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1780 results in Nursing

Page 63 of 89

  • 14 - Chronic obesity

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 210-225

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the underlying pathophysiology of chronic obesity and the associated risk factors

  • • describe health promotion and prevention strategies appropriate for individuals who are overweight and obese

  • • understand the nurse's role in the management of the chronically obese individual

  • • appreciate the impact chronic obesity has on the future of health care

  • • recognise the importance of advanced nursing practice in the management of obesity.

    • Introduction

    The worldwide prevalence of chronic obesity is rising and Australia is no exception with approximately 60 per cent of adults and 25 per cent of children classified as either overweight or obese (Grima & Dixon, 2013). The public health burden of obesity is significant as it is closely associated with other chronic conditions including cardiovascular disease and diabetes mellitus (Schuklenk & Zhang, 2014). Chronic obesity has not only physical implications for the individual – excess weight is closely associated with a reduced quality of life and an increased risk of morbidity and mortality (Grima & Dixon, 2013).

    Obesity is defined as an excessive accumulation of adipose tissue with potentially negative health consequences (Townsend & Scriven, 2014). There are a number of methods that can be used to measure obesity. The more commonly used methods include the body mass index (BMI), a weight-for-height calculation which determines weight status (Townsend & Scriven, 2014), and abdominal circumference measurements, both of which are simple and cost-effective assessment tools (Schuklenk & Zhang, 2014). However, the limitation of BMI measurement is that it fails to consider additional factors that can influence weight, including gender, age, bone structure, fat distribution and muscle mass (Schuklenk & Zhang, 2014), and is therefore an inaccurate reflection of adiposity (Townsend & Scriven, 2014). Abdominal circumference measurements, which indicate central obesity, are considered to more accurately reflect total body fat (Townsend & Scriven, 2014). This specific type of obesity measurement takes into consideration not only the degree of adipose tissue which is present but also where the fat is distributed, and suggests that greater levels of adipose tissue around the midsection are linked to poorer health outcomes (Rossen & Rossen, 2012).

    The nursing workforce spans an assortment of clinical settings, therefore placing nurses at the forefront of health promotion and obesity prevention.

  • 7 - Chronic cardiovascular conditions

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 96-112

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • demonstrate knowledge of the underlying pathogenesis of cardiovascular conditions and their associated risk factors

  • • recognise the importance of health promotion and prevention in the management of chronic cardiovascular conditions

  • • understand the concepts of patient-centred care and care coordination in relation to chronic cardiovascular conditions

  • • identify the nurse's role in the care of chronic cardiovascular conditions

  • • identify the characteristics of the role of a nurse who practises at an advanced level in cardiovascular health.

    • Introduction

    Cardiovascular disease (CVD) is considered the main contributor of death and disease burden in Australia and New Zealand. In 2012, CVD accounted for approximately 30 per cent of all deaths recorded within both nations (Department of Health, 2015; National Heart Foundation of New Zealand, 2015). This is the result of increased longevity and advances in CVD treatments (Department of Health, 2015). The successful management of CVD requires a number of key strategies, including continuous monitoring, prevention, risk factor reduction and advanced clinical management (Mendis, Puska & Norrving, 2011). Patients suffering from CVD are found across a variety of care environments. The nurses who provide care to these individuals are required to possess skills and knowledge that will enable optimal patient outcomes.

    The term ‘cardiovascular disease’ is used in reference to health conditions that affect the heart and blood vessels. This includes coronary heart disease (also known as ischaemic heart disease), acute myocardial infarction, heart failure and cardiomyopathy, hypertension, peripheral vascular disease and stroke (Department of Health, 2015). It is important to realise that CVDs are largely preventable. Increasing and improving health care access, in conjunction with early identification and reduction of CVD risk factors, may lead to a decrease in the health burden to which this collection of chronic conditions contributes (Mendis et al., 2011).

    This chapter focuses on several key issues relating to chronic CVD. The pathophysiology of the differing disease processes associated with CVD will be outlined. The importance of health prevention and promotion in CVD will be discussed, highlighting primary and secondary prevention.

