Improving medicolegal death investigative gaps of fatal elder abuse

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Inherent limitations of resources and practical realities of death investigation are discussed and recommendations are made for future research. Viewed broadly, deficiencies in elder death investigations can lead to the underreporting of elder abuse and the reduction of legal options for victims, which may reflect a systemic pattern of social injustice.     

Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change

Components of nursing home (NH) culture change include resident-centeredness, empowerment, and home likeness, but practices reflective of these components may be found in both traditional and “culture change” NHs. We use mixed methods to examine the presence of culture change practices in the context of an NH’s payer sources. Qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation. Findings indicate that heightened coordination of Medicare and Medicaid could influence NH implementation of reform practices.     

Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1–10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1–4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.     

鼻内窥镜下等离子低温射频治疗老年人鼻出血的护理

目的总结等离子低温射频治疗老年人鼻出血的护理要点。方法总结80例用等离子低温射频治疗仪治疗老年人鼻出血病例资料,总结护理体会。结果配合整体护理,明显提高了治疗疗效,减轻了患者痛苦。结论等离子低温射频治疗老年人鼻出血疗效显著,患者痛苦小。整体护理是治疗成功的的重要环节。     

Staff Perceptions of Same-Gender Sexual Contacts in Long-Term Care Facilities

An ongoing fear in the gay and lesbian community is that long-term care (LTC) facilities may not be sensitive to their needs. In the present study, 218 LTC staff members responded to one of three vignettes in which resident sexual contact was observed, with only the gender of the characters changing, to create different gender pairings. Results suggested that staff rated male-male and female-female pairings more negatively than heterosexual intimacy. Knowledge about older adult sexuality made little difference in staff ratings. However, staff attitudes were directly related to ratings of negative reaction and level of acceptability of same-gender sexuality.     

2000—2010年广东省老年人口空间分布演变研究

根据2000年第五次人口普查数据、2010年第六次人口普查数据和相关社会经济统计数据,利用地理信息系统技术对广东省老年人口空间分布变化和特征进行分析,阐明导致该空间格局演变的主要原因,并据此提出完善养老服务的建议,主要包括：全面提高全省医疗卫生服务水平;经济落后的、老人比例较高的地区应完善公办老年公寓、托老所、老人活动中心等相关养老福利的落实;经济发达的、老人比例较低的地区除提供基本养老福利以外,还可以尝试新型老人居住模式,如旧社区适老性改造、商住—养老复合社区等。     

Assessing social work and nursing students’ intentions to work with dying patients

This study assessed social work and nursing students’ intentions to provide end-of-life care, based on the Theory of Planned Behavior. A total of 181 social work and nursing students completed a questionnaire examining intentions to provide end-of-life care, attitudes, subjective norms, perceived control, death anxiety, subjective knowledge, and sociodemographic characteristics. Students manifested a moderate level of intentions to provide end-of-life care, with nursing students indicating higher levels of intentions than social work students. Multiple regression analyses revealed that attitudes, subjective norms, and previous experience were the main predictors of intentions to provide end-of-life care. Recommendations for academic programs are discussed.     

人口老龄化背景下机构养老国内外研究比较

当前学界对机构养老的讨论日趋热烈，但遍观国内现有文献，对国外机构养老研究进展普遍关注不足。本研究通过从机构养老的概念界定、养老机构、入住老年人群、机构养老服务质量这四个维度对国内外机构养老研究成果进行归类梳理，发现国内机构养老研究在功能界定、管理与运营、服务质量监管等方面差距较大，而对于入住老年人群的需求和入住意愿分析方面则与西方差距较小。同时，我国机构养老的理论对于实践的指导作用并不显著，我国理论界相对于养老实践有滞后之虞。基于以上分析，本文提出以下建议：探索机构养老发展的新模式，完善养老机构管理与运营结构以及发展第三方服务监管体系。     

大专护生医学英语学习的问题与对策

分析大专护生在学习医学英语时存在的主要问题,并在实践中寻求对策以培养大专护生学习医学英语的兴趣和信心。鼓励大专护生运用构词法分析和构建医学术语,从而掌握常用的构词成份。同时,在教学过程中尝试了小组合作学习、情景教学及角色扮演。大专护生阅读医学文献的能力得到显著提高,口语沟通能力也得到了增强,并且对医学英语的学习产生了兴趣。     

Children's nurses' experiences of child protection: what helps?

This paper reports on one area of findings of a study undertaken in the spring of 2008 at a district general hospital in the south of England. Individual semi‐structured interviews using an interpretive phenomenological approach were undertaken with 15 nurses and midwives working in paediatrics who had been involved in child protection cases. The aim was to explore their views and feelings of the experience. Very little research was found to inform this subject and none specifically with nurses working with sick children. Interviews were taped, transcribed and analysed thematically. It was discovered that involvement in child protection has a lasting impact on individuals; nurses need procedural information from a knowledgeable supporter during a case; and they need support from the right person in the right place at the right time for them. The Named Nurse was identified as being crucial in giving effective support to individuals during child protection cases and trusted advice and support helps staff follow through on niggling concerns, potentially preventing abuse. Copyright © 2009 John Wiley & Sons, Ltd.