Biomedical subjects

M B Ryden

Publications and source records attributed to M B Ryden.

At least 19 recordsLinked to original sources

PubMed1998

Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture.

OBJECTIVE: To compare the experience of pain and treatment of pain in cognitively impaired and cognitively intact older adults after surgical repair of a hip fracture. DESIGN: Prospective comparative survey design. PARTICIPANTS: A convenience sample of 88 hip fracture patients (53 cognitively impaired, 35 cognitively intact) from three Midwestern urban hospital orthopedic units was interviewed between days 2 and 5 postoperatively. Subjects whose Folstein Mini-Mental State Exam (MMSE) score was less than or equal to 23 were categorized as impaired. RESULTS: Pain report and intensity did not differ significantly between the two groups. One-third of the subjects in both groups rated pain as severe or worse. Cognitively impaired subjects scored significantly higher on the Checklist of Nonverbal Pain Indicators observed with movement (CNPI-m) than did cognitively intact subjects. Cognitively impaired subjects received significantly less opioid analgesics than cognitively intact subjects in the first and second 48 hours postoperatively. Both groups received less than 25% of the mean prescribed amount of opioid analgesics. Age, MMSE, and CNPI-m score accounted for 27% of the variance in the amount of opioid analgesic administered in the first 48 hours postoperatively. CONCLUSIONS: Pain is treated poorly in older postoperative patients. Cognitive impairment and age strongly influence the amount of analgesic nurses administer to older patients after surgical repair of hip fracture. Provision for patient comfort is a fundamental ethical obligation of healthcare providers. Clinicians need to pursue this goal more aggressively, especially for cognitively impaired, postoperative older adults.

Acetaminophen↗

PubMed1998

Assessment of depression in a population at risk ... newly admitted nursing home residents.

Depression in newly admitted nursing home residents is a frequently overlooked area of nursing concern. Educating staff to systematically use a standardized depression assessment protocol with all newly admitted residents would facilitate efforts to enhance the quality of residents' lives by identifying depression so that prompt treatment is possible. Other previously admitted residents who appear to be particularly vulnerable to depression would also benefit from this assessment. The use of this protocol for the assessment of depression offers the possibility of providing more accurate and more comprehensive information regarding mood states than that currently being documented in the Minimum Data Set.

Aged↗

PubMed1994

The clinical evaluation tool: a measure of the quality of clinical performance of baccalaureate nursing students.

This article describes an approach to the evaluation of students' clinical performance. Specifically, the paper describes: (a) the history of the evaluation of clinical performance in nursing education; (b) the development of the Clinical Evaluation Tool (CET), an instrument designed to measure the clinical performance of nursing students across settings; and (c) the relationships between basic baccalaureate nursing students' scores on the CET and the following variables: age, college credits earned prior to entry to the program, grade point average at entry, college aptitude, and moral reasoning.

Adult↗

PubMed1992

Aggressive behavior. Educating nursing assistants.

Caring for cognitively impaired aggressive residents presents a challenge to nursing assistants in long-term care facilities. Nursing assistants participated in an educational program that included content about cognitive losses, precipitants of aggression, communication techniques, strategies for preventing aggressive behavior, and managing personal feelings. Following the educational intervention in this study, nursing assistants reported that caring for cognitively impaired residents was significantly more rewarding and less frustrating. The use of the clinical nurse specialist to teach and assist in role modeling direct care of residents was effective in improving nursing assistant skill in working with aggressive cognitively impaired residents.

Aged↗

PubMed1992

Goal-directed care: caring for aggressive nursing home residents with dementia.

1. Aggressive behavior in elders with dementia occurs most often during personal care. It is often a response to invasion of private space and may be prevented or reduced by interpersonal approaches that reflect a set of individualized goals for the resident. 2. Five resident goals for preventing or reducing aggressive behavior are to feel safe, to feel physically comfortable, to experience a sense of control, to experience optimal stress, and to experience pleasure. 3. These goals provide a framework for humane care that respects the personhood of the individual and minimizes the need for psychotropic medications and physical restraints.

Aged↗

PubMed1992

We need to know more: nurse educators' interest and expertise in gerontology.

An assessment was made of 129 faculty who teach nursing students about the care of aged clients to determine their level of interest and expertise in 21 content areas related to gerontology. Faculty rated their expertise consistently lower than the relevance of, and their interest in, each of the content areas. Areas identified as most important for their professional growth tended to be areas where faculty ranked their expertise as already being high. The mean self-rated expertise of faculty who taught a course in gerontological nursing was significantly higher than those who did not. Most respondents lacked formal education in gerontology: 9% of respondents had gerontology in their undergraduate program; 27% in their graduate program. Only 4% were certified as gerontological nurses or gerontological nurse practitioners.

Adult↗

PubMed1991

Aggressive behavior in cognitively impaired nursing home residents.

Aggressive behavior was documented in a sample of 124 residents on units for the cognitively impaired in four nursing homes over a period of 7 days using the Ryden Aggression Scale. Some form of aggression was found in 86.3% of the residents, with no differences among facility, gender or diagnostic group. Neither mental status nor physical dependency was associated with aggression. The 68.5% who received psychotropic drugs had significantly higher aggression scores. Most incidents of aggression involved response to invasion of personal space and occurred during the day shift.

