Cognition and Self-Management in Type 2 diabetes in the older person was studied using neuropsychological evaluation and self-management assessments. Type 2 diabetes is increasing in prevalence, erodes quality of life, and places significant burden on healthcare services. The condition is largely self-managed, requiring daily performance of a variety of tasks. Impaired cognition has been associated with Type 2 diabetes, particularly in those who have had diabetes for longer or are older. It is unknown whether such changes in cognition seen in Type 2 diabetes affect the ability to self-manage the condition; the few studies that have been conducted in this area have shown little consensus in focus, methodology, or results. This thesis aimed to investigate any links between cognitive impairment and diabetes self management skills in an older population with Type 2 diabetes, by determining assessment schedules for both selfmanagement and cognition in this population and searching for associations between the two. Literature review, questionnaire and focus group studies pointed towards four main components of diabetes selfmanagement; diabetes knowledge, self-efficacy, motivation, and diabetesspecific problem solving abilities. A theoretical framework emerged from this analysis; Bandura’s Social Cognitive Theory provides a context for the interaction of environment, society and cognitions in health behaviours. A systematic review found several associations between self-management skills and abilities, and global and individual areas of cognition, including links between executive function and memory, and diabetes knowledge, insulin skills, adherence to medications, missed appointments, and decreased frequency of self-care activities. A further clinical study identified several associations including visual and working memory, and reaction times, with diabetes knowledge. Future studies with larger sample sizes might revisit these associations. Clinical implications include the need for routine cognitive assessment in an older population with Type 2 diabetes; interventions might include checking medication adherence, diabetes knowledge, and referral to support groups.

Darbo tikslas - išanalizuoti bendruomenės slaugytojų vaidmenį teikiant paliatyviosios priežiūros paslaugas. Darbo uždaviniai: 1. ištirti bendruomenės slaugytojų požiūrį į jų dalyvavimą nepagydoma liga sunkiai sergančių ligonių priežiūroje; 2. ištirti bendruomenės slaugytojų vaidmenį nepagydoma liga sunkiai sergančio ligonio priežiūroje; 3. ištirti bendruomenės slaugytojų vaidmenį teikiant paramą šeimai nepagydoma liga sunkiai sergančio artimojo priežiūros metu ir netekties atvejais; 4. išsiaiškinti priežastis, turinčias įtaką paliatyviosios pagalbos paslaugų teikimui Lietuvoje. Tyrimo metodika: tyrimas atliktas vienkartinės anoniminės apklausos būdu Kauno miesto atsitiktinės atrankos būdu parinktose 2 pirminės sveikatos priežiūros įstaigose 2008 m. kovo mėnesį. Tyrimo objektas – bendruomenės slaugytojų vaidmuo teikiant paliatyviosios priežiūros paslaugas nepagydoma liga sunkiai sergantiesiems ir jų artimiesiems priežiūros metu ir netekties atveju. Tyrime dalyvavo 64 bendruomenės slaugytojos. Naudota anoniminė anketa, sudaryta pagal literatūros analizę. Tyrimo išvados: 1. Slaugytojų požiūris į dalyvavimo nepagydoma liga sunkiai sergančių ligonių priežiūroje svarbumą priklauso nuo jų pasitenkinimo atliekamu vaidmeniu (p<0,05), tuo tarpu slaugytojų vaidmens lūkesčių atitikimas atliekamo darbo svarbai įtakos neturi (p>0,05). 2. Ištyrus bendruomenės slaugytojų vaidmenį nepagydoma liga sunkiai sergančio ligonio priežiūroje, nustatyta, kad bendruomenės slaugytoja dažniausiai... [toliau žr. visą tekstą] / Aim of study: to traverse community nurses role in lending palliative care assistance. Objectives: 1. To explore attitude of community nurses to rendering palliative care assistance. 2. To explore community nurses role in terminal ill patients care 3. To explore community nurses role in rendering family support during terminal ill patients care and bereavement 4. To find out a factors that have hold on rendering palliative care assistance by community nurses. Methods: the research was performed in the way of onetime anonymous questionnaire at Kaunas primary health institutions, in the march, 2006. The object of research – the community nurses role in rendering palliative care assistance to terminal ill patients and their family providing care and in bereavement. There were 64 community nurses. An anonymous questionnaire was used, which was developed according to literature analysis. Conclusions: 1. The community nurses attitude to importance of participation in terminal ill patient’s care is under influence of satisfaction with job (p<0,05) and is not under influence of nurses expectation of role (p>0,05). 2. After exploring community nurses role in terminal ill patient care, it was set, that nurses render palliative care assistance in a team in large part as family doctors assistant, also as health educator, consultant, render of health care assistance, while leading role is not prevalent. 3. After exploring community nurses role in lending support to terminal ill... [to full text]

