Kathleen Buckwalter
University of Oklahoma Health Sciences Center, Nursing, Faculty Member
Buku ini merupakan sumber referensi lengkap yang dirancang khusus untuk perawat yang merawat pasien geriatrik. Buku ini memuat berbagai informasi penting yang mendukung pengambilan keputusan klinis, di antaranya mengidentifikasi tanda dan... more
Buku ini merupakan sumber referensi lengkap yang dirancang khusus untuk perawat yang merawat pasien geriatrik. Buku ini memuat berbagai informasi penting yang mendukung pengambilan keputusan klinis, di antaranya mengidentifikasi tanda dan gejala, menegakkan diagnosis memilih hasil yang tepat, dan membuat program intervensi yang tepat.xv, 1109 hlm.: ilus.; 29 c
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The effect of caregiving on the family caregiver's general well-being is well documented. In a recent survey by Caring.com (2014), 76 percent of caregivers reported that their emotional health has suffered (76%) and 55 percent said... more
The effect of caregiving on the family caregiver's general well-being is well documented. In a recent survey by Caring.com (2014), 76 percent of caregivers reported that their emotional health has suffered (76%) and 55 percent said that their physical health has declined. Many studies have identified that caregiving for a person with dementia (PWD) can have a negative effect on the caregiver's physical, mental, and social dimensions of life, most often expressed in terms of depression, burden, or distress (Schoenmakers, Buntinx, & Delepeleire, 2010). The prevalence of depression among caregivers of PWD ranged from 30 to 80 percent depending on the sample and recruiting method.Most studies found that 20 to 50 percent of caregivers had clinically significant symptoms of depression, the most frequently used outcome in caregiver intervention studies (Cuijpers, 2005; Neundorfer, McClendon, Smyth, Strauss, & McCallum, 2006; Zarit & Femia, 2008). Poor caregiver health, care recipient irritability, and poorer quality of relationship between the caregiver and the PWD (Mahoney, Regan, Katona, & Livingston, 2005) were identified as predictors of caregiver depressive symptoms. A meta-analytic review of different types of professional dementia home care interventions determined that primary outcome measures of depression and burden were appropriate in assessing the effect of an intervention on family caregivers (Moniz-Cook et al., 2008).Research QuestionsPsychosocial interventions are the most frequently studied approach to caregiver support, and cognitive, behavioral, or social strategies are taught with an aim to prevent problematic situations and to improve caregivers' well-being. Analyses have yielded findings that interventions had very modest effects on indicators of caregiver health and quality of life (Snyder, Jenkins, & Joosten, 2007; Zarit, Femia, Watson, Rice-Oeschger, & Kakos, 2004).Certain types of evidence-based interventions may be more appropriate for caregiver depression. Further research is needed on the effect of psychosocial interventions in reducing caregiver depressive symptoms. The purpose of the current study was to evaluate whether an individualized, two-component, communitybased psychoeducational intervention, consisting of elements of two evidencebased interventions (hereafter referred to as the combined intervention) decreased levels of caregiver depression. Caregivers were recruited between 1998 and 2014 and followed over an eighteen-month period. Following approval from the institutional review board, data were collected through the Caregiver Program of Research (CPR) by trained research assistants (RAs) employed by the School of Nursing. Results of this quasi-experimental study will potentially add support to the growing body of evidence that combining two well-supported caregiver interventions can effectively treat caregiver depression and help practitioners to target caregivers of PWD who may benefit most from the intervention. Thus, the following questions were investigated:1. What were outcomes of the combined intervention on caregiver depression?2. Which caregivers benefited most from the combined intervention?Literature ReviewSeveral psychosocial interventions have reported success in reducing caregivers' distress. In these interventions various strategies were used to enhance capacity to succeed in the caregiver role. These programs demonstrated that caregivers benefit from acquisition of skills and knowledge related to the care tasks they perform. Successful interventions focused on developing more objective attitudes and problem-solving skills. For example, problem-solving and decisionmaking training and cognitive restructuring techniques were added to traditional components of education to deal with distress associated with caregiving (Ostwald, Hepburn, Caron, Burns, & Mantell, 1999). A systematic review of the effect of these psychological interventions on family dementia caregivers found evidence for the efficacy of six or more sessions of individual one-on-one behavioral management therapy centered on challenging behavior in the recipient. …
