As dementia progresses older adults may lose the ability to communicate their pain experiences to healthcare providers, relying on the ability of the provider to infer their pain (Kelley, Siegler, & Reid, 2008; Pesonen et al., 2009). In the long-term care setting, the licensed nurse and certified nurse aide provide direct patient care to these residents and may be more likely to identify nonverbal behaviors that may indicate pain (Nygaard & Jarland, 2006; Pautex, Herrmann, Michon, Giannakopoulos, & Gold, 2007). The Conceptual Model for Assessing Pain in Nonverbal Persons with Dementia highlights provider, patient, and method-related factors that can hinder the process of inferring pain in nonverbal persons with dementia. The purpose of this dissertation is to explore the impact of these potential barriers on pain assessment/screening. Each chapter of this dissertation explores provider, patient, or method-related factors that impair the judgment of pain in others, either through an integrative review of the literature or by secondary analysis of a data set that was originally collected for the psychometric evaluation of the Non-communicative Patient's Pain Assessment Instrument. Statistical analysis was completed using SPSS version 21.0. Results indicate that nurse-related factors are well supported in the literature as barriers to pain assessment and can impair the nurses' pain assessment decisions. Ethnic differences in the expression of the nonverbal pain behavior "pain words," signify the role of patient-related factors on the pain assessment process. Lastly, examination of method-related factors support the benefits of training staff to use nonverbal pain assessment tools, with those staff members who were trained having greater accuracy in pain assessment when compared to untrained raters. In closing, this dissertation has implications for nursing science, education, policy, and practice and serves as a valuable contribution to the current literature.

<p>In Alzheimer association’s clinique practice, there was a need to communicate with people with mild dementia. Videophone is considered as one of the best assistive communication tool for these people since video communication is not only a tool to break an isolation caused by the disease, but also a powerful way to help people demonstrate their ideas and understand what is said in a conversation with pictures, signs and body language. Therefore, an easy-to-use videophone for people with mild dementia is needed.</p><p>The goal of this master thesis is to design a graphical user interface (GUI) of an easy-to-use videophone for people with mild dementia according to their characteristics and difficulties of using everyday technology. User centered design (UCD) was used in the design. To get familiar with the user, literature research was conducted before design.</p><p>Low-fidelity prototype was created. With the help of Karolinska institute’ research group on people with dementia, the prototype was refined twice. Based on the refined low-fidelity prototype, an interactive prototype with navigation, sound and animation effect was created. A usability testing was conducted on older adults with this interactive prototype.</p><p>In addition to the GUI of functions for people with mild dementia, GUI of functions for other care givers was also created and presented in this master thesis.</p>

In Alzheimer association’s clinique practice, there was a need to communicate with people with mild dementia. Videophone is considered as one of the best assistive communication tool for these people since video communication is not only a tool to break an isolation caused by the disease, but also a powerful way to help people demonstrate their ideas and understand what is said in a conversation with pictures, signs and body language. Therefore, an easy-to-use videophone for people with mild dementia is needed. The goal of this master thesis is to design a graphical user interface (GUI) of an easy-to-use videophone for people with mild dementia according to their characteristics and difficulties of using everyday technology. User centered design (UCD) was used in the design. To get familiar with the user, literature research was conducted before design. Low-fidelity prototype was created. With the help of Karolinska institute’ research group on people with dementia, the prototype was refined twice. Based on the refined low-fidelity prototype, an interactive prototype with navigation, sound and animation effect was created. A usability testing was conducted on older adults with this interactive prototype. In addition to the GUI of functions for people with mild dementia, GUI of functions for other care givers was also created and presented in this master thesis.

Little is known about Registered Nurses (RNs) and their work in northern Canada and the care of older adults with dementia in this setting. As the prevalence of dementia is predicted to increase over the next 30 years, the purpose of this project was to discover key concepts that depicted salient issues in dementia care in northern Saskatchewan from the perspective of RNs working in northern health care facilities. A sequential exploratory mixed method design was chosen for this study with a qualitative lead complemented by a secondary analysis of quantitative data. <p>Interviews were conducted with 14 RNs, employed in small northern Saskatchewan communities, about their experiences with dementia caregiving and their perceptions of dementia care resources. The grounded theory method used in analysis of the interview data resulted in the construction of the theory, Insulating and Expanding the Awareness of Dementia in Northern Nursing. The study identified three categories of conditions that influenced awareness of dementia: Dementia Care and Community Caregiving, Characteristics of the Northern RN, and Northern Nursing Worklife. The quantitative secondary analysis, using a north-south comparison of data from the national survey (Stewart et al., 2005) in the multi-method study The Nature of Nursing Practice in Rural and Remote Canada (MacLeod et al., 2004), was used to explore contextual elements identified in the grounded theory analysis. The comparison of nursing practice in northern (n = 597) and southern (n = 2154) rural and small town communities found that fewer RNs in northern Canada reported dementia as a client characteristic, worked in long-term care, or in home care nursing positions, compared to RNs in southern Canada. Findings from both the qualitative and quantitative studies contribute to an understanding of the RNs awareness of dementia. Recommendations for increasing the awareness of dementia in northern nursing practice include enhancing the resources and services available to older adults with dementia in small northern communities. It is hoped that further exploration of dementia within northern communities will result in improved care for individuals with dementia and their families.

