This study investigates the activities and interactions of elderly patients in an acute medical geriatric unit and a psychiatric unit. The Clifton Assessment Procedures for the Elderly were used to measure cognitive and behavioural functioning, and the 24 subjects studied were divided into three groups: lucid, confused, and demented. Information about subjects' activities and interactions with nursing staff was gained from time sampling by non-participant direct observation. The results reveal very low levels of staff-patient interaction outside of expected routines of patient care. At no time during the observation periods did staff engage patients in social activities or prolonged informal conversations. Yet 306 nurses, of various grades, completed a questionnaire in which they ranked talking to patients as 'enjoyable', 'important', 'rewarding', and an 'objective' for themselves and the unit.
Nurses and other professional caregivers are increasingly recognising the issue of moral distress and the deleterious effect it may have on professional work life, staff recruitment and staff retention. Although the nursing literature has begun to address the issue of moral distress and how to respond to it, much of this literature has typically focused on high acuity areas, such as intensive care nursing. However, with an ageing population and increasing demand for resources and services to meet the needs of older people, it is likely that nurses in long‐term care are going to be increasingly affected by moral distress in their work. This paper briefly reviews the literature pertaining to the concept of moral distress, explores the causes and effects of moral distress within the nursing profession and argues that many nurses and other healthcare professionals working with older persons may need to become increasingly proactive to safeguard against the possibility of moral distress.
The study was designed to determine the attitudes of health care workers towards the elderly in acute care settings and to investigate variations in types of interaction between staff and elderly patients. A questionnaire and Kogan's Old People Scale were used together with direct non-participant observation of nurse-patient interaction. The questionnaire was completed by 50 registered nurses, 20 nursing aides, four degree nurses and eight volunteers. Of the four groups, the volunteers showed the most favourable attitudes, the registered nurses and degree nurses were virtually tied and the nursing aides were lower in the rating. Staff who expressed a preference for working in geriatrics and rehabilitation had a high correlation on the Kogan's Old People Scale: (r(77) = 0.38, P less than 0.01) and (r(77) = 0.32, P less than 0.01) respectively. It was also found that those who rated basic care as lower in importance to patient well-being than, for example, talking to patients, were more positive than were those who rated basic care higher in importance. In the second data collection, 47 female patients (mean age = 67.4 years) and 43 male patients (mean age = 71.5 years) were observed. It was found that 74% of patients spent almost 95% of their time inactively, either in bed or sitting in a chair. Neither age nor mental alertness relates to activity level, but mental alertness was found to be related to engaging in constructive activities. During the observation periods 41% of the patients did not interact with staff.(ABSTRACT TRUNCATED AT 250 WORDS)
for certain residents with dementia, PAS may allow assessment of both agitation and uncommunicated pain. It is possible that the PAS form of agitation "resistance to care" may indicate pain that individual cannot otherwise communicate. One possible response to such resistance would be to trial pain medication and reassess agitation. Nursing staff in LTC facilities may need additional training in pain assessment of residents with dementia.
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