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Biomedical subjects

I L Abraham

Publications and source records attributed to I L Abraham.

At least 37 records · Page 2Linked to original sources
PubMed1995

Conditions, interventions, and outcomes in nursing research: a comparative analysis of North American and European/International journals. (1981-1990).

This study compared the conceptual foci and methodological characteristics of research projects which tested the effects of nursing interventions, published in four general nursing research journals with predominantly North American, and two with predominantly European/International authorship and readership. Dimensions and variables of comparison included: nature of subjects, design issues, statistical methodology, statistical power, and types of interventions and outcomes. Although some differences emerged, the most striking and consistent finding was that there were no statistically significant differences (and thus similarities) in the content foci and methodological parameters of the intervention studies published in both groups of journals. We conclude that European/International and North American nursing intervention studies, as reported in major general nursing research journals, are highly similar in the parameters studied, yet in need of overall improvement. Certainly, there is no empirical support for the common (explicit or implicit) ethnocentric American bias that leadership in nursing intervention research resides with and in the United States of America.

Adult↗
PubMed1994

Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment.

Relaxing music was hypothesized to buffer the general noise level typically found in dining rooms of nursing homes, exert a calming effect, and thus reduce agitated behaviors among residents with severe cognitive impairment. Twenty-nine nursing home residents with severe cognitive deficits participated in a 4-week protocol in which, following baseline observations (week 1), relaxing music was introduced (week 2), removed (week 3), and reintroduced (week 4). Subjects were observed in terms of total number of behaviors of the Cohen-Mansfield Agitation Inventory present during a given week, and the number of behaviors present on the subscales of aggressive, physically nonaggressive, verbally agitated, and hiding/hoarding behaviors. Significant reductions were observed on the cumulative incidence of total agitated behaviors (63.4%); as well as the cumulative incidence of physically nonaggressive behaviors (56.3%) and verbally agitated behaviors (74.5%). No significant reductions were noted in terms of aggressive behaviors and hiding/hoarding behaviors. Where significant reductions were achieved, a distinct pattern was observed. Agitation decreased during week 2, increased again during week 3, only to decrease again in week 4. In addition, variance effects were noted as well, as ranges and standard deviations of agitated behaviors narrowed over time. These findings are interpreted within Hall and Buckwalter's (1988) model of a progressively lowered stress threshold among dementia patients.

Aged↗
PubMed1994

Risk profiles for nursing home placement of rural elderly: a cluster analysis of psychogeriatric indicators.

In an effort to better understand the clinical and functional status of patients served by our Rural Elder Outreach Program, more effectively identify risk groups, and more efficiently target services, we performed a cluster analysis on 92 older adults served by our program. The first cluster included patients with very poor health, mild cognitive impairment, very high care demands, and migrating toward active risk for institutionalization. The second cluster included patients with poor physical but good mental health, intact cognition, high care demands, and at passive risk. The third cluster comprised patients with high functional, physical, and cognitive impairment, intensive care demands, moderate mental health problems, poor insight into their situation, and at active risk for institutionalization.

Activities of Daily Living↗
PubMed1994

Cognitive screening of nursing home residents: factor structures of the Mini-Mental State Examination.

OBJECTIVE: To examine factor structures of the Mini-Mental State Examination, attempting first to replicate any of previously proposed 2-factor solutions; and to explore, secondly, the presence of clinically more differentiated and statistically stable factor structures representing common neurocognitive dimensions. DESIGN: Factor analytic investigation of descriptive dataset collected on nursing home residents. Two factor analyses were performed, one in which the number of factors was fixed at 2 in an effort to replicate previous studies, and one in which the number of factors to retain was determined by the scree test. Both factor analyses used established methods for judging the adequacy of the correlation matrix and the significance of factor loadings, and both applied principal components analysis for initial factor extraction and the equamax criterion for orthogonal rotation. SETTING: Seven nursing homes with a total of 894 beds. PARTICIPANTS: 922 assessments on nursing home residents were performed, of which 892 were complete and entered into the factor analyses. The observation-to-variable ratio exceeded 81:1, assuring the statistical stability of factor solutions derived. MEASUREMENT: The Mini-Mental State Examination, with standardization of words to be recalled and the inverted spelling of "world" as the mental reversal task. MAIN RESULTS: Two factor structures were derived. A 2-factor solution, explaining 36.5% of the variance and statistically and conceptually different from those obtained in previous studies, distinguished between Perceptual-Organizational and Psychomotor skills. A 4-factor solution, which explained 56.1% of the variance, included a factor named Executing Psychomotor Commands, while also further differentiating the perceptual-organizational processes into the factors of Memory, Concentration, and Language. CONCLUSION: The 2-factor solution shows that, notwithstanding previous claims to the contrary, the MMSE can make stable and independent distinctions between psychomotor and perceptual-organizational processes. However, this solution is statistically and conceptually limited and, therefore, of limited clinical and scientific relevance. The 4-factor solution of the MMSE maps well onto commonly recognized dimensions of neurocognitive ability. It offers a stable, intuitively sound, and statistically supported framework for clinical differentiation of cognitive screening data into independent clinical dimensions of neurocognitive functioning. Thus, it offers clinicians and researchers a 4-dimensional framework for interpreting data obtained by means of the MMSE. Studies with other populations of cognitively impaired and intact elderly are recommended to validate and extend the present findings.