  • 10 - Mental health issues of a psychotic nature

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 143-158

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • describe the challenges that face people experiencing mental health issues of a psychotic nature

  • • discuss the factors that increase the risk of experiencing mental health issues of a psychotic nature – pathophysiology and social determinants

  • • outline the principles underlying trauma-informed care

  • • discuss the significant features of recovery principles

  • • identify actions to support health promotion in relationship to mental health issues

  • • describe the various nursing roles and settings when working with people experiencing mental health issues of a psychotic nature.

    • Introduction

    This chapter focuses on the complex nature of psychotic illnesses and describes the care approach known as trauma informed strength based holistic care. Psychotic illness has been defined as a ‘low prevalence’ condition, but it is often more severe and enduring than this would suggest, and can require complex care (Morgan et al., 2014; Sara, Burgess, Malhi, Whiteford & Hall, 2014).

    Psychotic illnesses are conditions with varying symptoms. Each is an individual clinical presentation making diagnosis and treatment difficult. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) (American Psychiatric Association, 2013, p. 87) defines psychotic illnesses by abnormalities in one or more of the five areas of hallucination, delusions, disorganised thinking (speech), grossly disorganised or abnormal motor behaviour and negative symptoms. People experiencing psychotic illnesses may exhibit disturbances in thinking, perception, emotional responses and behaviour (Morgan et al., 2011).

    The DSM-V (American Psychiatric Association, 2013) categorises a broad spectrum of psychotic illnesses with the most common being schizophrenia, bipolar disorder, schizoaffective disorder, schizotypal (personality) disorder, brief psychotic disorder and schizophreniform disorder. Age of onset is in the late teens to early adulthood, with males (3.7 cases per 1000) experiencing earlier episodes and more frequent episodes than females (2.4 cases per 1000). Early onset disrupts a person's development of critical life skills, education, employment and relationships (Morgan et al., 2011). Table 10.1 lists the features of different psychotic disorders.

    In 2010, 4.5 people per 1000 in the Australian population, aged 18 to 64 years, were living with a psychotic illness and in contact with the public health system (Morgan et al., 2011). This accounts for a third of individuals living with a severe mental illness (Department of Health, 2013).

  • Three - Critique of active ageing models

  • Virpi Timonen, University of Dublin Trinity College
  • Book:
    Beyond Successful and Active Ageing
    Published by:
    Bristol University Press
    Published online:
    01 September 2022
    Print publication:
    29 April 2016, pp 35-60

  • Summary

    The previous chapter outlined the argument that the successful ageing paradigm seamlessly ‘translated’ or ‘migrated’ into the anti-ageing industry (Flatt et al, 2013). In this chapter, I argue that successful ageing ideas have also made their mark on policy, feeding into the notion of active ageing. Active ageing is ‘primarily a policy concept’ (Juul Lassen and Moreira, 2014, p 33). Gerontologists have contributed to the translation of successful ageing ideation into the policy sphere, where the ideas take on a more practice-oriented form; this is a manifestation of what I call modelling ageing.

    The meaning of active ageing remains somewhat vague, largely because the actors who employ the concept use it ‘as a convenient term for a wide range of policy discourses and responses concerning demographic change’ (Walker and Foster, 2013, p 28). Despite this blanket application, Foster and Walker (2015) argue that active ageing has emerged in Europe as ‘the foremost policy response to the challenges of population aging’ and that it ‘presents a more holistic, lifecourse- oriented approach than successful aging’ (p 83). Immediately following this statement, however, Foster and Walker qualify that the active ageing perspective ‘has been dominated by a narrow economic or productivist perspective that prioritizes the extension of working life’ and ‘has also been gender blind’ (p 83). Foster and Walker argue that the active ageing paradigm is split into two contrasting branches, one focused on productivity and employment, the other more ‘social’ and all-encompassing; a ‘comprehensive, non-coercive and inclusive approach’ in keeping with the latter type of active ageing is endorsed by Foster and Walker (2015, p 84). Their view of the concept is deeply bifurcated into ‘the good’ meaning of active ageing (understood as attempts to help everyone to age well, in accordance with their resources and with the help of supportive policies) and the ‘bad’ meaning of active ageing (understood as agendas for driving productivity and growth without regard to structural barriers that many older adults face). The parallels to the confusion over the meaning of the concept, and the objectivist and subjectivist understandings of successful ageing (outlined in Chapter Two) are striking.