Bendruomenės slaugytoja yra pirmasis asmuo, į kurį kreipiasi bendruomenės nariai, ištikus nelaimei, todėl esant poreikiui, slaugytojos teikia pagalbą bet kuriuo paros metu. Pacientų ir slaugytojų santykiai yra labai artimi, visapusiškai pasitiki, todėl slaugytojos neretai atlieka daugelį vaidmenų, reikalaujančius tarpdisciplininių žinių. Tai rodo slaugytojų didelį atsidavimą darbui ir atsakomybę už visapusišką bendruomenės narių sveikatą. Interviu analizė leido pamatyti bendruomenės medicinos punktų veiklos problemas: kitoje įstaigoje prisirašiusių asmenų aptarnavimo problema, bendradarbiavimo trūkumas su socialinių paslaugų teikėjais, bendruomenės slaugytojų savarankiškumo sumažinimas, rizikos grupės šeimų ir alkoholizmo problemos, kaimo retėjimo ir senėjimo problema. Pokyčių bendruomenės medicinos punktuose informantai nenori ir neorganizuoja, tenkinasi esama situacija. Anot respondentų, realiausia perspektyva – medicinos punktų uždarymas. Mobilių paslaugų idėjos įgyvendinimui respondentai griežtai priešinasi, nurodant tam įvairias priežastis: kiltų gyventojų nepasitenkinimas, nevisi bendruomenės nariai noriai įsileistų slaugytojas į namus, sumažėtų teikiamų paslaugų spektras ir PSP paslaugų prieinamumas. / The community nurse is the first person approached by the members of the community when disaster strikes, so if needed, nurses provide assistance at any time of the day. The relationships of patients and nurses are very close, so nurses often perform many different roles, which require interdisciplinary knowledge. It shows great dedication of nurses and the responsibility for comprehensive community health. Interview analysis identified community medical centers operating problems: serving customers which are not signed to the concrete community center, lack of cooperation with social service providers, loss of autonomy of community nurses, problems of families at risk and alcohol abuse, problems of village depopulation and aging. The informants do not organize any changes and are satisfied with the current situation of medical centers. Probably community medical centers will be closed in the future, but respondents were categorically against the idea of portable medical station, arguing, that: it would lead to dissatisfaction of community members, not all members of the community would be willing for nurses to come to their home, the range of services would reduce, the availability of primary health care would reduce.

The research investigates, qualitatively, the experience of primary caregivers of children who are ventilator-dependent and cared for at home. Advances in medical and nursing knowledge and technology have improved the biological outcome of children who are critically ill. As a result, there is an increasing number of children in hospital who are medically stable, however dependent upon long-term respiratory support. Due to the increasing change from healthcare delivery to home care, some ventilator-dependent children are discharged to their primary caregivers who undertake the medical and technical care of the children in their home. A review of the literature indicates limited research examining and addressing issues of pediatric home ventilation. Information concerning the experience and needs of the primary caregivers of an in-home ventilator-dependent child is thus unavailable for effective and appropriate clinical interventions and policy implementation. To address the gap in the literature, a phenomenographic research approach was used to identify and describe a limited number of qualitatively different ways in which the primary caregivers understood their experience of caring for a ventilator-dependent child at home. An in-depth interview was undertaken with each of those seventeen participants and recorded on audiotape for transcribing verbatim. Data was sorted using a qualitative software program--ATLAS.ti.--and analysed using a series of seven analytical steps recommended for a phenomenographic research (Dahlgren and Fallsberg, 1991). The outcomes of the research are seven categories of description with each representing a conception of the experience, and all categories combined constituting an outcome space that presents the structural relations between conceptions. The seven categories of description representing the care-giving experiences of the primary caregivers are: (1) 'Hospital is another world to me'; (2) 'It's a new world'; (3) An ambiguous social identity;(4) The medical technology associated with my child is frightening but necessary;(5) 'The difficulty is having the carers at home'; (6) Social isolation; and (7) The experience of changing as a person. Discussions on the outcomes of the research indicate a need for increased understanding of the 'new world' of the primary caregivers and a recognition and acknowledgement of the distinctive nature of the experience in caring for a ventilator-dependent child at home. Hence, increased financial, respite, psychological and social support are of central importance, in addition to ongoing healthcare research, education, and practice for appropriate policy development, implementation and evaluation.

The purpose of this study was to investigate the Hardiness level of battered women residing at a South Florida shelter and to investigate if there was a major difference in the hardiness level of women who were first time in a shelter as opposed to those who had been previously in shelters. Using a descriptive design, the Health-Related Hardiness Scale was given to 50 battered women residing at a shelter. The results confirmed our hypothesis that proposed that hardier women would leave their abusive environment. The total hardiness of these women was (M= 148.86 SD= 22.64). Furthermore, no major differences were found among the two groups, the total hardiness for the women who been in shelters before was (M=150.17 SD= 26.06) and for those who were first time users was (M=148.45 SD= 21.81). The results provide a baseline to begin to understand the role that hardiness play in the lives of battered women. These findings and future studies may have implications for breaking the cycle of domestic violence.

Depot medroxyprogesterone acetate (DMPA) is a long acting progesterone only contraceptive agent. Side effects such as irregular bleeding patterns and weight gain are attributed to discontinuation. The purpose of this study was to describe depot medroxyprogesterone acetate discontinuation after weight gain in 17 to 19 year-old adolescent girls.