Aged↗
PubMed1994

Geropsychiatric nursing: a clinical knowledge base in community and institutional settings.

1. The term clinical knowledge base refers to the foundations and areas of knowledge that are integral to an independent and interdependent clinical discipline. 2. The clinical content essential to establish a research base in geropsychiatric nursing includes normal and abnormal aging, nature and magnitude of geriatric mental health problems, diagnostic categories, caregiver and family roles, and cultural determinants of mental health problems and care. 3. The clinical knowledge base for geropsychiatric nursing care in both community and institutional settings consists of the components identified above and the logical integration of each. Integration can be achieved by including these themes in the theoretical and clinical training of nurses.

Clinical Competence↗
PubMed1994

Multidisciplinary assessment of patients with Alzheimer's disease.

The complexity of AD necessitates that multiple disciplines interface effectively in the assessment of patient, caregiver, and family. This multidisciplinary effort should not be focused on the mere exchange of data. As this article emphasized, just from the perspective of nursing, it is critical that the various disciplines involved know about the purpose, focus, and process of assessment approaches used by each in the convergent effort to comprehensively evaluate the disease and its possible changes, as well as its impact on function, cognition, behavior, and emotion. From this article, it should be apparent that effective multidisciplinary assessment is not exchange of data but rather purposive interchange of clinical information to achieve the clinical goals of assessment, diagnosis, explanation, intervention, prognosis, and evaluation.

Alzheimer Disease↗
PubMed1994

Care environments for patients with Alzheimer's disease.

Alzheimer's disease creates various demands in terms of community-based and institutional long-term care resources and services needed for patients, caregivers, and families. Nurses play a pivotal role in helping patients, caregivers, and families decide what resources and services are needed. The determinants involved in the decision-making process related to short-term and long-term care options are described. Next, the home, community, and institutional care environments are reviewed. Finally, policy recommendations related to care environments for Alzheimer's patients are discussed.

Aged↗
PubMed1994

Alzheimer's disease and nursing. New scientific and clinical insights.

This article aimed to provide an orientation to major new insights in the causes, pathogenesis, and management of AD. This article certainly does not offer a comprehensive overview, and this was not the intent. Instead, the aim was to provide an orientation to the major issues in the complex debate over "causes and cures," and to so serve as a foundation for further study as well as platform for this issue of Nursing Clinics of North America on AD.

Aged↗
PubMed1993

Psychogeriatric outreach to rural families: the Iowa and Virginia models.

Elderly residents of rural areas are at significant risk for mental health problems, yet have less access to mental health services. Thus, most mental health problems among rural elderly remain either undiagnosed or untreated. We describe two models of mental health outreach programs to rural elderly in Iowa and Virginia, serving demographically, culturally, and epidemiologically different populations in geographically and economically dissimilar regions. Programs are compared on the basis of initiation, community partnerships, target population, target region, clinical disciplines involved, coordinating discipline, referral sources, operational model, initial home assessment, care planning, sustainability, cost, patient demographics, and primary and secondary diagnosed. Outreach programs are argued to be effective models of delivering services to geographically and/or socially isolated elderly populations. The experiences of our programs, though limited to rural populations, may be of relevance to any outreach program attempting to serve elderly presenting with or at risk for mental health problems.

Aged↗
PubMed1993

The nature of inquiry: linking quantitative and qualitative research.

Views of research that dichotomize qualitative and quantitative methods and the paradigms in which they are couched reflect a limited interpretation of the process of inquiry. In this article, the authors propose that inquiry, regardless of the inquirer's chosen paradigm or method, is governed by six pursuits that integrate qualitative and quantitative research methods. Recognition of the synthetic nature of inquiry is essential to fuller explanation and understanding of questions and problems relevant to nursing.

Nursing Research↗
PubMed1992

Integrating the bio into the biopsychosocial: understanding and treating biological phenomena in psychiatric-mental health nursing.

