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Nursing diagnoses in elderly residents of a nursing home: A case in Turkey _ Elem Kocac¸al Gu¨ler, MSc, RN*, Ismet Es‚er, PhD, RN, Leyla Khorshid, PhD, RN, S‚ebnem C¸inar Yu¨cel, PhD, RN _ Department of Fundamentals of Nursing, Ege University School of Nursing, Izmir, Turkey
article info
abstract
Article history: Received 22 June 2010 Revised 25 February 2011 Accepted 4 March 2011 Online 23 June 2011
There are limited studies on nursing diagnoses of the elderly living in nursing homes worldwide. This study aimed to define the most frequent nursing diagnoses in the elderly residents of a nursing home elder care and rehabilitation center. Seventy-four elderly individuals were included in the study. Data were collected using the “Elderly Individual’s Introduction Form” between April 2007 to August 2007. The content of the form was based on a guide to gerontologic assessment, and Gordon’s Functional Health Patterns. The nursing diagnoses (NANDA-I Taxonomy II) were identified by the 2 researchers separately according to the defining characteristics and the risk factors. The consistency between the nursing diagnoses defined by the 2 researchers was evaluated using Cohen’s kappa (k). There was an 84.7% agreement about nursing diagnoses defined by the 2 researchers separately. The weighted kappa consistency analyses showed there was an adequate level of consistency (k ¼ 0.710), and the findings were significant ( p < 0.0001). The most frequent diagnoses were ineffective role performance (86.5%), ineffective health maintenance (81.2%), risk for falls (77%), and impaired physical mobility (73%). The diagnosis of ineffective role performance was more frequent in patients with dementia (x2 ¼10.993, df ¼ 1, p ¼ 0.001). There was a very significant relationship between dementia and the diagnosis of impaired verbal communication (x2 ¼ 32.718, df ¼ 1, p ¼ 0.0001). The relationship between mobility disorder and self-care deficit was also significant (x2 ¼ 19.411, df ¼ 1, p ¼ 0.0001). To improve quality in patient care, nurses should use nursing diagnoses with a systematic assessment and should help the elderly in health promotion or use of the maximum current potential.
Keywords: Elderly Nursing diagnosis Taxonomy
_ Khorshid, L., & Yu¨cel, S‚.C¸. (2012, FEBRUARY). Nursing diagnoses in Cite this article: Gu¨ler, E.K., Es‚er, I., elderly residents of a nursing home: A case in Turkey. Nursing Outlook, 60(1), 21-28. doi:10.1016/ j.outlook.2011.03.007.
Introduction The Turkish population is aging, just like the rest of the world.1-4 The Statistics Association of Turkey reported in 2008 that 6.84% of our population (4.893.423) was 65
years of age.5 This increase and the extended lifespan will cause a high degree of geriatric health problems and profound transformations in the family-socialeconomic-cultural structure of the society, which will have a direct influence on the health sector.2,4,6-10 In parallel with epidemiological changes, there is also an
The work was previously presented at the Third International (11th National) Nursing Congress, 2007 Bas‚kent University, Ankara, Turkey. * Corresponding author: Elem Kocac¸al Gu¨ler, Research Assistant, Ege University School of Nursing, 35100, Bornova, Izmir, Turkey. E-mail address:
[email protected] (E.K. Gu¨ler). 0029-6554/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.outlook.2011.03.007
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increase in the rate of chronic degenerative problems (coronary artery diseases [28%],11 hypertension [33.7%],12 diabetes [13.5%],13 osteoarthritis [10-35%]14 etc.), which will require support from qualified professionals and elderly community-oriented appropriate care models.15-18 The physiologic changes caused by aging bring about chronic diseases, psychological disorders, and problems (dementia [5-50%],19 depression [1-60%],20,21 sleep problems [60.9%]22) rising from inactivity, thereby creating a vicious circle.23 Elder care can differ in each country. Traditionally, elder care was provided by the family members. Increasingly in modern societies, it is now being provided by the state or charitable institutions. This change is caused by decrease in family size, a longer life expectancy for seniors, the geographical dispersion of families, and the tendency for women to be educated and work outside of the home.16,23,24 Despite the different socio-cultural structure of Turkey when compared with most European countries, the aforementioned changes are now increasingly affecting Turkish citizens as they have those in most other countries. Elder services in Turkey are, on an institutional level, predominantly offered by nursing homes. Social Services and Child Protection Association, Social Insurance Institution, municipalities, charitable institutions, and other community institutions in Turkey have provided service to elderly people in 259 nursing homes since 2008.7,25 Unfortunately, The number of institutions currently has a 341 personto-1-bed ratio for people aged 60 or above.26 In addition, our programs serving elderly people are not as multifaceted as they are in other countries, and do not include rest homes (nursing homes), nursing home elder care and rehabilitation centers, elderly counseling centers, and national associations devoted to advocating for elders.7,23 Studies on home care programs in Turkey have continued to grow since 1994.7 According to law on the Republic of Turkey Pension Fund for civil servants, practices of services for senior persons are conducted through rest homes and nursing homes. In line with the provisions of regulations, nursing homes lodge elderly people over 60 years of age who are socially or economically deprived, can independently carry out their daily activities (eg, eating, drinking, toilet), do not have a grave sickness or disability that would necessitate continued treatment and care, and are mentally and psychologically sound. Some seniors do not have relatives who are legally obliged to look after them. Those who do have someone who is legally obliged, but financially unable to look after them, and those with adequate economic power but who are socially deprived, are admitted to nursing homes but required to pay for their lodging.16,23,25,26 Some nursing homes have special care units to carry out the nursing and rehabilitation of elderly people who are permanently or temporarily bedridden or require special attention, support, and protection as a result of physical or mental decline.16,23