  • Five - Towards a theory of model ageing

  • Virpi Timonen, University of Dublin Trinity College
  • Book:
    Beyond Successful and Active Ageing
    Published by:
    Bristol University Press
    Published online:
    01 September 2022
    Print publication:
    29 April 2016, pp 87-102

  • Summary

    In this chapter, I take the first steps towards the model ageing theory. I employ the term ‘model’ in two different but closely related ways.

    First, I use it to describe what various actors do with and to ageing, and what then ensues: they model (verb) old age and the people who are defined as old. As a result of this modelling, different models (noun) of what are good, appropriate, proper ways to age have come into existence. Use of the terms successful ageing, active ageing, positive, healthy, productive ageing and so on is ubiquitous and variable. However, all these concepts attempt to model ageing as a phenomenon and stage of life that is perceived to be in need of direction, reshaping and control.

    For instance, gerontologists model (verb) successful ageing by generating data on how people within the older population fare (how long they live, how healthy they are, to what extent they take part in paid and unpaid work) and then assigning labels that signal how different categories of old people are performing (‘normal ageing’, ‘pathological ageing’, ‘successful ageing’ and so on). In addition to gerontologists, policy makers are very interested in older adults, and so they have also sought to model (verb) old age policy and older adults’ incentive structures in a particular way, for instance in a direction that would be encouraging of longer working lives. Businesses and entrepreneurs are another group interested in old people, in their case as consumers of goods and services, and so they also model (verb) their target group in a particular way: typically as dynamic and attractive, provided they become consumers of various goods and services.

    As a result of the efforts of these actors who model ageing, models (noun) of ageing have come into existence. For instance, the model (noun) of old age that suggests that older adults should continue working until retirement – and preferably longer – is now firmly a part of the definition of how to age appropriately in most developed welfare states. Another widespread model (noun) of ageing pertains to the idea that older adults should consume goods and services, that is, that they should promote both their own well-being and the good of the economy as a whole through their consumer power and choices.

  • One - Paradoxes and puzzles in ageing societies

  • Virpi Timonen, University of Dublin Trinity College
  • Book:
    Beyond Successful and Active Ageing
    Published by:
    Bristol University Press
    Published online:
    01 September 2022
    Print publication:
    29 April 2016, pp 1-12

  • Summary

    Puzzlement and curiosity underlie all discoveries and advancement of understanding. The discourses and scripts around ageing are replete with paradoxes, puzzles and contradictions that make me wonder about the ageing societies we live in. Paradoxes, puzzles and contradictions can be frustrating in practice, but they are also ripe material for theorising because they make us ask: ‘why do they exist?’ and ‘what do they tell us?’ – and even ‘whose interests do they serve?’ In the course of seeking to understand seemingly irreconcilable and contradictory phenomena, theory in the sense of accounts of what explains the existence of and relationships between (conflicting) concepts emerges. I will begin by drawing out some of the key paradoxes and puzzles in contemporary ageing-related discourses, with a view to identifying sensitising concepts that are important starting points in developing new critical insights and theory.

    Despite policy documents, marketing and media exhorting older adults to remain active contributors to society and to maintain their independence, older adults are often construed in ambivalent terms in parallel discourses. The paradigms of active and successful ageing (and the centrality of agency and individual responsibility inherent in these) are evident in, for example, the expectation that older people must act as ‘informed consumers’ who make choices and assume responsibilities regarding their own care (Bertelsen and Rostgaard, 2013). Yet older adults (especially those with care needs) are often treated as lacking personhood and agency (O’Dwyer and Timonen, 2010). I label this

    • • the paradox of (in)dependence: exhorting independence among a group of people who are simultaneously construed as dependent and vulnerable.

    What might explain this paradox? I will offer explanations in subsequent chapters, but my opening gambit is that this paradox exists because policy and literature are in fact not referring to the older population in totality but, rather, sending messages about sub-groups that they consider somehow problematic, in contrast to groups that are adhering to ideals of ‘ageing properly’.

    Policy aspirations pertaining to older populations have a strong gender dimension, both because women form the majority in older populations and because the aspirations have more extensive ramifications for women's life courses, which have traditionally diverged more than men's from some of the paths and patterns that are now prescribed (especially with regard to paid work).