Activities of Daily Living↗

PubMed1991

A behavioral comparison of the helping styles of nursing students, psychotherapists, crisis interveners, and untrained individuals.

Helping styles of nursing students were compared with those of subjects in a prior study (17 psychotherapists, 12 crisis interveners, and 15 untrained people). Subjects were 30 junior-year college students in the second part of a two-course sequence in interpersonal relations. The subjects were videotaped in a 3-minute interaction with a simulated client. An experienced psychotherapist who was trained in the use of the Helping Skills Verbal Response System instrument rated each student. The helping behaviors of nursing students were found to resemble those of trained mental health practitioners; their behavior was significantly different from those of untrained individuals, who were highly verbose, directive, and used minimal reflection of affect or content.

Adult↗

PubMed1989

Assess not assume--measuring the morale of cognitively impaired elderly.

The morale of cognitively impaired elderly has not been systematically studied as this group has been excluded in most studies of well-being. This study showed that most cognitively impaired persons who retain verbal skills were able to respond to a verbally administered assessment using the Philadelphia Geriatric Center Morale Scale. Support for the reliability and validity of measurement of morale in cognitively impaired elderly using the Philadelphia Geriatric Center Morale Scale was reported. Ratings of the morale of cognitively impaired persons by family members were significantly associated with self-report by elders, but tended to be lower.

Aged↗

PubMed1989

Multi-course sequential learning as a model for content integration: ethics as a prototype.

Multi-course sequential learning (MCSL), a model for integrating content throughout the curriculum, is described using ethics education as a prototype. In this model, content is presented via a vertical course, with units embedded in existing courses across various levels of the nursing program, which is designed to provide coherent organization of content, visibility, and accountability, and to prevent gaps and unnecessary duplication. This article describes the process of developing an Ethics MCSL, which is being implemented and evaluated with support from a three-year grant from the Fund for the Improvement of Postsecondary Education (FIPSE).

Curriculum↗

PubMed1989

Wrestling with the larger picture: placing ethical behavior in clinical situations in context.

This article provides an account of the use of a model-building process as an educational strategy for the teaching of ethics. Designed to integrate students' growing knowledge and skill in nursing with their intellectual and professional development, this model-building process has its theoretical foundations in cognitive moral development theory, and in an integrative approach to nursing education called Multi-Course Sequential Learning (MCSL).

Clinical Competence↗

PubMed1988

Aggressive behavior in persons with dementia who live in the community.

Aggressive behavior in persons with dementia who are living in the community was explored in a pilot study using a newly developed instrument, the Ryden Aggression Scale. Factors affecting this kind of research are addressed, including reliability and validity of the instrument, sample bias, diagnostic workup, and control groups. Results of a pilot survey of caregivers revealed aggressive behavior in 65% of a sample of 183 subjects, occurring weekly or more often in 31% and daily in 16%. Verbal and physical aggression were most prevalent (50% and 46%, respectively), while sexual aggression appeared less frequently (18%). Aggression was significantly related to degree of cognitive impairment and prior history of aggressive behavior, but not to diagnosis nor administration of psychotropic medications. Men showed significantly more sexual aggression. Further research to verify these findings is needed.

Aged↗

PubMed1985

Environmental support for autonomy in the institutionalized elderly.

The climate for autonomy in four urban proprietary nursing homes was investigated as part of a larger study of the relationship between perceived control and morale. Data from 113 residents, 137 caregivers, and 10 administrative personnel revealed that caregivers see themselves as the predominant decision makers. Although they prefer a slightly higher level of self-determination for residents, only in one-to-one and solitary activities do they prefer giving residents the primary decision making role, possibly because they see most residents as not capable of making decisions. Residents saw themselves as having more control than did staff. Grooming and eating were identified by both groups as areas where residents had the least control. A substantial proportion of caregivers and administrative staff did not emphasize the availability of options to residents.

Activities of Daily Living↗

PubMed1985

Limited-treatment policies in long-term care facilities.

Two-thirds of the long-term care facilities in Minnesota accept do-not-resuscitate (DNR) orders and 73% accept care plans to limit medical treatment. The major objectives for limited-treatment plans cited by the 16.3% of facilities with administrative protocols for such plans was to provide for the resident's physical and emotional comfort and dignity. Nearly half of the protocols said limited treatment plans were intended to limit emergency care or hospitalization or to allow death to occur. Protocols advocated the alleviation of physical discomfort, anxiety, and social isolation. Tube feedings were not recommended when oral feeding became impossible. Airway suctioning, oxygen, or antibiotic treatment was suggested only as needed to alleviate suffering. Only a fourth of the protocols described a primary role for the resident in these decisions. This study demonstrates that nursing homes are developing administrative protocols for the formulation of limited-treatment plans and suggests that model policy statements describing key decision-making principles, issues, and procedural safeguards could play a constructive role in this process.

Euthanasia↗

PubMed1985