Provision of services for seniors in the nursing home elder care and rehabilitation center are consistent with nursing homes with a special care unit. It is a goal that all services provided for elders, such as people meeting their daily needs (eg, meals, cleaning, lodging), treatment and care, psychological and social consultancy, developing their social relations, spending of their leisure time, and adequate diets based on their nutrient consumption levels and health conditions are supervised in coordination by staff such as a physician, social service specialist, psychologist, dietician, physiotherapist, and nurse.23 This professional supervision is required because most of the residents in this institution have cognitive problems such as dementia. Yet, there are not enough nurses to provide for or supervise these services in Turkey. According to the World Health Organization (WHO), Turkey is last among 51 countries in Europe in terms of the number of nurses available per 1000 individuals. In our country, the number of nurses is 2.4 per 1000 persons, whereas this rate is 9.5 nurses in Germany, 8.4 nurses in Sweden, 5.8 nurses in Austria, and 3.7 nurses in Spain.26 Duties and authorities of the nurses identified by the Social Services and Child Protection Association are to: collect data from seniors related to their diseases; prepare seniors for physical examination; help the physician, dentist, and physiotherapist arrange medical procedures; carry out medication administrations and monitor the effects of drugs; measure and evaluate vital signs; provide basic nursing skills for body systems; administer first-aid procedures and measures if necessary and inform physician about the situation; take necessary precautions when any infectious disease exists; accompany older persons referred to the hospital if necessary and deal with discharge from the hospital; administer infirmary affairs; ensure the general hygiene conditions in the institution; deal with meal delivery, monitor eating patterns, and encourage and assist elders with eating difficulty; record the nursing applications; and work in collaboration with the health care team.27 Nursing care contributes to a higher quality of life for the elderly. This can be possible by a systematic and comprehensive care by nurses. A comprehensive assessment is the first stage of the nursing care process.28-30 Systematic data facilitate the definition of suitable nursing diagnoses leading to care. Nursing diagnoses are used as a basis for projecting outcomes and determining nursing interventions with the aim of reaching those projected outcomes.29,31,32 Although there has recently been a new international trend in the use of nursing diagnoses,33 in our country their use is limited to those in the education field and a few private hospitals, but they are ignored by most nurses in
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practice. In a study conducted in the geriatric clinic of a university hospital in Sweden, it was found that nursing diagnoses comprised only 5% of all annual patient records,32 demonstrating that the use of nursing diagnoses is still at unsatisfactory levels in other countries as well. In addition, a review of the literature states that there are limitations in the amount of information, insufficiency of time, and inadequate patient data for the use of nursing diagnoses.31-34 So it is important to use nursing diagnoses to prevent ignoring the nursing care needs of the elders. There is not a standard form intended for assessment and nursing care plan of the seniors based on nursing diagnoses in the institutions. There are also very few studies on nursing diagnoses of the elderly living in nursing homes.17,18 This situation may lead nurses to ignore the problems and care needs of the elderly. Hence, this pilot study was planned to compose a standard elderly assessment form, define the suitable nursing diagnoses according to this form and make those widespread, and improve the quality of elder care. The findings of this study can begin the foundation for a comprehensive database for the researchers and geriatric nurses, sustain a holistic and systematic approach toward the care of elders, create a shared language among nurses, further develop documentation systems, ensure the continuity of the care, and provide individualized care of the elderly. In addition, the results of the study may help nurses to easily define the appropriate nursing interventions and establish nursing outcomes for the elder population. In the literature, most of the studies focus on only 1 or a few of the health problems of the elderly in our country. This study presents an overall view of those problems and nursing diagnoses of the seniors, and geriatric nurses especially may benefit from a vast amount of data and effective time management to facilitate care of older persons. Nurses’ workload is reduced in this way and, consequently, quality of nursing care of the elderly people is increased. Parallel to these data and time management skills, this study provides opportunity to researchers, scholars, and scientists for comparing the data of nursing diagnoses of the elderly in their own country.