As the Canadian population ages, the burden on our community and health care systems of age-related conditions, such as dementia, is increasing and research in these areas is becoming more critical. Dementia is a major health concern for adults as they age. Although dementia is the most common neurological disease in older adults, headaches are the most common neurological disorder across all ages. Migraines are a common form of headache disorders that affect millions of people worldwide. Both neurological disorders—dementia and migraines—cause significant impairment for the individual and strain on their caregivers, as well as substantial economic impact on society. The relationship between migraines and late-life cognitive health outcomes has not yet been thoroughly explored. Using data from the Manitoba Study of Health and Aging (MSHA), the relationship between migraines and various late-life cognitive health outcomes, including overall dementia, Alzheimer’s disease (AD), vascular dementia (VaD) and cognitive impairment-no dementia (CIND), was examined. As migraines and cognitive impairments are often associated with various comorbid disorders, analyses also investigated the impact of possible associated intervening variables: hypertension, diabetes, stroke, myocardial infarction and other heart conditions. A secondary focus of this project was to examine whether the association between migraines and late-life cognitive health outcomes varied by sex and family history of dementia. Migraines were a significant risk factor for both overall dementia and AD. However, the relationship between migraines and overall dementia appeared to be driven by the significant relationship between migraines and AD. Having a history of migraines was not significantly related to VaD. However, stroke was a statistically significant intervening variable in the relationship between migraines and VaD, indicating that the vascular event, stroke, plays an important part in the migraine-VaD relationship. A history of migraines was not a significant risk factor for CIND. Results could not be stratified by sex because of all participants with migraines, no men developed dementia and only one man developed CIND. Furthermore, despite a lack of significant results from models stratified by family history of dementia, the results are suggestive of possible genetic influences in the relationship between migraines and AD. Overall, this study supports the conclusion that migraines are a significant risk factor for late-life cognitive health, specifically AD. In addition, this study highlights the possibility that vascular events, such as stroke, may play an important role in the relationship between migraines and VaD. Increased understanding of mid-life risk factors for late-life cognitive health outcomes has important implications for researchers and clinicians in the form of interventions, preventative treatments and medications. In addition, this study suggests that there is a need for further research regarding possible genetic influences in the relationship between migraines and AD. As it was unable to be fully addressed in this study, future studies should investigate gender differences among individuals with migraines developing late-life cognitive health outcomes. This research aims to help develop new strategies that could aid in the prevention of cognitive decline, improve quality of life, and increase the likelihood of healthy aging.

Little is known about Registered Nurses (RNs) and their work in northern Canada and the care of older adults with dementia in this setting. As the prevalence of dementia is predicted to increase over the next 30 years, the purpose of this project was to discover key concepts that depicted salient issues in dementia care in northern Saskatchewan from the perspective of RNs working in northern health care facilities. A sequential exploratory mixed method design was chosen for this study with a qualitative lead complemented by a secondary analysis of quantitative data. <p>Interviews were conducted with 14 RNs, employed in small northern Saskatchewan communities, about their experiences with dementia caregiving and their perceptions of dementia care resources. The grounded theory method used in analysis of the interview data resulted in the construction of the theory, Insulating and Expanding the Awareness of Dementia in Northern Nursing. The study identified three categories of conditions that influenced awareness of dementia: Dementia Care and Community Caregiving, Characteristics of the Northern RN, and Northern Nursing Worklife. The quantitative secondary analysis, using a north-south comparison of data from the national survey (Stewart et al., 2005) in the multi-method study The Nature of Nursing Practice in Rural and Remote Canada (MacLeod et al., 2004), was used to explore contextual elements identified in the grounded theory analysis. The comparison of nursing practice in northern (n = 597) and southern (n = 2154) rural and small town communities found that fewer RNs in northern Canada reported dementia as a client characteristic, worked in long-term care, or in home care nursing positions, compared to RNs in southern Canada. Findings from both the qualitative and quantitative studies contribute to an understanding of the RNs awareness of dementia. Recommendations for increasing the awareness of dementia in northern nursing practice include enhancing the resources and services available to older adults with dementia in small northern communities. It is hoped that further exploration of dementia within northern communities will result in improved care for individuals with dementia and their families.

Thesis (Ph. D.)--Washington State University, December 2009. / Title from PDF title page (viewed on Dec. 16, 2009). "School of Economic Sciences." Includes bibliographical references.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2003. / Vita. Includes bibliographical references (leaves 74-84).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences