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Home care support program for frail elderly clients
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RESEARCH BRIEFS
craving response can be elicited on an experimental basis; whether certain factors, such as environmental cues, can influence craving; and how soCiodemographic factors contribute to craving. As the research describing the phenomenon of craving progresses, a logical step includes the identification of events or situations that precipitate craving. In addition, it is important to determine whether these situations differ among various groups based on such factors as education and marital status. Finally, an examination of what coping responses, or substitute strategies, successful exsmokers use to replace smoking during periods of craving may laelp nurses to design and test empirically sound interventions that promote permanent abstinence from smoking. REFERENCES Eraker, S.A., Becker, M.H., Strecher, V.J., & Kirscht, J.P. (1985). Smoking behavior, cessation techniques and the health decision model. American Journal of Medicine, 78, 817-825. Guilford, J.S. (1966) Factors related to successful abstinence from smoking. Pittsburgh, PA: American Institutes for Research. Hunt, W.A., & Matarazzo, J.D. (1973). Three years later: Recent developments in the experimental modification of smoking behavior. Journal of Abnormal Psychology, 81, 107114. MeFalI, R. (1978). Smoking cessation research. Journal of Consulting and Clinical Psychology, 46, 703--712. Pomerleau, O. (1979). Commonalities in the treatment and understanding of smoking and other self-management disorders. In N.A. Krasnegor (Ed.), Behavioral analysis of treatment and substance abuse. NIDA Research Monograph, 25, 140-156. Shiffman, S. (1979). The tobacco withdrawal syndrome. In N.A. Krasnegor (Ed.), Cigarette smoking as a dependence process. NIDA Research Monograph, 23, 158-184. Shiffman, S., & Jarvik, M. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35-39. From the Department of Life Span Process and the Center for Nu[sing Research, Ohio State University, College of Nursing, Columbus, OH. .M~-y Ellen Wewers, PhD, RN: Assistant Professor, Department of Life Span Process, Ohio State University, College of Nursing, Columbus, OH; Deborah S. Gonyon, PhD: Research Associate, Center for Nursing Research, Ohio State Univei'sity, College of Nursing, Columbus, OH. Address reprint requests to Mary Ellen Wewers, PhD, RN, Ohio State University, College of Nursing, 1585 NeiI Ave, Columbus, OH 43210. © 1989 by W.B. 5aunders Company. 0897-1897189/0201-0009505.00/0
Home Care Support Program for Frail Elderly Clients Rosalind Feldman, Elizabeth Weiss, and Norma Small
S THE POPULATION over 65 years of age increases, more frail elderly people live alone. In order to maintain maximum independence, many of these people require services from nonprofessionals who are trained and supervised by Community Health Nurses. These nonprofessionals observe and report to the nurses about clients' abilities to maintain personal hygiene and toileting; assess and discuss with the client and the nurse whether or not professional home health services are adequate; and maintain regular communication with clients. In many instances, volunteers provide this help. The Iona House Home Care Support Program (HCSP) uses volunteers to fill the gap between an elderly individual's release from the hospital and the beginning of paid services and when insurance no longer pays for home services. Once Medicare coverage for skilled home services ends, volunteers become crucial in the lives of frail elderly who are trying their utmost to remain in their own homes. Between October 1986 and September 1987, 62 clients were served by the HCSP. Forty-four were widowed or unmarried women with no family support network. Information about age was available for 59 clients: 28 (47%) were 80 to 89 years of age; 27 (46%) were 70 to 79 years of age; and four (7%) were 90 to 99 years old. Volunteers made a 1-year commitment to the program. At the end of the year they were given the option to continue, provided they had performed satisfactorily. Semiannual volunteer training featured a series of five sessions covering topics such as communication, physiological and psychosocial changes o f normal aging, home safety, community resources, nutrition, and information about devices that assist with mobility. After the first visit with a client, the volunteer called the nursing supervisor to inform her how the visit went and what help was needed. On subsequent visits, the volunteer called the supervisor only when problems arose.