Purpose and Research Questions The aim of this study was to define the most frequent nursing diagnoses in the elderly residents of a nursing home elder care and rehabilitation center in the Aegean region. The questions guiding this study are: 1. What are the nursing diagnoses of the elderly living in a nursing home and rehabilitation center? 2. Is there any relationship between nursing diagnoses and medical problems of the elder population?
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3. Is there any relationship between nursing diagnoses and selected descriptive variables of the elder population?
Methods Design and Setting The study was conducted between April 2007 and August 2007. The study was performed in a nursing home elder care and rehabilitation center with 96 beds. The study was approved by the Ethics Committee of the School of Nursing at the university and the related health center. The initial sample was to comprise 90 elderly individuals staying at the institution and include all residents in the study. However, 16 were excluded because they died during the data collection period.
Sample The sample of older adults (N ¼ 74) consisted of 51.35% females with a mean age of 76 8.27 years. Of the older adults, 40.5% were in the 75-85-year-old age group; 68.9% were widowers; and 5.4% were university graduates, 47.3% were secondary school graduates, 43.2% were illiterate; and 51.4% had no social security (Table 1). Of the elderly, 13.5% had no relatives, and 4.1% were found to be unknown.
Measurement and Data Collection Procedures Data were collected using the “Elderly Individual’s Introduction Form,” which was used in a previous study of approximately 250 elderly residents.35 The form had been developed in accordance with the literature by the researchers in that previous study, and some items were adapted to this research by the authors. For instance, one adaptation was a supplement to a new item in the socio-demographic details about presence of family or relatives of elders. Expert opinion was consulted by the researchers to evaluate the applicability of the re-edited form. The content of the form consists primarily of a guide to gerontologic assessment,36,37 and included 15 items for sociodemographic details, 18 items for the general health status, 20 items for physical assessment, 12 items for activities of daily living, and the last part for nursing diagnoses. In the form, Gordon’s Functional Health Patterns were also used during the data collection. Functional health patterns and gerontologic assessment were integrated to strengthen the form and as a guide to define nursing diagnoses according to Nursing Diagnoses Grouped in North American Nursing Diagnosis Association-International (NANDAI) Taxonomy II. The form was completed during faceto-face interviews, observation, and comprehensive
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Table 1 e Descriptive Details of the Elderly Descriptive details Age Groups 85 years Gender Women Men Marital status Married Single Widower/Divorced Education Illiterate Secondary school High school University Social security Social Security Institution Free of charge Occupation Housewife Clerk (civil servant) Employee Trader Unemployed Total
n
%
10 21 30 13
13.5 28.4 40.5 17.6
38 36
51.4 48.6
2 21 51
2.7 28.4 68.9
32 35 3 4
43.2 47.3 4.1 5.4
36 38
48.6 51.4
32 4 8 21 9 74
43.2 5.4 10.8 28.4 12.2 100
nursing assessment by the 2 researchers. Information about the health status of the elderly was collected from the health care professionals working in the centerdnurses, physicians, dentists, psychologists, and physiotherapists. Socio-demographic details and information on diseases and treatments were collected from both medical records and the health care team. The purpose of NANDA-I Taxonomy II is to provide a recognized and clinically beneficial classification for achievement of a standardized description of nursing diagnoses. As of 2008, NANDA-I Taxonomy II had 3 levels: 13 domains, 47 classes, and 206 approved nursing diagnoses.29,34,38,39 This classification system is widely used in several countries. In our country, it has been a current trend to use in a few private hospitals and commonly in the education arena. During their internship, nursing students receive education in every nursing school of Turkey to provide nursing care plans based on NANDA-I Taxonomy II diagnoses. A reference book by Erdemir,40 which was translated into Turkish from Carpenito’s Hand Book,29 is used during the preparation for nursing care. Most of the NANDA-I nursing diagnoses are consistent with our culture. The nursing diagnoses were identified by the 2 researchers separately according to the defining characteristics and the risk factors.
