Journal of advanced nursing
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The purpose of this paper is to assist advanced practice nurses to recognize, identify, and diagnose cognitive change in older adults. ⋯ It is essential to understand how the 4 'D's' are expressed and to recognize the potential contributing factors to an observable change in cognitive function for diagnosis and treatment. Recommendations for obtaining a person's history are included.
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Providing appropriate follow-up health/long-term care services after hospital discharge for elderly persons is important to enhance health and quality of life. Therefore, identifying factors that affect follow-up service utilization has become an important concern. Most studies of predictors of follow-up service utilization for elderly persons after discharge were conducted in the United States of America (USA). Taiwan differs substantially from the USA in health care system, clinical practice, case-mix, culture, and social organization; thus the findings from the USA need to be validated in Taiwan to ensure appropriate discharge referrals. ⋯ When taking nursing home and home nursing utilization into considerations at the same time, the elderly person's pre-admission institutionalization and the caregiver's preference for institutional displacement strongly predicted nursing home utilization after hospital discharge. The elder's self-care ability, conscious level, and tubes remaining before discharge strongly predicted the use of home nursing services after discharge.
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The use of the randomized consent design (commonly known as the Zelen design) is a controversial issue in randomized controlled trials. In the Zelen design, participants are randomly allocated prior to seeking consent. Those participants allocated to the intervention group are then approached and offered the intervention, which they can decline or accept. Zelen first proposed the design in 1979. It has been used infrequently since this time, although there are some notable exceptions in nursing, midwifery and some medical specialities. ⋯ It is hoped that by presenting issues pertaining to the Zelen design, other nursing and midwifery researchers may be prompted to consider its use when designing clinical research. The Zelen design is controversial, and debate about its merits and shortcomings is useful. This paper contributes to the ongoing debate.
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To develop and evaluate psychometric properties, that is reliability and validity, of an instrument to measure strategic and clinical quality indicators in postoperative pain management. ⋯ The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated.
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The aim of this phenomenological study was to find out what menopause was like as an experience for women who were not yet 40 years old. ⋯ This study revealed that the experience of menopause came as a shock for the women--it was perceived as a major epiphany in their lives and they were confronted with a multitude of issues related to the timing of the event and their embodied understanding of menopause. The experience of menopause resulted in multiple disruptions in the women's lives. The women discussed many aspects of their lives that now seemed to be 'out of synchrony'.