This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sloane, P. D. Articles by Hiatt, S. O. Search for Related Content PubMed PubMed Citation Articles by Sloane, P. D. Articles by Hiatt, S. O. Pubmed/NCBI databases Medline Plus Health Information Alzheimer's Disease Choosing a Doctor or Health Care Service Dementia Nursing Homes Social Bookmarking                         What's this?

Provision of Morning Care to Nursing Home Residents With Dementia: Opportunity for Improvement?

Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, psloane{at}med.unc.edu, Department of Family Medicine, University of North Carolina, Chapel Hill, psloane{at}med.unc.edu

Lois L. Miller, PhD, RN

School of Nursing, Oregon Health & Science University, Portland, Oregon

C. Madeline Mitchell, MURP

Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina

Joanne Rader, MN, RN

School of Nursing, Oregon Health & Science University, Portland, Oregon

Kristen Swafford, MS, RN

School of Nursing, Oregon Health & Science University, Portland, Oregon

Shirin O. Hiatt, MPH, RN

School of Nursing, Oregon Health & Science University, Portland, Oregon

Significant contact between nursing staff and nursing home residents with dementia occurs during assistance with activities of daily living during morning care; however, the content and process of morning care have received little attention in the scientific literature. To better understand the morning care process and its role in generation of pain symptoms, 51 videotaped episodes of morning care involving 17 nursing home residents from 3 long-term care facilities were coded and analyzed; each resident had a diagnosis of dementia and concern about possible pain during assistance with activities of daily living. The typical morning care episode involved performance of multiple activities of daily living during a short period of time, during which pain stimulation and expression occurred frequently. Much could be done to make morning care more an activity to be enjoyed rather than a task to be completed.

Key Words: pain • activities of daily living • morning care

References

• Talerico KA, Evans LK Making sense of aggressive/ protective behaviors in persons with dementia. Alzheimer's Care Quarterly. 2000;1:77-88.
• Liukkonen A. The content of nurses' oral shift reports in homes for elderly people. J Adv Nurs. 1993;18:1095-1100.[CrossRef][Medline] [Order article via Infotrieve]
• Rogers JC, Holm MB, Burgio LD, et al. Improving morning care routines of nursing home residents with dementia. J Am Geriatr Soc. 1999;47:1049-1057.[Medline] [Order article via Infotrieve]
• Wells DL, Dawson P., Sidani S., Craig D., Pringle D. Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. J Am Geriatr Soc. 2000;48:442-449.[Medline] [Order article via Infotrieve]
• Kihlgren M., Kuremyr D., Norberg A., et al. Nurse-patient interaction after training in integrity promoting care at a long-term ward: analysis of video-recorded morning care sessions. Int J Nurs Stud. 1993;30:1-13.[CrossRef][Medline] [Order article via Infotrieve]
• Feldt KS The Checklist of Nonverbal Pain Indicators (CNPI). Pain Manag Nurs. 2000;1:13-21.[CrossRef][Medline] [Order article via Infotrieve]
• Mentes JC, Teer J., Cadogan MP The pain experience of cognitively impaired nursing home residents: perceptions of family members and certified nursing assistants. Pain Manag Nurs. 2004;5:118-125.[CrossRef][Medline] [Order article via Infotrieve]
• Miller LL, Talerico KA, Rader J., et al. Development of an intervention to reduce pain in older adults with dementia: challenges and lessons learned. Alzheimer's Care Quarterly. 2005;6:154-167.
• Morris JN, Hawes C., Fries BE, et al. Designing the national resident assessment instrument for nursing homes. Gerontologist. 1990;30:293-307.[Abstract]
• Sloane PD, Hoeffer B., Mitchell CM, et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation and discomfort in patients with dementia: a randomized clinical trial. J Am Geriatr Soc. 2004;52:1795-1804.[CrossRef][Medline] [Order article via Infotrieve]
• Albert M., Cohen C. The Test for Severe Impairment: an instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc. 1992;40:449-453.[Medline] [Order article via Infotrieve]
• Morris JN, Fries BE, Morris SA Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999;54:M546-M553.[Abstract]
• Talerico KA, Miller LL Development of the Pain and Caregiving Tool (PACT): An Observational Measure of Care Recipients and Their Caregivers. Portland, OR: Oregon Health & Science University, School of Nursing; 2003.
• The Observer System for Collection and Analysis of Observational Data [computer program]. Version 5.0. Wageningen, Netherlands: Noldus Inc; 2003.
• Sherder E., Oosterman J., Swaab D., et al. Recent developments in pain in dementia. BMJ. 2005;330:461-464.[Free Full Text]
• Huffman JC, Kunik ME Assessment and understanding of pain in patients with dementia. Gerontologist. 2000;40: 574-581.[Abstract/Free Full Text]
• Herr K., Bjoro K., Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31:170-192.[CrossRef][Medline] [Order article via Infotrieve]
• Talerico K., Miller L., Swafford K., Rader J., Sloane P., Hiatt S. Psychosocial approaches to prevent and minimize pain in people with dementia during morning care. Alzheimer's Care Quarterly. 2006; 7:163-174.
• Rader J, Tornquist EM, eds. Individualized Dementia Care: Creative, Compassionate Approaches. New York, NY: Springer; 1995.
• Barton EM, Baltes MM, Orzech MJ Etiology of dependence in older nursing home residents during morning care: the role of staff behavior. J Pers Soc Psychol. 1980;38:423-431.[CrossRef][Medline] [Order article via Infotrieve]
• Rogers JC, Holm MB, Burgio LD, Hsu C., Hardin JM, McDowell BJ Excess disability during morning care in nursing home residents with dementia. Int Psychogeriatr. 2000;12:267-282.[CrossRef][Medline] [Order article via Infotrieve]
• Bliwise DL, Bevier WC, Bliwise NG, Edgar DM, Dement WC Systematic 24-hr behavioral observations of sleep and wakefulness in a skilled-care nursing facility. Psychol Aging. 1990;5:16-24.[CrossRef][Medline] [Order article via Infotrieve]

American Journal of Alzheimer's Disease and Other Dementias®, Vol. 22, No. 5, 369-377 (2007)
DOI: 10.1177/1533317507305593


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sloane, P. D. Articles by Hiatt, S. O. Search for Related Content PubMed PubMed Citation Articles by Sloane, P. D. Articles by Hiatt, S. O. Pubmed/NCBI databases Medline Plus Health Information Alzheimer's Disease Choosing a Doctor or Health Care Service Dementia Nursing Homes Social Bookmarking                         What's this?