Data Analyses Statistical analyses were conducted using the Statistical Package for the Social Sciences for Windows
Version 17.0 (SPSS, Inc., Chicago, IL). Frequencies were calculated for all variables, and the data were presented as numbers and percentages. Chi-square analysis test was used for data analysis. The consistency between the nursing diagnoses defined by the 2 researchers separately was evaluated using Cohen’s kappa (k).
Findings Our study revealed that there was an 84.7% consistency between the nursing diagnoses defined by the 2 researchers separately, and the result of weighted kappa consistency analyses showed there was an adequate level of consistency k:0.710, p < 0.0001). Among the 74 elders, 165 nursing diagnoses were found, averaging to 16.82 7.75 (min ¼ 4, max ¼ 36) per individual. The most frequent diagnosis was in the areas of activity-resting and security-protection, with 19 diagnoses in each (Table 2). The most frequent diagnoses were ineffective role performance (86.5%), ineffective health maintenance (81.2%), risk for falls (77%), impaired physical mobility (73%), deficient diversional activity (67.6%), and selfcare deficit and impaired social interaction (60.8%) (Table 3).
Relationships Between Nursing Diagnoses and Medical Problems of the Elder Population The most frequent symptoms and problems reported by elders in this study were memory disorders (58.1%), pain (39.2%), insomnia (23%), and incontinence (45.9%). Four elderly had allergies, 3 of whom were allergic to environmental allergens and 1 to drugs. All elderly persons were immunized for influenza. The most common chronic conditions were hypertension (33.8%) and coronary artery disease (16.2%). It was found that 67.2% had neurological, 56.8% had musculoskeletal, 54.1% had genitourinary, and 48.6% had cardiovascular Table 2 e The Numbers of Nursing Diagnoses in Each Category Nursing Diagnoses Categories
Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Domain 6 Domain 7 Domain 8 Domain 9 Domain 10 Domain 11 Domain 12
Health promotion Nutrition Elimination and Exchange Activity/Rest Perception/ Cognition Self perception Role relationships Sexuality Coping/Stress Tolerance Life principles Safety/Protection Comfort
Number of Nursing Diagnoses 6 8 9 19 9 10 3 1 12 2 19 4
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Table 3 e The Distribution of Nursing Diagnoses Most Commonly Identified in the Elderly Nursing Diagnoses n % Health promotion Ineffective health maintenance Ineffective therapeutic regimen management Nutrition Deficient fluid volume, risk for imbalanced nutrition: Less than body requirements Imbalanced nutrition: More than body requirements Elimination and exchange Bowel incontinence Functional urinary incontinence Risk for constipation Activity/Rest Impaired physical mobility Deficient diversional activity Self-care deficit Impaired walking Risk for activity intolerance Risk for disuse syndrome Ineffective tissue performance Perception/Cognition Impaired verbal communication Impaired memory Impaired environmental interpretation syndrome Disturbed sensory perception Wandering Self-perception Disturbed personal identity Powerlessness Risk for loneliness Role relationships Ineffective role performance Impaired social interaction Coping/Stress tolerance Ineffective coping Decreased intracranial adaptive capacity Life principles Noncompliance Safety/Protection Risk for falls Risk for trauma Ineffective protection Risk for peripheral neurovascular dysfunction Comfort Chronic pain
60 33
81.1 44.6
19 17
25.7 23
17
23
36 36 22
48.6 48.6 29.7
54 50 45 43 25 16 15
73 67.6 60.8 58.1 33.8 21.6 20.3
37 34 32
50 45.9 43.2
21 10
28.4 13.5
27 27 20
36.5 36.5 27
64 45
86.5 60.8
20 19
27 25.7
19
25.7
57 23 19 18
77 31.1 25.7 24.3
20
27
problems (Table 4). Of the elderly, 82.4% took medications, and of these, 25.4% were taking 3 to 5 medications, and 21.6% were not compliant with their prescribed treatment (Table 5). Of the elderly, 18.8% could perform daily life activities, whereas 58.1% needed caregivers’ help during these activities and 31.1% were totally dependent on caregivers. The diagnosis of ineffective role performance was more frequent in patients with dementia (x2 ¼10.993, df ¼ 1, p ¼ 0.001). There was a significant relationship
Table 4 e Medical Problem Areas in the Elderly Problem areas Neurologic Musculoskeletal Genitourinary Sensorial Cardiovascular Emotional Hematologic Gastrointestinal Pulmonary Endocrine
n
%
49 42 40 39 36 30 9 9 7 6
67.2 56.8 54.1 52.7 48.6 40.5 12.2 12.2 9.5 8.1
between dementia and the diagnosis of impaired verbal communication (x2 ¼ 32.718, df ¼ 1, p ¼ 0.0001). The relationship between mobility disorder and selfcare deficit was significant (x2 ¼ 19.411, df ¼ 1, p ¼ 0.0001). There was no significant relationship between descriptive characteristics (ie, age, gender, marital status, education level, social security, occupation) and all nursing diagnoses ( p > 0.05).
