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Biomedical subjects

M B Ryden

Publications and source records attributed to M B Ryden.

30 records · Page 2Linked to original sources
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↗
PubMedDate not supplied

Nursing home resuscitation policies and practices for residents without DNR orders.

The purpose of this study was to explore the policies and practices of nursing homes with respect to the resuscitation of residents who do not have a do-not-resuscitate (DNR) order. Responses from a survey of 36 facilities revealed that most residents had DNR orders and most facilities were capable of providing basic cardiopulmonary resuscitation (CPR). Less than 30% had performed CPR in the past 6 months, and 22.8% had no written CPR policies. More facilities required CPR in witnessed arrests of non-DNR residents (79.3%) than in unwitnessed arrests (24%). Methods for identifying CPR status need improvement to enable accurate identification and prompt resuscitation of residents who want CPR.

Advance Directives↗
PubMedDate not supplied

Challenging misperceptions about nurses' moral reasoning.

Discussions in the nursing literature about the usefulness of Kohlberg's theory of moral reasoning for women and nurses, and assertions about the level of moral reasoning scores of nurses have been clouded by inaccuracies and misperceptions. In this article, theoretical and measurement issues related to moral reasoning are clarified and a critical review of the literature is provided about the moral reasoning of nursing students and nurses as measured by the Defining Issues Test (DIT). The review indicates the need for greater rigor in studies of moral reasoning among nurses and the need for accuracy in interpreting and reporting moral reasoning scores. The data show that the moral reasoning of nurses, like that of other groups, tends to increase with formal education. Nurses' scores are usually comparable to, and sometimes higher than, scores of their academic peers.

Ethics, Nursing↗
PubMedDate not supplied

Morale and perceived control in institutionalized elderly.

This study explored patterns of causal relationships among perception of situational control, health, socioeconomic status, functional dependency, length of stay, and morale in institutionalized elderly. Causal patterns in residents at two levels of care were contrasted. A total of 113 residents on intermediate and skilled care units chosen randomly from 4 urban proprietary nursing homes were studied. Variables were measured by means of an interview. Instruments included the Philadelphia Geriatric Center Morale Scale, Chang's Situational Control of Daily Activities Scale, and the Resident's Questionnaire. Path analysis was used with a causal model to estimate direct and indirect effects of the independent variables on morale. Important differences in the way the independent variables affected morale for residents on the two levels of care were reported. Perception of situational control proved to be a key variable, significantly related to the morale of residents on both levels of care, although the strength of the association was stronger for residents on skilled care. Functional dependency, health, and socioeconomic status had significant direct effects on the morale of residents on intermediate care but not those on skilled care.

Activities of Daily Living↗