Compared with younger veterans, older veterans have less social support, greater employment and health challenges, and, perhaps greater motivation to change.
In 2000, the Senior Mentor Program was implemented as an innovative, instructional method in the University of South Carolina's medical school curriculum designed to enhance and strengthen student training in geriatrics. This study qualitatively analyzed second- year medical students' and senior participants' perceptions of and attitudes towards the Senior Mentor Program as an effective learning modality. A total of 36 second-year students from two consecutive classes (2002-2003) and 42 senior mentors at USC's School of Medicine participated in five and seven separate focus group interviews, respectively. The group discussions were transcribed and a content analysis performed using NVivo. The coding scheme and analyses were driven by the data collected and recurrent themes were examined across all focus groups. Overall, student and senior mentor participants viewed the program positively. Thematic comparisons by participant type indicate a shared view that the mentoring relationship has a far-reaching, educational, professional, and personal impact. Both students and seniors agreed that myths and stereotypes about aging were dispelled and students indicated that a close, caring relationship with an older person will change they way they practice. A longitudinal mentoring program that pairs students with community-dwelling seniors can be a valuable addition to traditional geriatric curricular activities designed to increase students' skills and compassion for caring for older adults.
This study examined the relationship between race and advance care planning, hospitalization, and death among nursing home residents receiving hospice care. Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify documentation of these activities for White, Black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable. Across different types of advance directives, compared to White nursing home residents, Black, Hispanic, and Asian residents who received hospice services were significantly less likely overall to have documented advance directives. All racial groups were also more likely to experience hospitalization while on hospice, regardless of whether they had a documented "do not hospitalize" order. As nursing homes become more diverse, recognizing differences in hospice use and end-of-life planning will continue to increase in importance.
Several lessons were evident and inform future Community-Based Disaster Coalition efforts including adapting training to meet coalition needs; supporting the process of coalition building; following up with extended training opportunities and resources; continuing to provide trainings to counties that have not yet participated; and expanding training in other states, regions, territories, and internationally.
The emphasis in disaster situations is on preserving life, and this goal is both appropriate and laudable. There is a risk, however, that the needs of people who are dying can become lost when there is a sudden surge of people needing acute intervention. There are significant ethical considerations inherent in society's prioritization of care needs across the acute, rehabilitative, and palliative spectrum in general, let alone in a disaster situation. These ethical conundrums are not the focus of this article. Rather, we anchor our discussion on the assumption that care needs are equally valid, and our purpose is to explore the issues that impact the provision of quality end-of-life care in nursing home settings for those who require this care when a disaster occurs. Nursing home residents, in particular, are at heightened risk for experiencing negative disaster-related outcomes due to compromised physical or mental health that requires skilled nursing care. Moreover, within the already vulnerable nursing home population are many people who are receiving palliative end-of-life services when a disaster strikes. Education and training in end-of-life services for nursing home staff, disaster emergency responders, and other lay people is vital to build capacity for adapting the delivery of these services in disaster situations in the interest of equity and human rights. Given the present lack of guidance in the literature as to what end-of-life care looks like when adapted to the context of disaster response, there is also a pressing need for research to inform this discussion. The purpose of this article is to draw attention to this topic and highlight some of the critical issues, gaps, and opportunities.
Rehabilitation nurses play an integral role in helping patients and communities plan for, respond to, and recover from disasters. This article provides an overview of various types of disasters, the terminology used by planners and responders, and the structure that governs the delivery of services, resources, and patient care. Information about specialized training in disaster response and volunteer opportunities through national and state humanitarian relief programs are provided. Although each nursing specialty lends expertise to emergency and disaster situations, rehabilitation nurses are particularly well‐suited to help during times of complex, multifaceted medical and emotional responses.
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