Discussion The concurrent use of medical diagnosis and nursing diagnoses allows for a better description of a patient’s actual situation to be made and provides a better basis for decisions about adequate interventions.32,33,41 The similarities between medical and nursing diagnoses include using a comprehensive diagnostic process when making a clinical judgment and determining expected outcomes.42-44 Conversely, depending that a medical diagnosis alone does not provide enough information to accurately diagnosis a patient from a nursing perspective. A medical diagnosis may be a related (or etiologic) factor for a nursing diagnosis (eg, dementia and impaired memory), but nurses must identify defining characteristics of a nursing diagnosis during the assessment.42 A holistic nursing assessment is critical to identify the nursing diagnoses. Unfortunately, nursing diagnoses are in use in only a few health care centers in Turkey and gaps exist regarding this topic in the institutions providing care for the elderly. Thus, we came to the conclusion that
Table 5 e Medication Use in the Elderly and Their Compliance n % Medication use Yes No Compliance to treatment Compliant Noncompliant
61 13
82.4 17.6
58 16
78.4 21.6
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although nursing diagnoses of elderly people living in a nursing home elder care and rehabilitation center are defined, the needed activities that will help widespread use of nursing diagnoses that are determinant in patient outcomes and interventions were emphasized. Aging is a natural process; however, physical and loss of abilities increase as a result of anatomic and physiologic changes in this period, and the person may become dependent on others. This process is generally associated with a gradual decline in respiratory, cardiovascular, genitourinary, gastrointestinal, hematologic, neurologic, sensorial, and endocrine system functions.45 Physical reactions are slowed because of an increased lag time of neurons transmitting information, and slowing manifests itself in the learning process.45-47 In our study, 25.7% of the elderly had neurological problems. Aging also affects bone deposition and resorption and causes a reduction in bone density; an increase in bone fragility; degeneration in cartilage; and a decrease in tendon elasticity, muscle mass, tonus, and strength.15,45 The high rates and variability of nursing diagnoses in the areas of activity and rest and security and protection may be caused by the changes in the musculoskeletal system. In this study, musculoskeletal problems were reported by 67.2% of the seniors. Genitourinary changes are also associated with aging. The bladder’s ability to expand is limited, and the volume of residual urine increases.45-47 In our study, genitourinary problems were seen in more than half of the elderly (54.1%). Over time, the skin thins and loses its vascularity, cellularity, and sensitivity. Hearing loss usually occurs at higher frequencies. In the eyes, the size of pupils grows smaller with age and the ability to focus becomes less accurate. Sensitivity to glare increases. Taste becomes less acute and the sensation of thirst is reduced, increasing the risk of dehydration. Many older people often complain of food being “tasteless.”46,47 In this study, sensorial problems were reported by more than half of the elderly (52.7%). Age changes make the heart less able to pump efficiently, and less blood pumped results in lowered blood oxygen levels. Blood vessels lose elasticity with age, forcing the heart to pump harder to circulate blood throughout the body. The amount of oxygen delivered to the bloodstream and the rate of blood flow declines with age. Even if lung capacity remains normal, the lung tissues seem to lose their facility for adequately allowing oxygen to transfer into the bloodstream. Because older persons cannot breathe as quickly as younger persons, there is less oxygen entering the blood per minute.45-47 In agreement with the literature, in the current study 48.6% of the elderly had cardiovascular problems and 9.5% had pulmonary problems. Older adults are more likely to lose their teeth to gum disease than to problems with the teeth themselves. It is also fairly common for older people to have less frequent bowel movements and to have
constipation.45-47 In our study, gastrointestinal problems were seen in 12.2% of the elderly. Pain, depression, bowel and bladder incontinence, dysfunction in balance, and falls are prevalent among nursing home residents.3,4,15,48 We found in our study that the most common complaints in the elderly were disorders of memory (58.1%), incontinence (45%), pain (27%), and insomnia (23%), and this result was consistent with the literature. Ehrenberg and Ehnfors found that pain was reported by 66% and sleep disorders by 19% of the elderly. 