Gerontologic nursing
Chapter 6: Family Influences
Role and Function of Families
Families play a significant role in the lives of most older persons
When family is not involved it generally is because the older person has no living relatives nearby or there have been long standing relationship problems
Families
Several demographics and social trends have affected families abilities to provide support
Increasing aging population
Living arrangements
Disability and activity (limitations in ADLs and IADLs)
Decrease in birth rate
Increase in employment of women
Mobility of families (live in different city or state)
Increase in blended families
Older adults providing as well as receiving support
The state of the senior housing industry
Caregiver workplace issues (missing work)
Late Life Family Issues
Some of the most common issues and difficult decisions families face include:
Changes in living arrangements
Nursing facility placement
Financial and legal concerns
End of life health care decisions
See Table 6.2 on page 95: Common End of Life Documents
Vehicle driving issues
Table 6.3 on page 96: Online Resources for Older Adults who Drive
Family caregiving
See Table 6.1 on page 94: Internet Resources
Changes in Living Arrangements
Older family member begins to have problems living alone
Family members are often emotionally torn between allowing a person to be as independent as possible and creating a more secure environment
It can be particularly frustrating when a family knows an older relative has difficulty functioning independently yet refuses to accept help in the home
See Box 6 – 2 and 6 – 3 on pages 93 and 94
Should I move my parents into my home
Questions to consider when moving from independent living to a supervised living facility
Nursing Facility Placement
Many older people need help with things such as:
Housekeeping
Meals laundry
Transportation
Continuing care retirement community (CCRC)
Restaurants
Pools
Fitness centers
Spas
Assisted living
Financial and Legal Concerns
Paying for long term care
Helping an older person who has problems managing money
Many families do not discuss finances before a crisis and then it is often too late
Hesitate to discuss financial concerns for fear of appearing overly interested in inheritance
End of Life Care Decisions
The main interests of patients nearing the end of life are pain and symptom control, financial and health decision planning, funeral arrangements, being at peace with God, maintaining dignity and cleanliness and saying goodbye
Tools
Five wishes
Issues of Driving
How does age affect driving
Joints may get stiff
Muscle weaken
Difficult to turn head
Safely hit the brake
Need more light to see things
Glare from oncoming head lights
Peripheral vision narrows
Eye disease (cataracts, macular degeneration, glaucoma)
Reflexes get slower
Attention span shortens
Issues of Driving
Older drivers are more likely to get into multiple vehicle accidents
Most likely to get traffic citations for (indication of decreased driving ability):
Failing to yield
Turning improperly
Running red lights
Running stop signs
Issues of driving
Factors that contribute to increased risk:
Loss of hearing acuity
Loss of visual acuity
Limited mobility and increased reaction time
Medications
Dementia or mental impairment
Driving symbolizes autonomy, control, competence, self-reliance, freedom, and belonging to the mainstream of society, so older persons alter their driving when their abilities decline
Drive during the day
Limit geographic area
Issues of Driving
Health problems:
Arthritis
Parkinson’s disease
Diabetes
Depression (easily distracted)
Sleep disturbances
Heart disease (pacemaker)
Medications
Sleep aids
Anti-depressants
Antihistamines
Pain killers
Issues of Driving
Is it time to give up driving:
Do others often honk at you
Have you had some accidents
Do you get lost
Am I driving less because I am not sure about my driving
Family Caregiving
Provided by adult children of the older person
Types and levels of family caregiving
Routine care: regular assistance / daily routine
Back up care: provided at request of caregiver
Circumscribed care: boundaries (hair appt., nails)
Sporadic care: irregular participation
Dissociation: potential caregiver does not participate al all in care
Challenges & Opportunities of Caregiving
Few families are prepared to cope with the physical, financial and emotional cost of caregiving
Caregivers may become frustrated and exhausted because of unrealistic expectations or lack of knowledge and time
Chronic stress is another challenge to family caregivers – the families normal routine may be disrupted
Many adult caregivers express frustration regarding the inequality of the contributions by their siblings
Caregiver Stress
See Figure 6.1 on page 105:
Modified Caregiver Strain Index
Just as an older adult’s situation can change and require reassessment, so can family’s situation and a caregivers ability to provide care
Change in older adult’s condition
Change in family structure (marriage, divorce, birth, death)
Change in employment status of the caregiver
Interventions to Support Family Caregivers
Education
Understanding the family member’s medical condition
Improving coping skills / stress management
Dealing with family issues
Communicating effectively with older persons
Using community services
Long term planning / legal and financial plans
Respite Programs
Designed specifically to benefit the caregiver
Allows caregivers planned time away from their caregiving role
Premises to respite care
Shared responsibility for caregivers
Caregivers support
Respite Programs
Often underused
Lack of awareness
Apprehension (leaving loved one with a stranger)
Caregiver attitudes
Timing / a last resort (seek help too late)
Finances
Care receiver resistance
Energy required to use program
Program inflexibility and bureaucracy
Support groups
Some support groups are oriented to specific diseases
Cancer
Parkinson’s disease
Lung diseases
Alzheimer’s disease
Support group may be a place where caregivers get:
Advice
Gain knowledge about medical condition
Share experiences and feelings
Develop new coping strategies
Learn about community resources
Decision Making
Families find it helpful to have a model to follow as they make decisions or solve problems
Gathering information
Clearly identify issue
Formulating options
See all possible options
Evaluating options
Assess the advantages and limitations of each option
Creating a plan
Implementing the plan
Put plan into action
Reassessing
Assess the outcome / how well plan is working
Decision Making
Involving the older person in decision making
Validating feelings
Families experience many emotions when faced with difficult decisions and caregiving
May include: grief, frustration, anger, resentment, embarrassment or guilt
Because feelings, beliefs and attitudes influence behavior, it is important to address the belief systems and feelings of family members
NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 1
Purpose
NR449 Evidence-Based Practice
RUA: Analyzing Published Research Guidelines
The purpose of this paper is to interpret the two articles identified as most important to the group topic.
Course outcomes: This assignment enables the student to meet the following course outcomes.
CO 2: Apply research principles to the interpretation of the content of published research studies. (POs 4 and 8) CO 4: Evaluate published nursing research for credibility and clinical significance related to evidence-based practice.
(POs 4 and 8)
Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.
Total points possible: 200 points
Preparing the assignment 1. Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. 2. Please make sure you do not duplicate articles within your group. 3. The paper will include the following:
a. Clinical Question (30 points/15%) 1. Describe the problem: What is the focus of your group’s work? 2. Significance of problem: What health outcomes result from your problem? Or what statistics document this
is a problem? You may find support on websites for government or professional organizations. 3. Purpose of the paper: What will your paper do or describe? ***Please note that although most of these questions are the same as you addressed in paper 1, the purpose of this paper is different. You can use your paper 1 for items 1 & 2 above, including any faculty suggestions for improvement provided as feedback.
b. Evidence Matrix Table: Data Summary (Appendix A) - (60 points/30%) Categorize items in the Matrix Table, including proper intext citations and reference list entries for each article. 1. References (recent publication within the last 5 years) 2. Purpose/Hypothesis/Study Question(s) 3. Variables: Independent (I) and Dependent (D) 4. Study Design 5. Sample Size and Selection
6. Data Collection Methods 7. Major Findings (Evidence)
c. Description of Findings (60 points/30%) Describe the data in the Matrix Table, including proper intext citations and reference list entries for each article. 1. Compare and contrast variables within each study. 2. What are the study design and procedures used in each study; qualitative, quantitative, or mixed method
study, levels of confidence in each study, etc.? 3. Participant demographics and information. 4. Instruments used, including reliability and validity. 5. How do the research findings provide evidence to support your clinical problem, or what further evidence
is needed to answer your question? 6. Next steps: Identify two questions that can help guide the group’s work.
d. Conclusion (20 points/10%) Review major findings in a summary paragraph. 1. Evidence to address your clinical problem. 2. Make a connection back to all the included sections.
NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 2
NR449 Evidence-Based Practice
RUA: Analyzing Published Research Guidelines
3. Wrap up the assignment and give the reader something to think about.
e. Format (30 points/15%) 1. Correct grammar and spelling 2. Include a title and reference page 3. Use of headings for each section:
o Problem o Synthesis of the Literature
− Variables
− Methods
− Participants
− Instruments
− Implications for Future Work 4. Conclusion 5. Adheres to current APA formatting and guidelines 6. Include at least two (2) scholarly, current (within 5 years) primary sources other than the textbook 7. 3-4 pages in length, excluding appendices, title and reference pages
For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library.
Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned.
2
NR449 Evidence-Based Practice
RUA: Analyzing Published Research Guidelines
NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 3
Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.
Assignment Section and Required Criteria
(Points possible/% of total points available)
Highest Level of Performance
High Level of Performance
Satisfactory Level of
Performance
Unsatisfactory Level of
Performance
Section not present in
paper
Clinical Question (30 points/15%)
30 points 26 points 24 points 11 points 0 points
Required criteria 1. Describe the problem: What is the focus of your group’s work? 2. Significance of problem: What health outcomes result from your
problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations.
3. Purpose of the paper: What will your paper do or describe?
Includes 3 requirements for section.
Includes 2 requirements for section.
Includes 1 requirement for section.
Present, yet includes no required criteria.
No requirements for this section presented.
Evidence Matrix Table: Data Summary (Appendix A)
(60 points/30%) 60 points 56 points 47 points 25 points 0 points
Required criteria Categorize items in the Matrix Table, including proper intext citations and reference list entries for each article. 1. References (recent publication within the last 5 years) 2. Purpose/Hypothesis/Study Question(s) 3. Variables: Independent (I) and Dependent (D) 4. Study Design 5. Sample Size and Selection
6. Data Collection Methods 7. Major Findings (Evidence)
Includes 7 requirements for section.
Includes 6 requirements for section.
Includes 5 requirements for section.
Includes 4 or less requirements for section.
No requirements for this section presented.
Description of Findings
(60 points/30%) 60 points 53 points 47 points 23 points 0 points
Required criteria Describe the data in the Matrix Table, including proper intext citations and reference list entries for each article. 1. Compare and contrast variables within each study. 2. What are the study design and procedures used in each study;
qualitative, quantitative, or mixed method study, levels of confidence in each study, etc.?
3. Participant demographics and information.
Includes 6 requirements for section.
Includes 5 requirements for section.
Includes 4 requirements for section.
Includes 3 or less requirements for section.
No requirements for this section presented.
NR449 Evidence-Based Practice
RUA: Analyzing Published Research Guidelines
NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 4
Assignment Section and Required Criteria
(Points possible/% of total points available)
Highest Level of Performance
High Level of Performance
Satisfactory Level of
Performance
Unsatisfactory Level of
Performance
Section not present in
paper
4. Instruments used, including reliability and validity. 5. How do the research findings provide evidence to support your
clinical problem, or what further evidence is needed to answer your question?
6. Next steps: Identify two questions that can help guide the group’s
work.
Conclusion (20 points/10%)
20 points 18 points 15 points 8 points 0 points
Required criteria Review major findings in a summary paragraph. 1. Evidence to address your clinical problem. 2. Make a connection back to all the included sections. 3. Wrap up the assignment and give the reader something to think
about.
Includes 3 requirements for section.
Includes 2 requirements for section.
Includes 1 requirement for section.
Present, yet includes no required criteria.
No requirements for this section presented.
Format (30 points/15%)
30 points 26 points 23 points 11 points 0 points
Required criteria 1. Correct grammar and spelling 2. Include a title and reference page 3. Use of headings for each section:
o Problem o Synthesis of the Literature
▪ Variables ▪ Methods ▪ Participants ▪ Instruments ▪ Implications for Future Work
4. Conclusion 5. Adheres to current APA formatting and guidelines 6. Includes at least two (2) scholarly, current (within 5 years) primary
sources other than the textbook 7. 3-4 pages in length excluding appendices, title and reference pages
Includes 7 requirements for section.
Includes 6 requirements for section.
Includes 5 requirements for section.
Includes 4 or less requirements for section.
No requirements for this section presented.
Total Points Possible = 200 points
NR449 Evidence-Based Practice
RUA: Analyzing Published Research Guidelines
NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 5
Appendix A
EVIDENCE MATRIX TABLE
Article
References
Purpose Hypothesis
Study Question(s)
Variables Independent(I) Dependent(D)
Study Design Sample Size &
Selection
Data Collection Methods
Major Finding(s)
1 Smith, L. (2013). What How do educational support D-Dietary Quantitative N- 18 Focus Groups Support and education (SAMPLE should I eat? A focus for groups effect dietary modifications modifications Convenience improved compliance with ARTICLE) those living with diabetes. in patients with diabetes? I-Education sample-selected dietary modifications.
Journal of Nursing from local support Education, 1(4), 111-112. group in Pittsburgh, PA
1
2
3
4
5
Gerontology Class Discussion
Scenario #1: Family An 83, year old woman is recovering from pneumonia. She has Alzheimer’s disease and has become increasingly hostile and unmanageable in the home setting. Her 65, year old daughter is distraught about the idea of placing her mother in a long term care facility but feels she is not able to care for her.
Question:
• The original post must be at least 200 – 300 words in length • What is your role in this situation? • How might you help the daughter with her decision? • What information would you give the daughter?
Scenario #2: Family A 78, year old man is a retired banker whose wife died several years ago. He is able to perform all ADLs but needs help with meal preparation and transportation. He lives in a deteriorating neighborhood and no longer feels safe. He does not want to live with family members or completely give up his independence.
Question : • The original post must be at least 200 – 300 words in length • What housing options would be appropriate for him? Why? • What advantages would such housing options offer over living alone?
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