Monthly Archives: September 2014

Hospital shares effective training program on advance directives and end-of-life care

Nurses

An educational program for nurses can help address knowledge gaps related to advance health care directives (AHCDs) – thus helping to ensure that patients’ wishes for care at the end of life are known and respected, reports a paper in the October/December Journal of Christian Nursing, official journal of the Nurses Christian Fellowship. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Maureen Kroning, EdD, RN, of Nyack (N.Y.) College and Good Samaritan Hospital presents her hospital’s experience with developing an inservice educational program to provide nurses with needed information on advance directives. She writes, “It is vital to recognize and address problems associated with AHCD so nurses can provide competent and compassionate care.”

Program Meets Nurses’ Need for Knowledge on Advance Directives

Research shows that, while most adults want their wishes for end-of-life care response, only about one-third have completed AHCDs. Despite the growing need for advance care planning, many health care professionals lack the knowledge to teach patients about advance directives.

At the study hospital, there was a “recognized problem” with AHCD education. On admission, patients were provided with an AHCD information packet and told to ask a nurse if they had any questions. “However,” Maureen Kroning writes, “nurses expressed not fully understanding AHCDs, feeling incompetent to educate patients, nor did they believe AHCD education was an important part of their role.”

A subsequent survey of 49 nurses found significant deficits in knowledge regarding AHCDs, especially among less-experienced nurses. Nurses “specifically and repeatedly” addressed the need for more AHCD education.

In response, the hospital developed an AHCD inservice education program, specifically addressing the knowledge gaps uncovered by the survey and tailored to the needs of adult learners. The two-hour program included information on AHCDs and living wills, and relevant federal and state laws. In addition to lecture and discussion, the program included role-playing opportunities and questions and answers. The online version of the article includes links to the author’s lecture slides and an AHCD patient booklet.

The educational program led to significant improvements in nurses’ knowledge of AHCDs. The hospital also saw vital changes in several areas related to AHCDs, including increased awareness of the problem by hospital leadership and the desire obtain further AHCD education by nurses.

Other hospitals have been provided with and are implementing the educational intervention. Providing time for nurses to attend the program during regular work hours is a key factor in ensuring access to the inservice program.

The experience highlights the need to provide nurses with practical and relevant information about AHCDs and end-of-life care, Maureen Kroning believes. She writes, “If nurses lack the education to effectively educate, how are patients going to make desired decisions about their wishes at the end of life?” She also highlights some key issues for further research related to AHCDs, including addressing patients’ distress around end-of-life care, issues surrounding healthcare team relationships, and the optimal timing of conversations with patients and families about completing an advance directive.

http://www.medicalnewstoday.com/releases/282625.php

 

 

Keeping fit aids bone and joint health whilst aging

Anti_Aging_IM_GP_FM_Cardiology_Orthopedics_Naturopathy_Podiatry_Rheumatology

Being physically active may significantly improve musculoskeletal and overall health, and minimize or delay the effects of aging, according to a review of the latest research on senior athletes (ages 65 and up) appearing in the September issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

It long has been assumed that aging causes an inevitable deterioration of the body and its ability to function, as well as increased rates of related injuries such as sprains, strains and fractures; diseases, such as obesityand diabetes; and osteoarthritis and other bone and joint conditions. However, recent research on senior, elite athletes suggests usage of comprehensive fitness and nutrition routines helps minimize bone and joint health decline and maintain overall physical health.

“An increasing amount of evidence demonstrates that we can modulate age-related decline in the musculoskeletal system,” said lead study author and orthopaedic surgeon Bryan G. Vopat, MD. “A lot of the deterioration we see with aging can be attributed to a more sedentary lifestyle instead of aging itself.”

The positive effects of physical activity on maintaining bone density, muscle mass, ligament and tendon function, and cartilage volume are keys to optimal physical function and health. In addition, the literature recommends a combined physical activity regimen for all adults encompassing resistance, endurance, flexibility and balance training, “as safely allowable for a given person.” Among the recommendations:

Resistance training. Prolonged, intense resistance training can increase muscle strength, lean muscle and bone mass more consistently than aerobic exercise alone. Moderately intense resistance regimens also decrease fat mass. Sustained lower and upper body resistance training bolsters bone density and reduces the risk of strains, sprains and acute fractures.

Endurance training. Sustained and at least moderately intensive aerobic training promotes heart health, increases oxygen consumption, and has been linked to other musculoskeletal benefits, including less accumulation of fat mass, maintenance of muscle strength and cartilage volumes. A minimum of 150 to 300 minutes a week of endurance training, in 10 to 30 minute episodes, for elite senior athletes is recommended. Less vigorous and/or short-duration aerobic regimens may provide limited benefit.

Flexibility and balance. Flexibility exercises are strongly recommended for active older adults to maintain range of motion, optimize performance and limit injury. Two days a week or more of flexibility training – sustained stretches and static/non-ballistic (non-resistant) movements – are recommended for senior athletes. Progressively difficult postures (depending on tolerance and ability) are recommended for improving and maintaining balance.

The study also recommends “proper” nutrition for older, active adults to optimize performance. For senior athletes, a daily protein intake of 1.0 to 1.5 g/kg is recommended, as well as carbohydrate consumption of 6 to 8 g/kg (more than 8 g/kg in the days leading up to an endurance event).

“Regimens must be individualized for older adults according to their baseline level of conditioning and disability, and be instituted gradually and safely, particularly for elderly and poorly conditioned adults,” said Dr. Vopat. According to study authors, to improve fitness levels and minimize bone and joint health decline, when safely allowable, patients should be encouraged to continually exceed the minimum exercise recommendations.

http://www.medicalnewstoday.com/releases/281660.php

 

 

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