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Purpose: A quasi-experimental design was used to evaluate the impact of the two-component psychosocial intervention on caregiver depression. Methods: The intervention was based on two evidence-based components: the Progressively Lowered... more
Purpose: A quasi-experimental design was used to evaluate the impact of the two-component psychosocial intervention on caregiver depression. Methods: The intervention was based on two evidence-based components: the Progressively Lowered Stress Threshold model and a family meeting strategy based on Mittelman’s New York University intervention. Caregivers (N = 127) were followed for eighteen months to assess depression using the Geriatric Depression Scale (GDS). Results: There were slight changes in the GDS scores over time (14.6 at baseline and 12.9, 13.0, and 13.0, respectively, at six-, twelve-, and eighteen-month follow-up, p = 0.002). Individuals with a high school degree or less had significantly higher GDS scores than their counterparts. Caregivers facing financial strain had a significant reduction in their GDS scores compared to those of their counterparts. Implications: The combined two-component intervention decreased the level of caregiver depression, adding to the growing evidence base for practice interventions
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BACKGROUND:Depression has a substantial negative impact on quality of life. Underdiagnosis and undertreatment of de-pression are major problems in nursing home residents.OBJECTIVES: This study sought to determine the prevalence of... more
BACKGROUND:Depression has a substantial negative impact on quality of life. Underdiagnosis and undertreatment of de-pression are major problems in nursing home residents.OBJECTIVES: This study sought to determine the prevalence of de-pression among older adults in nursing homes in rural Iowa using the Geriatric Depression Scale (GDS), Minimum Data Set (MDS), and primary care provider (PCP) depression diagnosis.DESIGN: This is a secondary analysis of data collected from 279 randomly selected residents of nursing homes in rural Iowa.RESULTS: The prevalence of depression based on the GDS (score of 6 or greater) was 37.3%, the MDS was 21.3%, and the PCP depression diagnosis was 39.1%.CONCLUSION: There was only chance agreement in identifying depression among the measures. The overall prevalence of depression (as indicated by a positive depression marker in any group) was 67.1%, suggesting depression continues to be a problematic clinical and quality-of-life issue in rural nursing homes....
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This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors... more
This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their careg...
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Nursing home culture change (NHCC) aims to change the way care is provided in nursing homes. Valid and reliable measures are needed to evaluate the impact of NHCC on outcomes. The current systematic review provides an overview of... more
Nursing home culture change (NHCC) aims to change the way care is provided in nursing homes. Valid and reliable measures are needed to evaluate the impact of NHCC on outcomes. The current systematic review provides an overview of instruments designed to measure NHCC and criteria for others to evaluate and choose instruments according to their own purpose. Ten instruments were identified that measure NHCC on an organizational level. Lack of development description hindered their assessment, and studies examining the relationship between NHCC and outcomes are rare. A common limitation of the instruments reviewed was the lack of psychometric testing; thus, their validity and reliability need further exploration. [Res Gerontol Nurs. 2018; 11(2):103-112.].
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Research Interests: Geriatrics, Health Promotion, Mental Health, Leadership, Health Care, and 15 moreHousing, Medicine, Cognitive Sciences, Independent Living, Humans, Aging in Place, Psychological Intervention, Social Environment, Clinical Sciences, Aged, Public health systems and services research, Environment Design, Conceptualization, Social Engagement, and Residence Characteristics
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Peripheral intermittent infusion devices are commonly used to administer periodic doses of medications to adults and children. Research findings provide a strong base for changing practice to using saline instead of heparin to flush these... more
Peripheral intermittent infusion devices are commonly used to administer periodic doses of medications to adults and children. Research findings provide a strong base for changing practice to using saline instead of heparin to flush these devices in children over 28 days old and in adults. This research-based change in practice will enhance the quality of care that patients receive and decrease the costs of their care.