41 The lower rate of pain reported in our study may be a result of the difficulty in the ability of an elderly person with dementia to express pain. Chronic conditions have great impact on the quality of life in the elderly. In addition, senility and cognitive changes are the most important reasons for long-term disability in half of the elderly.15,49 Dementia, which was highly prevalent in the elderly in our study, may cause irreversible changes in cerebral function, memory disorders, impaired decision-making, roles, interpersonal relationships, and activities of daily living. Thus, the relationship between dementia and diagnoses of ineffective role performance (86.5%) and impaired verbal communication (50%) was significant in our study. We believe that the prevalence of nursing diagnoses for dementia and related conditions were the result of 2 factors: (1) Most of the elderly were >75 years old and (2) elderly individuals who could not take care of themselves were living in the institution. In our study, the diagnosis of disturbed sensory perception was determined to be present in 28.4% of the individuals. In a study by Marin et al, visual sensory perception alteration, related to the changes in the ability to perform activities, was identified in 62.7% of the elderly who were multiple drugs.17 This difference in ratios is thought to be associated with the demographic characteristics of the residents and the environment in which the studies took place. The most prevalent nursing diagnoses in the activity-rest domain were risk for falls (77%) and impaired physical mobility (73%), leading to a decreased ability to ambulate and limiting the performance of activities of daily living. This prevalence is higher than that reported by other studies. The risk for falls was also demonstrated in 50.7% of the seniors in the study by Marin et al. Risk for falls may be related to impaired sensorial perception, sleep problems, use of multiple medications, impaired balance, and extrinsic factors.17 In the study by Ehrenberg and Ehnfors, one third of the nursing diagnoses focused on the patients’ activities (eg, mobility, activities of daily living).41 Impaired physical mobility was present in 58.2% of the elderly patients in the study by Marin et al. 17 In their study, Sakano and Yoshitome diagnosed 50.74% of elderly with impaired physical mobility and 32.83% with activity intolerance.18 We believe the higher rates of nursing diagnoses in our study may be related to the sample consisting of elderly people who required continuous care and their sensorial (52.7%), neurological (67.2%), and emotional (40.5%) problems.
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In addition, the nursing diagnoses might be associated with use of medications (82.4%). Many elderly people complain about musculoskeletal changes, osteoarthritis, rheumatoid arthritis, osteoporosis, and pain related to fractures.15,49 We found the prevalence of chronic pain to be 27%. This is thought to be associated with gastrointestinal (12.2%) and musculoskeletal (56.8%) problems of the elderly in our sample. Our results were consistent with those of Ehrenberg and Ehnfors (20%), Vasconcelos et al (28.4%), and Sakano and Yoshitome (28.35%).18,41,50 In the study by Marin et al, 59.7% of the seniors reported pain.17 Our study revealed that 165 nursing diagnoses distributed across the several domain classes of the taxonomy used were identified, whereas in a study by Vasconcelos et al, the data only provided evidence to formulate 54 nursing diagnoses.50 This significant difference may be related to the majority of seniors who were dependent on care in our institution.
Limitations The data from this pilot study provide an initial description of health problems and nursing diagnoses in a nursing home elder care and rehabilitation center in west Turkey. The results of the research may not be generalized beyond one individual nursing home in Turkey, because this institution was unique in that it is both a nursing home and elder care rehabilitation center, and there was not any other institution like this in the region at the time of study. Because the population in this study was limited to one geriatric care facility, the sample size was too small to generalize the results. It is recommended that the study be replicated using a larger sample size from a variety of geriatric care facilities such as resident homes, nursing homes, and home health care agencies. More research to validate the findings of this study should be conducted in similar settings to provide a more comprehensive description of the elder population in Turkey.
Conclusion and Recommendations We found that a majority of elderly people have multiple significant health problems and multiple nursing diagnoses. Training in nursing diagnoses and preparing nurses to implement assessments of older persons’ situations and of nursing diagnoses are essential. To improve quality in elderly care, nurses should make nursing diagnoses using a systematic assessment and should help the elderly in health promotion or use of the maximum current potential. Although in-service training seminars are offered to groups who work with elderly people through the cooperation of the government, universities, and nongovernmental organizations, even if at an insufficient level, these efforts must be spread out, developed, and coordinated.