A
RESEARCH BRIEFS
Since the HCSP began, evaluating volunteer training and services has been an essential part of the program. An evaluation package has been developed that includes the following instruments: Volunteer's Satisfaction With Individual Training Sessions; Volunteer's Evaluation of the Entire Training Program; Volunteer's Attitudes Toward the Elderly Upon Entry into the Program and After Six Months; Nursing Supervisor's Evaluation of Volunteer; weekly check list for each client; and Client Satisfaction With Volunteer Services. Ratings of the volunteer program were obtained from 15 volunteers. On a scale of 1 to 5, with 1 being outstanding and 5 being poor, the range of scores was 1 to 4 on each on the following characteristics of the training program: organization (mean, 1.57), classroom discussion (1.92), education about the elderly (1.86), skills development (1.73), volunteer role (1.86), personal growth (2.2), and the importance of issues discussed (1.8). The training session that volunteers found most valuable was a presentation by elderly individuals about coping with sensory changes. The three main reasons given for volunteering were to help others, to engage in meaningful activity, and a commitment to aging individuals. When asked to rank the services they provided in order of frequency, talking to clients was first and observhzg and reporting about clients' physical and mental condition to the nttrsing supervisor was second. Among the 20 clients who were interviewed with the Client Satisfaction Questionnaire, all expressed satisfaction with volunteer services. When asked to rank the quality of service on a scale of 1 to 5, with 1 being outstanding and 5 unsatisfactory, the mean score was 1.5. The following comment is typical of clients' reaction to volunteers: "The volunteer was'very sociable and kind, and made me feel happy . . . and explained everything." Had HCSP not been available, clients chose the following alternatives for help in descendidg order of preference:family and friends, didn't know where to turn, or another agency. Among the 20 clients, three believed that HCSP provided an alternative to nursing home care. Most of the suggestions for improving the service involved its continuation. Clients stated that they "would like more visits" and "would like it to be a continuous service." For the most part, clients missed the volianteer visits once they ended
49
and desired them to continue indefinitely. The value of the HCSP was verified by a recent appropriation of funds by the D.C. Office on Aging. This study supports the positive aspects--from both the patients' and volunteers' perspectives---of volunteer home care for the elderly. The data provides direction for future training of volunteers and types of services offered to clients. From Georgetown University School of Nursing and lona House Senior Service Center, Washington, DC. Rosalind Feldman, DNSc, RN: Assistant Professor, Georgetown University. School of Nursing, Washington, DC; Elizabeth Weiss, MSN, RN: Coordinator, Home Care Support Program, lona House Senior Service Center, Washington, DC; and Norma Small, PhD, RN: Director of Graduate Program, Georgetown University, School of Nursing, Washington, DC. Address reprint requests to Rosalind Feldman, DNSc, RN, 13822 Flint Rock Rd, Rockville, MD 20853. © 1989 by W.B. Saunders Company. 0897-189718910201-0010505.00/0
Spouses' Experiences During Pregnancy and the Postpartum Jacqueline Fawcett
A
PROGRAM of nursing research has been established to test a theory proposing that wives and husbands have similar pregnancyrelated experiences. The research has been guided by a conceptual framework of the family as a living open system (Fawcett, 1975). There were conflicting findings from three studies in which the relationship between spouses' strength of identification and similarities in changes in various body image components during and after pregnancy were investigated. However, the weight of evidence indicated that spouses do not have similar patterns of change in their body images during pregnancy and the postpartum (Drake, Verhulst, Fawcett, & Barger, 1988; Fawcett, 1978, 1987; Fawcett, Bliss-Holtz, Haas, Leventhal, & Rubin, 1986). In contrast, findings from two other studies that included investigation of the relationship between spouses' strength of identification and similarities in their reports of physical and psycholog-
RESEARCH BRIEFS
craving response can be elicited on an experimental basis; whether certain factors, such as environmental cues, can influence craving; and how soCiodemographic factors contribute to craving. As the research describing the phenomenon of craving progresses, a logical step includes the identification of events or situations that precipitate craving. In addition, it is important to determine whether these situations differ among various groups based on such factors as education and marital status. Finally, an examination of what coping responses, or substitute strategies, successful exsmokers use to replace smoking during periods of craving may laelp nurses to design and test empirically sound interventions that promote permanent abstinence from smoking. REFERENCES Eraker, S.A., Becker, M.H., Strecher, V.J., & Kirscht, J.P. (1985). Smoking behavior, cessation techniques and the health decision model. American Journal of Medicine, 78, 817-825. Guilford, J.S. (1966) Factors related to successful abstinence from smoking. Pittsburgh, PA: American Institutes for Research. Hunt, W.A., & Matarazzo, J.D. (1973). Three years later: Recent developments in the experimental modification of smoking behavior. Journal of Abnormal Psychology, 81, 107114. MeFalI, R. (1978). Smoking cessation research. Journal of Consulting and Clinical Psychology, 46, 703--712. Pomerleau, O. (1979). Commonalities in the treatment and understanding of smoking and other self-management disorders. In N.A. Krasnegor (Ed.), Behavioral analysis of treatment and substance abuse. NIDA Research Monograph, 25, 140-156. Shiffman, S. (1979). The tobacco withdrawal syndrome. In N.A. Krasnegor (Ed.), Cigarette smoking as a dependence process. NIDA Research Monograph, 23, 158-184. Shiffman, S., & Jarvik, M. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35-39. From the Department of Life Span Process and the Center for Nu[sing Research, Ohio State University, College of Nursing, Columbus, OH. .M~-y Ellen Wewers, PhD, RN: Assistant Professor, Department of Life Span Process, Ohio State University, College of Nursing, Columbus, OH; Deborah S. Gonyon, PhD: Research Associate, Center for Nursing Research, Ohio State Univei'sity, College of Nursing, Columbus, OH. Address reprint requests to Mary Ellen Wewers, PhD, RN, Ohio State University, College of Nursing, 1585 NeiI Ave, Columbus, OH 43210. © 1989 by W.B. 5aunders Company. 0897-1897189/0201-0009505.00/0
Home Care Support Program for Frail Elderly Clients Rosalind Feldman, Elizabeth Weiss, and Norma Small
S THE POPULATION over 65 years of age increases, more frail elderly people live alone. In order to maintain maximum independence, many of these people require services from nonprofessionals who are trained and supervised by Community Health Nurses. These nonprofessionals observe and report to the nurses about clients' abilities to maintain personal hygiene and toileting; assess and discuss with the client and the nurse whether or not professional home health services are adequate; and maintain regular communication with clients. In many instances, volunteers provide this help. The Iona House Home Care Support Program (HCSP) uses volunteers to fill the gap between an elderly individual's release from the hospital and the beginning of paid services and when insurance no longer pays for home services. Once Medicare coverage for skilled home services ends, volunteers become crucial in the lives of frail elderly who are trying their utmost to remain in their own homes. Between October 1986 and September 1987, 62 clients were served by the HCSP. Forty-four were widowed or unmarried women with no family support network. Information about age was available for 59 clients: 28 (47%) were 80 to 89 years of age; 27 (46%) were 70 to 79 years of age; and four (7%) were 90 to 99 years old. Volunteers made a 1-year commitment to the program. At the end of the year they were given the option to continue, provided they had performed satisfactorily. Semiannual volunteer training featured a series of five sessions covering topics such as communication, physiological and psychosocial changes o f normal aging, home safety, community resources, nutrition, and information about devices that assist with mobility. After the first visit with a client, the volunteer called the nursing supervisor to inform her how the visit went and what help was needed. On subsequent visits, the volunteer called the supervisor only when problems arose.