  • Four - The problem with modelling ageing

  • Virpi Timonen, University of Dublin Trinity College
  • Book:
    Beyond Successful and Active Ageing
    Published by:
    Bristol University Press
    Published online:
    01 September 2022
    Print publication:
    29 April 2016, pp 61-86

  • Summary

    ‘Model ageing’ vs anti-model

    Chapters Two and Three have provided ample evidence of the productivity of policy makers and academics in developing and ‘selling’ the concepts of active and successful ageing. I have already alluded to my aim to examine these two concepts, as well as other related concepts such as productive, positive and healthy ageing, under the umbrella term of model ageing. This chapter elaborates on the case for viewing the notions of active and successful ageing, as well as other ‘prescriptions’ for ageing appropriately, through the prism of model ageing – an integrative concept that throws light on the reasons for, and the consequences of, thinking about ageing populations within models of ‘how to age well/properly’.

    In order to examine the interface of these models and individual experience, I will employ the heuristic devices of ‘model’ and ‘antimodel’ older person – ‘model’ being aligned with active/successful ageing, and ‘anti-model’ deviating from the model behaviours and outcomes. We can begin to understand some of the parameters of being a ‘model older person’, as well as obstacles to becoming a ‘model older person’, by reflecting on who might fit the model, and on those who do not conform to it. The ‘model’ ageing citizen is a social construction and a policy aim; but it is also manifest (embodied) in people who (intentionally or unwittingly) adhere to (elements of) the model.

    We can surmise that some of the ‘model agers’ are privileged (for instance a professor who continues to work in her 70s – because she can, and wants to); others are socially disadvantaged (for instance an older low-income worker who derives no enjoyment from his menial and exhausting work but needs the income). Some enjoy fitting the ‘model’; others resent it. However, it is important to acknowledge that we know little about the lived experience of being an ageing ‘model citizen’, or the ‘antithesis’ of the model. Investigating the lived experience of ‘model citizens’ is important for scholarly and policy reasons, because this helps to elucidate the drivers of and obstacles to ‘model’ behaviour. But we cannot fully understand the dynamics of the model unless we also study people who do not adhere to the model, and stand in stark contrast to it.

  • Two - Critique of successful ageing models

  • Virpi Timonen, University of Dublin Trinity College
  • Book:
    Beyond Successful and Active Ageing
    Published by:
    Bristol University Press
    Published online:
    01 September 2022
    Print publication:
    29 April 2016, pp 13-34

  • Summary

    The ubiquity and longevity of successful ageing

    If you have had any exposure to gerontology, the study of ageing, the chances are that you have come across the concept of successful ageing. Indeed, if you observe any Western ageing society you will come across the term very quickly: in advertising, policy documents and in the media. However, if asked to define the concept, you would most likely proffer a different definition than the next person (even if you are both gerontologists). This is because successful ageing is a construct that has no single widely accepted and applied definition. Depp and Jeste (2006), in their review of 29 successful ageing studies, identified almost as many (28) definitions of successful ageing. Cosco and colleagues (2014) identified 105 operational definitions of successful ageing. This does not mean that the concept is unimportant, or too vague to have exerted an influence on the study of ageing. On the contrary, the fact that diverse definitions abound demonstrates the ‘appetite’ for a summative concept like successful ageing, in the sense of a desire to spell out what it is, and who is living it – in all cases underpinned by a particular understanding of what constitutes ‘success’.

    The idea of a ‘recipe’ of successful ageing is old: one of the earliest examples of pointing to a path to a good old age can be found in Cicero's (106–43 BCE) De Senectute(‘on old age’). When his two young friends enquire about the positive and negative aspects of old age, the elder statesman Cato responds that he continues to enjoy intellectual activities; does not miss the physical vigour of his youth; and has adjusted his activities to be manageable. For Cato/Cicero, old age ‘may well be very busy indeed, always in the middle of some activity, or projecting some plan – in continuation, of course, of the interests of earlier years’. However, Cicero was dismissive of advice regarding good old age: ‘Advice in old age is foolish; for what can be more absurd than to increase our provisions for the road the nearer we approach to our journey's end.’ Notions of successful ageing, therefore, have abounded through history, but few recent writers have taken Cicero's reluctant stance on sketching out how to age well.