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By using an assessment form and nursing diagnoses, nurses may improve the quality of nursing care for the elderly
references
1. Hugman R. Ageing and the care for older people in Europe. London: Macmillan Press Ltd; 1994. 2. http://www.ageingresearch.group.shef.ac.uk/pdf/hcm_ review_low.pdf. Accessed October 24, 2009. ¨ zcebe H. Increasing quality of life of elderly. 3. Telatar TG, O Turkish J Geriatr 2004;7:162-5. 4. Gebam Bu¨lteni. Tu¨rkiye’de Yas‚lı Nu¨fusun Demografik Durumu. Available at: http://www.gebam.hacettepe.edu.tr/ bultenler/gebambulten2006.pdf Accessed October 15, 2009. 5. Turkish Statistical Institute. News Bulleting page. Available at: http://www.turkstat.gov.tr/Start.do;jsessionid¼NHnvLK7 TS4HHQBm25fr5tGyp8cDntGLV2tPmFhdT7dSjmsZV1FMD!1344760502. Accessed October 24, 2010. 6. Akgun S, Bakar C, Budakoglu II . Trends of elderly population in the world and Turkey: Problems and recommendations. Turkish J Geriatr 2004;7:105-10. 7. Altay B, Emiroglu ON. Services for the elderly. O M U Med J 2005;22:165-70 [in Turkish]. 8. Yazgan C, Kora K, Topcuoglu V, et al. Factors influencing quality of life nondemented elderly nursing homes residents. Turkish J Geriatr 2006;9:143-9. 9. So¨ylemez Z. Elderly Care & Elderly Structures in Turkey. Available at: http://www1.gantep.edu.tr/wgukamer/proje1/ docs/Wup2.ppt. Accessed October 15, 2009. 10. Salam A. Conceptualizing a geriatric care facility. Turkish J Geriatr 2009;12:31-5. ¨O ¨ . Cardiovascular functions in the 11. Demirsoy N, Tas‚kıran O elderly. Turkish J Geriatr 2010;(Suppl 2):125-33. 12. Yorgun H, Kabakc¸ı G. Diagnosis and treatment of hypertension in elderly. Turkish J Geriatr 2010;(Suppl 2):5-12. _ [Tu¨rkiye’de diyabet edipediyolojisi. 13. Halk Sag lıg ı 13. Satman I. lıkta Es‚itsizlikler Konus‚ma Metinleri Kitabı] Kongresi Sag 2010;177. 14. Tuncer T. [Yas‚lilik ve Hareket Si˛stemi˛ Sorunlari]. Available at: http://www.phd.org.tr/17.ppt. Accessed October 24, 2010. 15. Kurtulus Z, Yildiz H, Pinar R. Use of health-related quality in geriatrics. J Summ Health 2006;1:21-6 [in Turkish]. _ Akdemir N, et al. Social policies regarding ¨ , Akyar I, 16. Go¨rgu¨lu¨ U elderly people in Turkey and in the world/Dunyada ve Ulkemizde Yaslilara Yonelik Sosyal Politikalar. Turk J Phys Med Rehab 2010;56:30-3. 17. Marin MJ, Rodrigues LC, Druzian S, et al. Nursing diagnoses of elderly patients using multiple drugs. Rev Esc Enferm USP 2010;44:46-51. 18. Sakano LM, Yoshitome AP. Diagnosis and nursing interventions on elderly inpatients. Acta Paul Enferm 2007;20:495-8. _ ¨ , Kartal A. Signs of depression in the elderly 19. C¸ınar IO relationship between depression and sociodemographic characteristics. TAF Prev Med Bull 2008;7:399-404. lu P, Pıc¸akc¸ıefe M, Giray H, et al. Yas‚lılarda 20. Keskinog depresif belirtiler ve risk etmenleri. Genel Tıp Dergisi 2006; 16:21-6. lu G, Okanlı A, et al. The prevalence of 21. Ekinci M, Tortumluog depression in elderly living at home in eastern Turkey: Erzurum. Int J Human Sci 2004;1:1-10. _ Khorshid L, C¸ınar Y. Sleep quality of older adults in 22. Es‚er I, nursing homes in Turkey enhancing the quality of sleep improves quality of life. J Gerontol Nurs 2007;33:42-9. 23. T.R. Prime Ministry, State Planning Organization. The Situation of Elderly People in Turkey and National Plan of
28
24.
25.
26.
27.
28. 29. 30.
31.
32.
33. 34.
35.
36.