Abstract Background: Access to adequate palliative care has been identified as a challenge globally, in Canada, and in the province of Ontario. While pockets of excellence exist, there is a national call for allocation of resources and implementation of best practices to improve the care for individuals with life limiting illnesses. Furthermore, the location of care along with a desire for dying at home has shifted responsibility onto family members often without the equivalent shift in community resources to meet patient and family needs. To respond to issues of access and quality, nurse practitioners (NPs) have been increasingly added to diverse practice settings across the globe and research showing how they are contributing to diverse care settings. As a strategy to improve community palliative care locally, NPs have been added to community settings in Ontario. However, because NPs are new to palliative care settings little is known about how NPs enact their role within this unique context. NP role enactment is defined as the actual activities that NPs engage in that constitute their daily work. Aim: The purpose of this study is to better understand how NPs enact their role as consultants in a specific community palliative care setting in Ontario. Methodology and Methods: A focused ethnography was conducted in one specific geographic health administration region of Ontario between July of 2018 and October of 2020. A convenience sample was used recruiting NPs from one community palliative care consultation team. Data collection methods included observation (487.5 hrs over 89 discrete observation sessions, distributed across 7 study participants), fieldnotes and semi-structured interviews with participants (n = 7 NPs). Results: The NPs enacted their role with patients by formulating relationships, that for them, facilitated a deeper understanding of the patient and family situation, strengths, challenges and desires. Using conversations and conversational skills to have difficult and important conversations, NPs facilitated future planning for patients. Conversations also included addressing questions about MAiD, which were nuanced and often about more than MAiD, also addressing fears of suffering and uncertainty. The NPs used advanced clinical judgment and skill to diagnose and treat complex and difficult to manage symptoms and supported families to understand complicated medication regimes. Valuing their role as educators, the NPs supported their peers by offering teaching and providing clinical support in complex care scenarios. Pull together disparate and loosely connected care providers, NPs created a shared understanding of patient needs. Deficiencies in community care resourcing and organization made it difficult at times for NPs to facilitate continuity in care or to build capacity. The NPs often navigated an environment where nursing staffing was transient, inconsistent and overextended and where physicians were inconsistently available to support rapidly evolving situations. Conclusion: Findings suggest that NPs have an important role to play in supporting patients and families as well as supporting their nursing and physician colleagues. Furthermore, the broader system would benefit from embedding palliative care NPs more systematically. However, broader structural enhancements like shared communication and documentation mechanisms and adequate staffing across care settings need to be addressed to maximize the potential contributions NPs are able to offer.

The Visiting Nurse Association of Indianapolis, formerly the Public Health Nursing Association of Indianapolis, is a nonofficial community agency in Marion County. It was incorporated January 11, 1913. According to its constitution, it was organized to "provide graduate registered nurses to teach needy individuals and the general public hygiene, cleanliness, and the proper care of the sick; to prevent disease; and to render such aid as may from time to time be proper."I This organization has provided nursing care in homes, in clinics, in industries, and in other situations outside the hospitals since its beginning. Since 1921 it also has provided field experience for student nurses from basic schools of nursing and since 1937, for students from Indiana University, Division of Nursing Education. The purpose of this paper is to present an historical account of the activities of the Visiting Nurse Association from 1913 through 1959.

Obesity and inactivity are prevalent among central Appalachian adolescents. Appalachian residents have been labeled "fatalistic," a time perspective unsupportive of health-promoting behaviors such as regular participation in physical activity. The theory of planned behavior has been used extensively to explain the physical activity behaviors of adolescents. Constructs within the theory of planned behavior include attitudes toward the behavior, subjective norms, perceived behavioral control, and intention to perform the behavior. The purpose of this study was to determine the time perspective of central Appalachian adolescents and examine the relationship between time perspective and the constructs within the theory of planned behavior. A descriptive, correlational design was used to examine time perspective and the physical activity behaviors of a convenience sample of 185 central Appalachian adolescents. Data collection occurred in school. Results indicate central Appalachian adolescents are hedonistic with positive attitudes toward the past. Females were more future-oriented than males. Future oriented students were more likely to plan to attend college. Constructs within the theory of planned behavior were moderate predictors of physical activity that lasted long enough or was intense enough to produce sweat.

BACKGROUND: This presentation concerns the evaluation of an additional clinical experience in case management for senior baccalaureate students. During their final leadership course, nursing students can elect to do an additional 80-hour precepted clinical experience focusing on case management in primary care clinics. As part of that experience, they rotate through seven nurse-managed rural primary health clinics in Tennessee. METHOD: As part of the evaluation process, students and preceptors were asked to review the experiences that students had participating in the clinical. RESULTS: For the most part, students were highly satisfied with the case management experience and thought it provided an additional skill set for them as they were completing their final year in nursing school and preparing to enter the nursing workforce as graduates of the Bachelor of Science in Nursing program. CONCLUSION: A community case management clinical opportunity in primary care allows a community experience for students that provides them with an opportunity to witness an RN practicing to the full scope of the license.