A
RESEARCH BRIEFS
Since the HCSP began, evaluating volunteer training and services has been an essential part of the program. An evaluation package has been developed that includes the following instruments: Volunteer's Satisfaction With Individual Training Sessions; Volunteer's Evaluation of the Entire Training Program; Volunteer's Attitudes Toward the Elderly Upon Entry into the Program and After Six Months; Nursing Supervisor's Evaluation of Volunteer; weekly check list for each client; and Client Satisfaction With Volunteer Services. Ratings of the volunteer program were obtained from 15 volunteers. On a scale of 1 to 5, with 1 being outstanding and 5 being poor, the range of scores was 1 to 4 on each on the following characteristics of the training program: organization (mean, 1.57), classroom discussion (1.92), education about the elderly (1.86), skills development (1.73), volunteer role (1.86), personal growth (2.2), and the importance of issues discussed (1.8). The training session that volunteers found most valuable was a presentation by elderly individuals about coping with sensory changes. The three main reasons given for volunteering were to help others, to engage in meaningful activity, and a commitment to aging individuals. When asked to rank the services they provided in order of frequency, talking to clients was first and observhzg and reporting about clients' physical and mental condition to the nttrsing supervisor was second. Among the 20 clients who were interviewed with the Client Satisfaction Questionnaire, all expressed satisfaction with volunteer services. When asked to rank the quality of service on a scale of 1 to 5, with 1 being outstanding and 5 unsatisfactory, the mean score was 1.5. The following comment is typical of clients' reaction to volunteers: "The volunteer was'very sociable and kind, and made me feel happy . . . and explained everything." Had HCSP not been available, clients chose the following alternatives for help in descendidg order of preference:family and friends, didn't know where to turn, or another agency. Among the 20 clients, three believed that HCSP provided an alternative to nursing home care. Most of the suggestions for improving the service involved its continuation. Clients stated that they "would like more visits" and "would like it to be a continuous service." For the most part, clients missed the volianteer visits once they ended
49
and desired them to continue indefinitely. The value of the HCSP was verified by a recent appropriation of funds by the D.C. Office on Aging. This study supports the positive aspects--from both the patients' and volunteers' perspectives---of volunteer home care for the elderly. The data provides direction for future training of volunteers and types of services offered to clients. From Georgetown University School of Nursing and lona House Senior Service Center, Washington, DC. Rosalind Feldman, DNSc, RN: Assistant Professor, Georgetown University. School of Nursing, Washington, DC; Elizabeth Weiss, MSN, RN: Coordinator, Home Care Support Program, lona House Senior Service Center, Washington, DC; and Norma Small, PhD, RN: Director of Graduate Program, Georgetown University, School of Nursing, Washington, DC. Address reprint requests to Rosalind Feldman, DNSc, RN, 13822 Flint Rock Rd, Rockville, MD 20853. © 1989 by W.B. Saunders Company. 0897-189718910201-0010505.00/0
Spouses' Experiences During Pregnancy and the Postpartum Jacqueline Fawcett
A
PROGRAM of nursing research has been established to test a theory proposing that wives and husbands have similar pregnancyrelated experiences. The research has been guided by a conceptual framework of the family as a living open system (Fawcett, 1975). There were conflicting findings from three studies in which the relationship between spouses' strength of identification and similarities in changes in various body image components during and after pregnancy were investigated. However, the weight of evidence indicated that spouses do not have similar patterns of change in their body images during pregnancy and the postpartum (Drake, Verhulst, Fawcett, & Barger, 1988; Fawcett, 1978, 1987; Fawcett, Bliss-Holtz, Haas, Leventhal, & Rubin, 1986). In contrast, findings from two other studies that included investigation of the relationship between spouses' strength of identification and similarities in their reports of physical and psycholog-