N u r s O u t l o o k 6 0 ( 2 0 1 2 ) 2 1 e2 8
Action on Ageing. Available at: http://ekutup.dpt.gov.tr/ nufus/yaslilik/eylempla-i.pdf. Accessed October 24, 2010. Somers M. Eldercare made easier: Doctor Marion’s 10 steps to help you care for an aging loved one. Omaha, NE: Addicus Books; 2006. Giray H, Meseri R, Saatlı G, et al. Proposal for elderly health care system in Turkey. TSK Koruyucu Hekimlik Bu¨lteni 2008; 7:81-6. Pınar R, Sert H. How should the Turkey’s National Elderly Care Policy be? Hems‚irelikte Aras‚tırma ve Gelis‚tirme Dergisi 2009;2:46-55. Huzurevleri ile huzurevi yas‚lı bakım ve rehabilitasyon i. Available at: http://www.shcek.gov. merkezleri yo¨netmelig tr/userfiles/pdf/Huzurevleri.pdf. Accessed October 28, 2010. Coskun A. Form for nursing diagnoses of the elderly individual. Nurs Bull 1993;6:25-33 [in Turkish]. Carpenito LJ. Handbook of nursing diagnosis. 10th ed. Philadealphia: Lippincott Williams & Wilkins; 2004. Armstrong J, Mitchell E. Comprehensive nursing assessment in the care of older people. Nursing Older People 2008;20:36-40. Higuchi KAS, Dulberg C, Duff V. Factors associated with nursing diagnosis utilization in Canada. Nurs Diagn 1999;10: 137-47. Olsson PT, Gardulf A. Nurses and head nurses views of nursing diagnoses at a geriatric clinic. J Clin Nurse 2006;15: 1338-9. Lee T. Nursing diagnoses: factors affecting their use in charting standardized care plans. J Clin Nurs 2005;14:640-7. Herdman TH. NANDA international nursing diagnoses: Definitions & classification 2009-2011. Hoboken, NJ: WileyBlackwell; 2009. Kocac¸al E, Du¨ven A, Gu¨ler B, et al. The constitution of the database of elderly residents in Narlidere Nursing Home and determination of care needs of the elderly. Second National _ Nursing Students Congress poster award, 2003, Izmir, Turkey [in Turkish]. Lueckenotte AG. Pocket guide to gerontologic assessment. 3rd ed. St Louis MO: Mosby; 1998.
37. Meiner S, Lueckenotte AG. Gerontologic assessment. In: Maguire SR, editor. Gerontologic nursing. 3rd ed. St. Louis, MO: Mosby; 2006. p. 63-93. 38. Birol L. Hems‚irelik su¨reci: hems‚irelik bakımında sistematik _ yaklas‚ım. 9. Baskı. Etki Matbaacılık, Izmir, 2009. 39. Boldt C, Grill E, Bartholomeyczik S, et al. Combined application of the international classification of functioning, disability and health and the NANDA International Taxonomy II. J Adv Nurs 2010;66(8):1885-98. 40. Erdemir F. Hems‚irelik tanıları el kitabı. Ankara, Turkey: Nobel Tıp Kitapevleri; 2005. 41. Ehrenberg A, Ehnfors M. Patient problems, needs, and nursing diagnoses in Swedish nursing home records. Int J Nurs Terminol Class 1999;10:65-76. 42. NANDA International. Home page. Available at: http://www. nanda.org. Accessed November 4, 2010. 43. Daniels R. Nursing diagnosis. In: Grendell RN, editor. Nursing fundamentals, caring and clinical decision making. Clifton Park, NY: Thomson Delmar Learning; 2004. p. 221-3. 44. Lee T, Mills ME. The relationship among medical diagnosis, nursing diagnosis, and nursing intervention and the implications for home health care. J Prof Nurs 2000;16: 84-91. ¨ zbek Z, O ¨ ner P. Biochemical and physiological changes of 45. O aging. Tu¨rk Klinik Biyokimya Dergisi 2008;6:73-80 [in Turkish]. 46. Wisc-Online. Physical Changes Associated with Aging. Available at: http://www.wisc-online.com/Objects/ ViewObject.aspx?ID¼OTA2505. Accessed November 4, 2010. 47. Gokce YK, Cakmakci M, Unal S. Assessment of elderly patient. In: Unal S, editor. Geriatrics I. Ankara, Turkey: Physician Publications Association; 1997:61e64. [in Turkish] 48. Wang J, Kane RL, Elberly LE, et al. The effects of resident and nursing home characteristics on activities of daily living. J Gerontol Am Med Sci 2009;64:473-80. 49. Danter JH. Geriatric assessment. Nursing 2003;33:52-5. 50. Vasconcelos FF, Araujo TL, Moreira TMM, et al. Association among nursing diagnoses, demographic variables, and clinical characteristics of patients with high blood pressure. Acta Paul Enferm 2007;20:326-32.