  • Preface

  • Virpi Timonen, University of Dublin Trinity College
  • Book:
    Beyond Successful and Active Ageing
    Published by:
    Bristol University Press
    Published online:
    01 September 2022
    Print publication:
    29 April 2016, pp vii-xii

  • Summary

    In 2014 I became preoccupied with the idea of successful ageing and cognate concepts such as positive, productive, active and healthy ageing. It seemed to me that these concepts shared something – a family resemblance, if you like. I found myself wondering: what do these concepts that seek to encapsulate ‘ageing well’ have in common? I had of course come across these concepts before then, many times, but perhaps there was something about another birthday bringing me a little closer to ‘old’ that set off a keener interest in the concepts. I was also aware that yet another ‘Centre for Successful Ageing’ was about to be opened in a local hospital, and I started to marvel at the longevity and prevalence of this concept that had always struck me as bordering on marketing lingo.

    A Web of Science search, using the key words ‘successful’ and ‘ageing’ (or the US spelling ‘aging’) resulted in staggering 2,743,785 hits, despite the search's being limited to recent publications. It is evident that in addition to policy makers and salespeople who promote successful and active ageing as a way to achieve their aims (reforming old-age policy, selling stuff to older people), academics and researchers have generated a huge corpus of work around these concepts. There are also many academic works that challenge the concepts of successful and active ageing; yet the literature lacks a comprehensive, theory-oriented critique of these ubiquitous concepts. Perhaps this is not surprising in view of the fact that people who conduct research on ageing are one of the vested interests that drive the use of these concepts.

    There is one book in particular that made me quite determined to marshal a comprehensive critique of successful ageing, active ageing, and related concepts. The book is entitled Winning Strategies for Successful Ageing (Pfeiffer, 2013). I found this book so astonishing that I felt I had no choice but to take to task the concepts that incorporate ‘models’ (noun) of ageing – and those who ‘model’ (verb) ageing in the sense of presenting ideas and ideals of how to age well – hence my term ‘model ageing’. The following are selected highlights from Pfeiffer's manifold exhortations and advice for older adults who want to age successfully.

  • 5 - Leadership in interprofessional dementia care

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 81-92

  • Summary

    Learning outcomes

  • Outline why interprofessional leadership is required.

  • Describe the leadership skills required to facilitate interprofessional practice.

  • Discuss the development of interprofessional leadership within the interprofessional practice context.

    • Key terms

  • capabilities

  • dementia

  • leadership

    • Leadership

    Some are born to leadership; some achieve leadership; others have leadership thrust upon them.

    Marie’s letter to Malvolio in Shakespeare’s Twelfth Night

    Introduction

    Historically health service provision has worked on a hierarchical system of leadership in which the doctor has been seen to be the lead both legally and ultimately in practice for any decisions about a patient’s care. However, practice is starting to change. In 2000, in Canada, the legislation changed to ensure that any health professional could be nominated as leader and is then legally responsible for the care of the individual.

    Why has this move away from doctors always being legally responsible happened? In many situations the doctor is not always present or reachable, for example, in remote, rural locations and some community settings. As Australia has an increasingly ageing population, there are not enough doctors and other health care professionals to service their needs. This has led to the realisation that new health care models and ways of working need to be developed.

  • 8 - Person- and relationship-centred care in dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 115-134

  • Summary

    Learning outcomes

  • Understand the principles of person-centred care of a person with dementia.

  • Understand who is the person in person-centred care.

  • Discuss approaches aimed at achieving person-centred care.

  • Understand the principles of relationship-centred care of a person with dementia.

  • Discuss the importance of the interprofessional team to collectively identify remaining abilities and the care pathway for the individual.

    • Key terms

  • interprofessional practice (IPP)

  • patient-focused care

  • person-centred care

  • relationship-centred care

    • Introduction

    In this chapter, we discuss two key concepts involved in the care of patients with dementia: person-centred care and relationship-centred care. In addition to explaining the meaning and origins of person-centred care as a term, key emphasis is placed on principles and achievement of person-centred care. We also discuss the specifics of those with dementia that need consideration and the benefits of providing person-centred care in dementia patients. Relationship-centred care is explained in the context of interplay between collaboration, communication and relationships, and key interactions involved in dementia patients are also highlighted. We discuss relationships between various stakeholders involved in care of patients with dementia from the perspective of the agency theory. The chapter concludes with a consideration of interprofessional practice (IPP) in the provision of patient-centred care in dementia and the interprofessional team work is illustrated in a case study.

Page 63 of 89