Advances in neuroscientific understandings of the interrelationships between brain, behavior, emotion, and cognition offer new opportunities for psychiatric-mental health nursing. Yet, even though the discipline conceptually embraces a biopsychosocial perspective as part of its holistic mandate, the factual integration of biological sciences into practice, research, and education is limited. Integrating the biological perspective into a holistic paradigm and progressing toward a discipline in which the biological, psychological, and social interact coherently and interdependently requires a dual focus on understanding and treating patients and their social and physical environments. We describe how in the past the discipline has strived toward understanding and treating patients from predominantly psychological and social perspectives. We also show how progress in the biology of mental health and illness provides new avenues for understanding and treating patients' responses to actual and potential health problems. This in turn will contribute to the emergence of a truly holistic discipline of psychiatric-mental health nursing.

Biological Psychiatry↗
PubMed1992

Cognitive nursing interventions with long-term care residents: effects on neurocognitive dimensions.

We recently reported that cognitive nursing interventions--such as cognitive-behavioral group therapy and focused visual imagery group therapy--administered over time may produce significant and lasting improvements in overall cognitive status in nursing home residents with slight to moderate cognitive impairment, when compared with subjects participating in educational discussion groups. To further elucidate the cognitive gains made by subjects, we reanalyzed the data focusing on the 15 neurocognitive parameters tested by means of the Modified Mini-Mental State Examination. Main effects of intervention were noted on neurocognitive operations involving abstraction and conceptual thinking, concentration and linguistic manipulation, and execution of auditorily presented language skills. Main effects for time were observed on short and medium term recall, fluency of category retrieval, abstraction and conceptual thinking, concentration and linguistic manipulation, and execution of visually presented commands. Intervention and time were found to produce interaction effects on subjects' ability to visually and linguistically identify objects and their praxic ability to recognize and redraw simple but intersecting geometric figures. From a functional brain perspective, these effects involved brain functions at higher cortical and subcortical/limbic levels, and lower and more basic cortical functions were not affected. These findings underscore the role of psychogeriatric nursing in maintaining or restoring cognitive function in nursing home residents with mild to moderate cognitive impairment, not only for the sake of cognition itself but also for the (corollary) sake of promoting functional independence and self-care in a high-risk population.

Aged↗
PubMed1992

Longitudinal reliability of the Life Satisfaction Index (Short Form) with nursing home residents: a cautionary note.

We administered the Life Satisfaction Index (Short Form) 18 times over a 39-wk. period to an initial sample of 76 old, frail, multiply impaired, and depressed nursing home residents participating in a longitudinal quasi-experimental study of the effects of cognitive group interventions on cognition and depression. As no changes over time were observed on the outcome variable of life satisfaction, the stability of the instrument's internal consistency could be examined. Kuder-Richardson KR-20 coefficients ranged from .11 to .60, with a mean of .42 (SD = .11). We conclude that caution should be used when applying this instrument to measure life satisfaction in frail nursing home residents.

Aged↗
PubMed1992

Assessing geropsychiatric patients.

Although other disciplines involved in the care of geriatric patients with psychiatric or neurobehavioral problems have established assessment procedures, this is not the case for nursing. Some approaches to assessing geropsychiatric patients from a nursing perspective have been proposed (Baldwin, 1987; Burnside, 1981; Ninos, 1985), but they have been limited in scope (Abraham, 1990b). However, with nursing assuming an increasingly central role in the multidisciplinary care of geropsychiatric patients and their families, a comprehensive and accepted method of multidimensional geropsychiatric nursing assessment is necessary. This method enables nurses to provide the best possible nursing care to patients and families while contributing effectively to multidisciplinary assessment and intervention. To this end, Abraham and associates (Abraham, 1990a; Thompson-Heisterman, 1992) developed the Psychogeriatric Nursing Assessment Protocol (PNAP). Previous articles have described the rationale and content of the PNAP (Abraham, 1990a; Thompson-Heisterman, 1992). This article will draw on the authors' clinical experience in using the PNAP and will offer practical clinical strategies for assessment within the PNAP framework. The PNAP is presented in the Figure, and readers are referred to previous articles for detailed descriptions of the various aspects of the PNAP. A rating form has been developed for use with the PNAP that permits quantification of clinical observations and the determination of selected clinical scores.

Caregivers↗
PubMed1992

A clinical and research database management system for a geriatric nursing outreach program to rural elderly: purpose and general structure.

The need to systematically and comprehensively manage data to support nursing services asserts itself in all areas and contexts where nursing services are delivered to patients and families. While most applications have targeted inpatient nursing services, several systems to sustain ambulatory nursing care have been proposed as well. In this paper, we outline the purpose and general structure of a custom-designed computerized database management system to support the clinical, administrative, and research operations of a geriatric nursing outreach program in rural Virginia.

Aged↗