the same age group. The course of disease could be improved too. The enteral route of feeding is the best choice, so enteral nutrition (EN) should be the first option, but in the occasions when it is contraindicated parenteral nutrition (PN) is applied. This review article discusses cardiac, renal and liver diseases, cystic fibrosis and AIDS in children, from the nutritional point of view.
Understanding resilience  [PDF]
Gang Wu,Hagit Cohen,Joanna J. Kim,Aleksander A. Mathé
Frontiers in Behavioral Neuroscience , 2013, DOI: 10.3389/fnbeh.2013.00010
Abstract: Resilience is the ability to adapt successfully in the face of stress and adversity. Stressful life events, trauma, and chronic adversity can have a substantial impact on brain function and structure, and can result in the development of posttraumatic stress disorder (PTSD), depression and other psychiatric disorders. However, most individuals do not develop such illnesses after experiencing stressful life events, and are thus thought to be resilient. Resilience as successful adaptation relies on effective responses to environmental challenges and ultimate resistance to the deleterious effects of stress, therefore a greater understanding of the factors that promote such effects is of great relevance. This review focuses on recent findings regarding genetic, epigenetic, developmental, psychosocial, and neurochemical factors that are considered essential contributors to the development of resilience. Neural circuits and pathways involved in mediating resilience are also discussed. The growing understanding of resilience factors will hopefully lead to the development of new pharmacological and psychological interventions for enhancing resilience and mitigating the untoward consequences.
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