Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8



^ Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8.
This article describes a partnership between staff, residents and relatives of a nursing home for older people with Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 mental health problems, and lecturers within an academic department of nursing. The aim of the partnership is to develop practice and to improve the setting of the care home as an Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 environment for living, working and learning. In our attempts to create a teaching nursing home, we recognize the need to ensure that all participants - residents, relative and staff - feel that Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 they are valued members of the team. We describe our progress to date, together with some of the challenges of working together.


^ Dawson S., Rico C, Trocchio J. (2001). Finding and keeping staff. Health Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 Progress, Vol. 82, No. 6.

This article provides information on the current and impending crisis in the long-term care workforce; provides an argument for the need to address the crisis; and outlines Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 strategies employers can use to recruit and retain direct-care workers in long-term care. The 'Employer of Choice' strategy calls for the employer to recognize caregiving as a vocation, provide decent compensation and Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 personal development opportunities, cultivate a supportive work environment that takes into account employees' personal lives, and invest in organizational change practices that take it towards better quality care.


Deguchi A, Nakamura S Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, Yoneyama S, Hamaguchi H, Kawamura Y, Horio S, Nishimoto Y, Saito Y, Deguchi K. (2000). Improving symptoms of senile dementia by a night-time spa bathing. Arch Gerontol Geriatr. , 29(3):267-73.

In our Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 medical and welfare facilities, many patients with senile dementia require aid in taking a bath. In most institutions, patients usually take a bath in the daytime within the working hours of the staff. However Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, most of these patients used to take a bath in the evening or at night at their homes. Some patients even fall asleep after daylight bathing. Thus, we studied the stabilizing effects Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 of night-time spa bathing on symptoms associated with dementia. Ten patients (two male and eight females, aged 75-88) in special nursing institution for the aged, were enrolled in this study. They Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 were all assessed as +4 on the Karasawa's clinical criteria for grading dementia. For 9 weeks, night-time spa bathing was performed at 18:00-19:00 twice a week. Except for the night-time spa bathing period Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, the bathing hour was 14:00-15:00 as usual. The observations of symptoms including restlessness, wandering and aggression were carried out ten times daily along with those on sleeping condition five times daily, to Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 compare symptoms and conditions during 2 weeks of baseline daytime bathing periods, 9 weeks of night-time bathing periods and 2 weeks of daytime bathing periods, totaling 13 weeks. The results showed that sleeping conditions Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 were ameliorated in more than 60-90% of the subjects. Their sleeping conditions began to improve 2 weeks after the start of night-time spa bathing with a remarkably improvement 4-6 weeks after the start. Restlessness was Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 recognized in six subjects, wandering in eight and aggression in four at baseline, and 75-100% of the subjects with such symptoms improved markedly.


