Suchergebnisse

Sequential mixed methods is a useful research design to inform second-stage methodology when investigating an area of practice in which relatively little is known. This article describes how focus group findings were used to measure advance care planning practice among community-based case managers. The initial qualitative study utilized focus groups to explore aspects of practice in this area. Data revealed themes that embodied ambiguous views of advance care planning, divergent roles in practice, a continuum of practice activities, and multiple facilitators and barriers to practice. In order to further examine case managers' advance care planning practices, qualitative findings were used to develop the Case Managers Advance Care Planning Practices Instrument. Implications for qualitative to quantitative measurement are discussed.

Many more people are reaching old age than ever before, and older people are increasingly living longer. As the nation experiences this unprecedented growth of older Americans, geriatric case managers are likely to encounter many clients at very advanced ages. Concomitantly, practitioners will confront elders with questionable decision-making capacity, as dementia and other cognitive impairments are more common among the older age groups. These clients pose potential safety and well-being concerns and may be vulnerable to exploitation, neglect, and abuse in their homes. Case managers' responses to such client scenarios may range from little involvement, by acquiescing to the client's right to make autonomous decisions, to resorting to legal action, which may lead to a substantial loss of rights for the elder. This article provides considerations for practice with elders presenting with questionable decision-making capacity and precarious living situations. The distinction between capacity and competency is presented and factors affecting decision making are discussed. Ethical aspects are addressed and the process of assessing capacity is reviewed to enhance case managers' practices in this area.

Mounting efforts to improve care and promote healthy aging throughout society and across the care continuum have created unique opportunities for gerontological nursing practice. Population aging has invoked a multitude of responses among all levels of international and national organizations, foundations, health care, and government to meet the needs and promote preferences of older adults. Large-scale programs by the World Health Organization, The John A. Hartford Foundation, Institute for Health-care Improvement, and Trust for America's Health have galvanized to advance the momentum of age-friendly communities, health care, and public health. Gerontological nurses can leverage this growing interest in aging by enhancing their knowledge about age-friendly movements, influencing these movements with their expertise in evidence-based practices, and advancing their own competencies in caring for older adults in any setting.

Because of their mouthing behaviors, children have a higher potential for exposure to available chemicals through the nondietary ingestion route; thus, frequency of hand‐to‐mouth activity is an important variable for exposure assessments. Such data are limited and difficult to collect. Few published studies report such information, and the studies that have been conducted used different data collection approaches (e.g., videography versus real‐time observation), data analysis and reporting methods, ages of children, locations, and even definitions of "mouthing." For this article, hand‐to‐mouth frequency data were gathered from 9 available studies representing 429 subjects and more than 2,000 hours of behavior observation. A meta‐analysis was conducted to study differences in hand‐to‐mouth frequency based on study, age group, gender, and location (indoor vs. outdoor), to fit variability and uncertainty distributions that can be used in probabilistic exposure assessments, and to identify any data gaps. Results of this analysis indicate that age and location are important for hand‐tomouth frequency, but study and gender are not. As age increases, both indoor and outdoor hand‐to‐mouth frequencies decrease. Hand‐to‐mouth behavior is significantly greater indoors than outdoors. For both indoor and outdoor hand‐to‐mouth frequencies, interpersonal, and intra‐personal variability are ∼60% and ∼30%, respectively. The variance difference among different studies is much bigger than its mean, indicating that different studies with different methodologies have similar central values. Weibull distributions best fit the observed data for the different variables considered and are presented in this article by study, age group, and location. Average indoor hand‐to‐mouth behavior ranged from 6.7 to 28.0 contacts/hour, with the lowest value corresponding to the 6 to <11 year olds and the highest value corresponding to the 3 to <6 month olds. Average outdoor hand‐to‐mouth frequency ranged from 2.9 to 14.5 contacts/hour, with the lowest value corresponding to the 6 to <11 year olds and the highest value corresponding to the 6 to <12 month olds. The analysis highlights the need for additional hand‐to‐mouth data for the <3 months, 3 to <6 months, and 3 to <6 year age groups using standardized collection and analysis because of lack of data or high uncertainty in available data. This is the first publication to report Weibull distributions as the best fitting distribution for hand‐to‐mouth frequency; using the best fitting exposure factor distribution will help improve estimates of exposure. The analyses also represent a first comprehensive effort to fit hand‐to‐mouth frequency variability and uncertainty distributions by indoor/outdoor location and by age groups, using the new standard set of age groups recommended by the U.S. Environmental Protection Agency for assessing childhood exposures. Thus, the data presented in this article can be used to update the U.S. EPA's Child‐Specific Exposure Factors Handbook and to improve estimates of nondietary ingestion in probabilistic exposure modeling.