Holistic Geriatric Care Resource Center

Review by Genevieve M. Bartol, RN, ABCS, EdD, AHN-BC

Good Grief: Strategies for Building Resilience and Supporting Transformation by Cheryl A. Barrett, RN, MSN (2018). Outskirts Press. 202 pgs.

Good Grief was recently named a 2018 AJN Book of the Year in the category of Palliative Care and Hospice. The author, a nurse, draws from her personal experiences of loss and grief following the sudden death of her husband of 46 years. She shares reflections on her loss and the strategies she used for healing. The resulting book is not a how-to manual, but rather the story of one person’s experience after the death of a loved one. The author points out that some people try to avoid the pain of grieving by increasing physical and/or mental activity, or withdrawing and retrieving into isolation, but neither of these coping mechanisms are useful. Rather, the author reminds the reader that the grieving person needs to care for their self and suggests that doing so offers the best way to care for others. Certainly, each story is unique, and yet, reading this author’s story provides an opportunity for reflection and should be helpful to all nurses.

Review by Genevieve M. Bartol, RN, ABCS, EdD, AHN-BC

End of Life, Nursing Solutions for Death with Dignity by Lynn Keegan and Carole Ann Drick (2011). New York: Springer Publishing, 252 pp.

This book, part of the Watson Caring Science Institute, Springer Publication Caring Science Library Series, addresses our culture’s need for expanded attention to the dying process and proposes as an innovative solution: “Golden Rooms” that offer personalized, peaceful, dignified and loving care at the end of life. It received the 2011 AJN Book of the Year Award in Hospice/Palliative Care and Gerontology.

The authors argue that nurses need to pay equal attention to the dying process as to the birth process. They begin with a discussion of how and when dying moved from homes—where the dying person was surrounded and supported by loved ones—to hospitals and intensive care units (ICUs) where, too often, patients die alone and only after needless suffering.

• Part 1 focuses on end-of-life issues, current costs of care, and legal and ethical matters. Statistics related to deaths add interest and help put things in perspective.
• Part 2 offers an overview of primary and supportive theories that is helpful in guiding practice.
• Part 3 offers a guide for implementing the concept of the Golden Room.

Each section includes case examples and highlights issues of concern for reflection that provide excellent opportunities for further discussion. Nurse educators would find these case examples and concerns useful for teaching students.

Sprinkled throughout the text are tables of useful detailed information that serve as gentle prompts for all nurses, such as basic communication skills to promote meaningful conversation about the dying process and the physical and neuropsychological signs of approaching death. Valuable information about advanced directives, living wills, and durable powers of attorney are also included. Discussion on “releasing and letting go” offers every reader an opportunity to consider one’s own attitudes and how they are preparing for their own deaths.

The authors present an important subject that deserves attention.

AHNA is pleased to provide this list of online resources to support holistic nursing care of older adults.

Try This®: Best Practices in Nursing Care to Older Adults from The Hartford Institute for Geriatric Nursing, New York University, College of Nursing

The goal of the "Try This: Assessment Tools" is to provide best practices in care of older adults and to encourage the use of these best practices by all direct care nurses. These Assessment Tools are designed to be:

Each “Try This” issue includes a 2-page document with a description of why the topic is important and an assessment tool that can be administered in 20 minutes or less. The series is accessible online through the link above. “Try This” instruments are designed to be used as screening tools, not for diagnosis, and include a:

• Quality Improvement Series

Do You Know Enough About Advance Directives and Older Adults? 

Do You Know Enough about Healthcare Decision Making in Older Adults? 

Capable persons have a well-established right, grounded in law and Western bioethics, to determine what is done to their bodies. In any healthcare setting, the exercise of self-determination (autonomy) is seen in the process of informed consent to and refusal of treatment and/or care planning. 

Determination of decision-making capacity is a compelling clinical issue because treatment and diagnostic interventions have the potential for significant benefit, burden, and/or risk. Honoring the decisions of a capable patient demonstrates respect for the person; honoring the decisions of a patient without capacity is an act of abandonment. Learn more at the link above.

Exercise Can Minimize Pain Effects of Parkinson's

Highlighted Article: Allen, Natalie E.A; Moloney, Niamh; van Vliet, Vanessa; Canning, Colleen G. "The Rationale for Exercise in the Management of Pain in Parkinson’s Disease". Journal of Parkinson's Disease, vol. 5, no. 2, pp. 229-239, 2015. 

Pain is a distressing non-motor symptom experienced by up to 85% of people with Parkinson’s disease (PD), yet it is often untreated. This pain is likely to be influenced by many factors, including the disease process, PD impairments as well as co-existing musculoskeletal and/or neuropathic pain conditions. Expert opinion recommends that exercise is included as one component of pain management programs; however, the effect of exercise on pain in this population is unclear.

This review presents evidence describing the potential influence of exercise on the pain-related pathophysiological processes present in PD. Emerging evidence from both animal and human studies suggests that exercise might contribute to neuroplasticity and neuro-restoration by increasing brain neurotrophic factors, synaptic strength and angiogenesis, as well as stimulating neurogenesis and improving metabolism and the immune response. These changes may be beneficial in improving the central processing of pain. There is also evidence that exercise can activate both the dopaminergic and non-dopaminergic pain inhibitory pathways, suggesting that exercise may help to modulate the experience of pain in PD.

While clinical data on the effects of exercise for pain relief in people with PD are scarce, and are urgently needed, preliminary guidelines are presented for exercise prescription for the management of central neuropathic, peripheral neuropathic and musculoskeletal pain in PD. To read more click the link above.

American Society for Pain Management Nursing (ASPMN) 

The American Society for Pain Management Nursing's mission is to advance and promote optimal nursing care for people affected by pain by promoting best nursing practices. This is accomplished through education, standards, advocacy and research. 

Nurses Improving Care for Healthsystem Elders (NICHE)

NICHE works to ensure that adults age 65 and over receive care that promotes function, autonomy, and dignity. We are the leading nurse-driven program designed to address the complex needs of older adults. NICHE provides the principles, education and tools to support healthcare systems in transforming and achieving patient centered care. The NICHE Knowledge Center houses a variety of geriatric-specific resources and tools to help bridge the geriatric nursing training gap and achieve real improvement in older patient care.

Changing Aging

The National Indian Council On Aging 

NICOA was founded in 1976 by members of the National Tribal Chairmen’s Association. The mission of NICOA is to advocate for improved comprehensive health, social services, and economic well-being for American Indian and Alaska Native Elders.

Center to Advance Palliative Care 

Rosalynn Carter Institute for Caregiving 

The Rosalynn Carter Institute for Caregiving establishes local, state, national, and international partnerships committed to building quality, long-term, home and community-based services. They believe this begins with providing caregivers with effective supports to promote caregiver health, skills and resilience. They also believe strongly in the need to provide greater recognition for professional and family caregivers. They focus on helping caregivers coping with chronic illness and disability across the lifespan. The RCI overall goal is to support caregivers – both family and professional – through efforts of advocacy, education, research, and service.