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Rural elders are an undeserved and vulnerable population with compromised access to health and human services leading to premature institutionalization. Even though elders living in rural areas have psychiatric illnesses that would prompt... more
Rural elders are an undeserved and vulnerable population with compromised access to health and human services leading to premature institutionalization. Even though elders living in rural areas have psychiatric illnesses that would prompt them to use mental health services, their use of these services remains low. This study developed predictive models of psychiatric hospitalization, use of mental health services, and use of crisis intervention by rural elders participating in an outreach case-management program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression. Being married and having supplemental insurance in addition to Medicare predicted 23% of the variance for utilization of psychiatric hospitalization. Only one variable, Medicaid, predicted 14% of the variance for use of mental health services. Type of caregiver, marital status, household composition, and Medicaid insurance accounted for 23% of the variance in utilization of crisis intervention by rural elders. Overall, the two variables that most likely predicted use of psychiatric mental health services were marital status and type of insurance.
Research Interests: Mental Health, Medicine, Crisis Intervention, Prospective studies, Population, and 14 moreHumans, Hospitalization, United States, Female, Male, Mental Disorders, Mental health services, Medicaid, Aged, Outreach, Rural Health Services, Marital Status, Psychology and Cognitive Sciences, and Medical and Health Sciences
This study examined the use of prayer and religious coping among caregivers of persons with Alzheimer's disease (AD) and related disorders. A repeated measures correlational design was used, combined with data from a larger,... more
This study examined the use of prayer and religious coping among caregivers of persons with Alzheimer's disease (AD) and related disorders. A repeated measures correlational design was used, combined with data from a larger, experimental study (NIH, R01-NR-3434). This expansion study and secondary analysis added two instruments, the Springfield Religiosity Schedule (SRS)1 and the Jalowiec Coping Scale (JCS)2 to the original study, as well as structured interviews to determine the role of prayer and religious coping in the caregiving stress and coping process. A modification of Lazarus and Folkman's3 Stress and Coping model was used that included religious variables. Results showed that caregivers (N = 64) used prayer and religious coping frequently, that they perceived prayer and trusting in God as effective coping mechanisms, and that internal religious activities helped them get through the caregiving situation. Clinical implications are discussed.
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THE RESEARCH CULTURE in nursing has evolved in the last 150 years, beginning with Nightingale's work in the mid-1850s and culminating in the creation of the National Institute of Nursing Research (NINR) at the National Institues... more
THE RESEARCH CULTURE in nursing has evolved in the last 150 years, beginning with Nightingale's work in the mid-1850s and culminating in the creation of the National Institute of Nursing Research (NINR) at the National Institues of Health (NIH). This article highlights nursing's efforts to facilitate the growth of the research culture by developing theory, establishing the importance of a research-based practice, advancing education, and providing avenues for dissemination of research. Similarities with the chiropractic profession are discussed, along with a commentary by Cheryl Hawk, D.C, Ph.D.
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Much of what is in the literature regarding nursing of AD patients and their families is anecdotal, has not been validated by systematic research, and is atheoretical. The majority of nursing research in AD has focused on patient... more
Much of what is in the literature regarding nursing of AD patients and their families is anecdotal, has not been validated by systematic research, and is atheoretical. The majority of nursing research in AD has focused on patient characteristics and problem behaviors or on the needs and experiences of family care givers rather than on characteristics of SCUs. Research should continue in these areas, along with testing nursing interventions to maintain the optimal cognitive, physical, social, and emotional function of residents with AD in institutional settings. Explanatory theories should be devised and tested to advance the development of nursing knowledge in the care of residents with AD and family care givers. Finally, more evaluation research is needed to test the cost effectiveness of SCU programs, including effects on residents with AD, family members, and staff care givers.
