Construction of a tool to assist nurses to assess the abilities of patients, with chronic conditions, to feed themselves was based upon twenty-one identified feeding behaviors derived from observations of a random sample of fifty such patients from two urban hospitals. Observations were also made of the nurses who cared for these patients. Identifying specific behavior items was concurrent with defining five categories along the dependence-independence continuum during analysis of the data. A 3:1:1 ratio for weighting behavioral components was established arbitrarily. The Kenny Self-care five point numerical rating scale was adapted to provide a method of determining the amount of help a patient would require to feed himself. Experts in the field agreed, with minor modifications, that the tool could determine a measure of independent feeding. A reliability test, using eight pairs of registered nurses to assess thirty-two patients produced a reliability coefficient of .849; evidence that this tool is dependable and consistent in measuring the relative state of feeding dependence-independence of patients with chronic conditions. Rating behaviors provides written evidence of the degree to which the patient is able to feed himself. The difference between what a patient can do and the criteria for independent feeding provides a measure of the help a patient will require to feed himself. Further research is indicated in the areas of usefulness of the tool for registered nurses, identifying psychosocial behaviors more precisely, testing the tool in different feeding situations and expansion of the tool to include the other activities of daily living. / Applied Science, Faculty of / Nursing, School of / Graduate

Using symbolic interaction as a theoretical framework, the researcher explored the nurses' interpretation of their interactions with elderly, confused patients for the purposes of understanding nurses' behavior and of implementing more effective nurse-patient interactions. Qualitative data were collected during interviews with 18 registered nurses currently working either full-time or part-time in one of three extended care units. Findings indicated that the nurses perceived specific patient behaviors, nurse behaviors, and external factors as influencing all phases of this interaction. Six categories of patient behaviors emerged from the data. These categories are: (a) disruptive behaviors, (b) contextually inappropriate behaviors, (c) unintelligible behaviors, (d) memory-impaired behaviors, (e) unproductive repetitions, and (f) unpredictable fluctuations. These behaviors influenced the nurse-patient interaction by reducing the frequency with which nurses attached understandable meaning to patients' behavior, thereby reducing the effectiveness of and their satisfaction with the interaction. The nurses' perceived that their behavior influenced the type, frequency, and duration of nurse-patient communication, the degree to which the interaction was individualized and patient focused, and the extent of patient control during the interaction. When patients influenced nursing behaviors in ways that reduced the frequency and person-oriented nature of the interaction, the nurses experienced the interaction as stressful and dissatisfying and subsequently withdrew to some degree. External factors described as personal, interpersonal, and impersonal either facilitated or impeded the nurses' ability to assign understandable meaning to patients' behavior. The amount of understanding that occurred influenced the quality of care and communication and the amount of stress experienced by the nurse. The findings suggest that geriatric nurses should focus their behavior on patients' psychosocial and emotional needs in addition to their physical needs. Nurses must be aware of the impact of behavior identified as confusion on the interaction. In response they must direct their caregiving and communication behaviors toward minimizing the impact of the reduced understanding that occurs during the interaction. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of the present study was to attempt to use the principles of behavior therapy and group psychotherapy to enhance social adjustment of the geriatric patients in an institutional environment. There are several factors positively related to satisfactory adjustment to old age such as educational level, marital status, employment history, religion, health, and membership in groups.

As women age, they face challenging health issues. Their average life expectancy is longer than their male counterparts, yet they often have multiple chronic, ongoing health problems that complicate their care, accentuate their infirmity, and reduce their quality of life. Often, they fail to receive the same quality or amount of healthcare service, sometimes because of a lack of data specific to their demographics, at other times for myriad unclear reasons. What data are available suggest that they will usually glean the same benefits as their male and younger female counterparts, often with little increased risk of adverse effects from available medical diagnostic and therapeutic options. Cardiovascular disease, malignancies, musculoskeletal disorders (particularly osteoporosis), and cognitive and psychiatric illness are the most frequent, and often most devastating, health issues in this growing segment of the population. An understanding of the differences in disease frequencies, presentations, and response to treatments is necessary to provide older adult women with optimal health care.

As women age, they face challenging health issues. Their average life expectancy is longer than their male counterparts, yet they often have multiple chronic, ongoing health problems that complicate their care, accentuate their infirmity, and reduce their quality of life. Often, they fail to receive the same quality or amount of healthcare service, sometimes because of a lack of data specific to their demographics, at other times for myriad unclear reasons. What data are available suggest that they will usually glean the same benefits as their male and younger female counterparts, often with little increased risk of adverse effects from available medical diagnostic and therapeutic options. Cardiovascular disease, malignancies, musculoskeletal disorders (particularly osteoporosis), and cognitive and psychiatric illness are the most frequent, and often most devastating, health issues in this growing segment of the population. An understanding of the differences in disease frequencies, presentations, and response to treatments is necessary to provide older adult women with optimal health care.

The EPP Project was a descriptive and inferential study designed to determine the psychosocial and medical needs of elderly post-hospital dischargees. The areas of need assessed were (1) living arrangements, (2) use of leisure time, (3) vocational adjustment, (4) financial functioning and (5) adjustment to illness. The instrument adopted for the purpose of this study was an adaptation of a scheduled in the New York Study. The New York Study, described in The Elderly Ambulatory Patient: Nursing and Psychosocial Needs by Doris Schwartz, Barbara Henley and Leonard Zeitz was a long-range study of the needs of elderly clinic patients. The schedule utilized both open-end and structured responses. Interviews were conducted in the homes of respondents. A sample of 63 patients was drawn and found from a population of elderly dischargees of the Kaiser Foundation Hospital in Portland, Oregon. The study group was composed of 20 patients adjudged by their physicians as having a high probability of need for post-hospital skilled nursing care. The control group included 43 patients systematically selected from a sample of the general hospital populace of elderly patients discharged during the same period of time as the study group and not considered to be in need of special nursing services. Findings yielded evidence to support the hypothesis that patients adjudged by the doctors as having more medical needs also had more social needs. A second hypothesis stating that medical and social needs of the study group were the same as medical and social needs of the control group was rejected. Those in the study group evidenced greater medical and related social needs. The third hypothesis sought to test the reliability of the Greenlick prediction formula, an instrument used in a previous Kaiser Hospital study to estimate the need for skilled nursing service in a population following hospital discharge. Findings indicated that the Greenlick prediction formula was effective in ascertaining need for immediate post-hospital care and was effective, with greater variance, in predicting needs over time. The final hypothesis asserted that the needs of the patients in the EPP Project were the same as those determined in the New York Study. This hypothesis was rejected when analysis of data yielded evidence that the patients in the EPP Project functioned at a higher level in all areas considered than did the patients in the New York Study. Unexpectedly, the findings disproved the stereotype emphasized in social work literature characterizing the elderly as being needy and in distress both socially and medically. On the contrary, findings indicated that such unqualified generalizations about elderly patients as a homogeneous group cannot appropriately be made. Collection and analysis of the data pointed to the need for social work services in the area of budgeting for medical expenses and utilization of appropriate community resources. A further indication was the need for volunteers to provide services such as transportation to enhance participation in social and recreational activities. The use of volunteers would also facilitate grocery shopping and obtaining medical attention. Implications for further research suggested the need for additional empirical studies of elderly post-hospital patients in a variety of settings.

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