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Research Interests: Psychology, Nursing, Decision Making, Gerontology, Dementia, and 15 moreEvidence Based Practice, Cognition, Medicine, Activities of Daily Living, Memory, Cognitive training, Humans, Disease, Cognitive Therapy, Neuronal Plasticity, Psychosocial, Medline, Gerontological Nursing, Alzheimer Disease, and Early Diagnosis
Research Interests: Methodology, Depression, Cancer, Biology, Medicine, and 15 moreComorbidity, Biological Sciences, Biological Psychiatry, Humans, Age, Disease, Biological, Depressive Disorder, Hiv Infection, Heart Disease, Aged, Cardiovascular Diseases, Acquired immunodeficiency syndrome, Medical, and Medical and Health Sciences
Only recently have the health sciences, including nursing, begun to focus on the dynamics of mental health and aging. Reports on rural initiatives, are beginning to appear; these developments have occurred without the benefit of context... more
Only recently have the health sciences, including nursing, begun to focus on the dynamics of mental health and aging. Reports on rural initiatives, are beginning to appear; these developments have occurred without the benefit of context and direction, however, especially in terms of how these issues apply in rural areas. The article reviews selected issues in the interface of aging and mental health in rural areas. It offers a research agenda comprising descriptive, intervention, and utilization studies as a context to guide research and knowledge development in mental health nursing of rural elderly.
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Research Interests: Nursing, Forecasting, Benchmarking, Medicine, Humans, and 15 moreNeeds Assessment, Geriatric Nursing, Hospitalization, United States, Psychiatric Nursing, Goals, Excellence, Organizational Policy, Geriatric Psychiatry, Aged, Questionnaires, Inpatient Care, Health Care Surveys, personnel staffing and scheduling, and hospital units
Research Interests: Psychology, Nursing, Quality of Mental Health Care, Health Policy, Benchmarking, and 14 moreMedicine, Foundations, Nursing Research, Humans, Program Development, Geriatric Nursing, Nursing Education, United States, Excellence, Aged, Gerontological Nursing, Older Adult, Health services for the aged, and Quality of health care
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Research Interests: Mental Health, Dementia, Medicine, Humans, Human Resources for Health, and 15 moreFemale, Male, Mental Disorders, Psychogeriatrics, Aged, Outreach, Patient Care Team, Rural Area, Iowa, Health services for the aged, Health Services Accessibility, Health Resources, Psychology and Cognitive Sciences, Medical and Health Sciences, and Referral
Research Interests: Dementia, Medicine, Mood, Humans, Natural Killer cells, and 15 moreDescriptive Statistics, Female, Male, Power Analysis, Caregivers, Multiple Regression, Aged, Pilot study, Analysis of Variance, Behavior Problems, Natural, Biological markers, Immune function, Pilot Projects, and Medical and Health Sciences
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Too often, the role of nursing in geriatric neurorehabilitation is defined in terms of extending the care of other disciplines and assuring continuity of selected aspects of care over 24 hours. This article argues that nursing has made... more
Too often, the role of nursing in geriatric neurorehabilitation is defined in terms of extending the care of other disciplines and assuring continuity of selected aspects of care over 24 hours. This article argues that nursing has made significant clinical and scientific progress in contributing, independently and interdependently, to quality rehabilitation care for older adults; and that the role of nursing clearly exceeds the realm of mere extension and continuity of care. Reviewed are nursing's innovations in the areas of promoting comprehensive assessment; fostering functional independence, self-care, and self-care agency; enhancing communication; encouraging family involvement; improving cognitive status; and assuring quality physical care. We conclude with a discussion of the relationship of nursing to other disciplines, and how nursing's contributions can be optimized within the broader context of multidisciplinary geriatric rehabilitation.
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Mental health for older adults is a looming public health problem. Yet, geriatric mental health specialists are a scarce commodity, and few generalists have had formal education in either geriatrics or mental health. A multilevel... more
Mental health for older adults is a looming public health problem. Yet, geriatric mental health specialists are a scarce commodity, and few generalists have had formal education in either geriatrics or mental health. A multilevel collaboration using a diffusion of innovation model served to achieve change nationally in preparing entry-and advanced practice-level nurses to improve the mental health of older Americans. The John A. Hartford Foundation Geropsychiatric Nursing Collaborative at the American Academy of Nursing is the exemplar described here. The Geropsychiatric Nursing Collaborative developed and infused mental health competency enhancements for generalist and specialist nurses; identified and disseminated teaching-learning strategies to convey related key concepts using the POGOe (Portal of Geriatric Online Education) website; raised awareness through multiple presentations and publications; and notified deans of every school of nursing about these new resources. Fully embracing diffusion of innovation principles, the Geropsychiatric Nursing Collaborative is achieving change in this critical area of nursing practice.