^ Deutschman M. (2001). Interventions to nurture excellence in the nursing Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 home culture. J Gerontol Nurs., 27(8):37-43.
There is no one formula for culture change. A joint steering committee of staff members can develop plans that will build trust, address each other as equals, and drive Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 out fear as they move the process of change. Training and sharing information help staff recognize this is a process, not an event. New well-screened team members need training to integrate them Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 into the culture. It is important to identify the knowledge and expertise of team members to maximize their energies and talents. Recruitment and retention of those who share the values Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 of this culture are of paramount importance. It is worth the time and effort to secure commitment to these values. One example of this effort is a facility in Pennsylvania that, at its Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 worst, had two thirds of its staff turnover in a year. The national average was 82% in 1995, an increase from 71.5% the year before. They were able to reduce their turnover rate to 27% by examining Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 the hiring records and finding that workers with certain personality traits and attitudes were less likely to leave. They looked for compassion and communication skills, perceptions of older adults Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, ability to cope with death and dying, and ability to handle the unpleasant tasks of resident hygiene and bathroom visits. Current staff members determined and voted on best fit of candidates (Montague, 1997). Although Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 training and evaluation are an important component of retention and commitment to values in any organization, training and evaluation of nursing home employees may be quite different from other employment. A nurse in Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 a nursing home needs to be evaluated not only on clinical skills, but on communication skills, attitude, and leadership (Meyer, 1995). Then training and employee development programs can be targeted to specific Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 areas for corrective action. What is taught in training and what occurs on the job should correspond, or role conflict occurs increasing the likelihood of turnover (Steffen, Nystrom, O'Connor, 1996). Although Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 occasional exit of poor performers and fresh ideas of new recruits can be beneficial, inability to retain experienced personnel can result in replacement costs as high as $7,000 per employee (Proenca & Shewchuk, 1997). Furthermore, fostering employee Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 commitment also has a mediating effect on family members' satisfaction with service quality (Steffen, Nystrom, & O'Connor, 1996). Each organization must be sensitized to its own problems. Attitudes cannot be changed by rules Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. Staff members need to be involved with listing all the strengths and weaknesses and how to change the negatives to positives in their own facilities. This requires a continuous learning process Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. The learning organization usually needs to restructure to improve its operation to reduce the hierarchy. If all employees understand the reasons for change and have participated in the change process, they Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 are more likely to have learned organizational values such as trust, commitment, honesty, and integrity by inculcating these values and teaching them to others. Every employee is a partner in building a good reputation Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 for the organization. One person can make a difference in creating, protecting, and building an organization's good name (Young, 1996). Staff members need to have a collaborative relationship with those who survey them Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, those who use their services, and those who compete with them. That does not mean "cronyism" (a dishonest, close relationship), but an honest, sharing relationship that fosters problem-solving and sharing of Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 best practices. Leaders of the future must be more flexible with a broader variety of experiences. Their ceremonial responsibilities as the head of the organization become a critical and necessary Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 function (Steere, 1996). Ceremonies, rites, and rituals bind the members to the organization. The values and culture work well because leaders exhibit these values in their interactive communication behaviors. The trend toward Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 increasingly empowered organizations addresses the need to move decision-making to lower levels, leaving the leadership role to one of clearly articulating and demonstrating a sense of purpose and direction dedicated to excellence Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 and quality.


DeYoung S, Just G, Harrison R. (2002). Decreasing aggressive, agitated, or disruptive behavior: perticipation in a behavior management unit. J Gerontol Nurs. 2002 Jun;28(6):22-31.
A 32-bed Behavior Management Unit was opened in a long Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8-term care facility to care for dementia patients who exhibit aggressive, agitated, or disruptive (AAD) behaviors. The purpose of the study was to evaluate the effectiveness of the Behavior Management Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 Program (BMP) in decreasing such behaviors. The sample consisted of all patients (N = 32) who resided in the unit for at least 3 months. The Nursing Home Behavior Problem Scale (NHBPS) was used to Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 collect data. Hypothesis 1, predicting participation in the BMP would decrease the total number of AAD behaviors was supported, with a significant decrease from the baseline to 6-month measurements. Hypothesis 2, predicting participation in Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 the BMP would decrease the frequency of occurrence of specific AAD behaviors was supported, with 7 behaviors being significantly reduced by 6 months. Nurses in long-term care often treat patients with AAD behavior. Because staff Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 members on general long-term care units and even in dementia units may not be experts in caring for patients with AAD behaviors, the implications of this study might Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 be helpful. The interventions that were effective in reducing AAD behaviors included verbal distraction, time-outs, activity diversion, getting to know the patient well, and managing the environment.


Dickinson JI, McLain-Kark J Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. (1998). Wandering behavior and attempted exits among residents diagnosed with dementia-related illnesses: a qualitative approach. J Women Aging., 10(2):23-34.

Exiting attempts and wandering behavior among residents diagnosed with dementia-related illnesses were investigated Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. Residents were exposed to three test conditions: a mini-blind that concealed the view from the door, a cloth panel that concealed the panic bar of the door, and both the mini-blind and Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 the cloth panel. During these test conditions, qualitative observations were conducted in addition to recording the attempted exits. The purpose of this paper is to present the qualitative findings in relationship Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 to a model developed. The findings suggests that residents seemed to exit due to goal-orientation, exit-seeking behaviors, and attraction to the panic bar.


Doyle C, Zapparoni T, O'Connor D, Runci Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 S. (1997). Efficacy of psychosocial treatments for noisemaking in severe dementia. International Psychogeriatrics, 9, 405-422.
ABSTRACT: Noisemaking is one of the most disturbing behavior disorders associated with dementia. Standard management practices, including pharmacological interventions Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, are not very successful in treating the behavior. Very little research has been carried out to evaluate innovative treatments or to determine the etiology of noisemaking. In this article, we Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 report on a series of 12 case studies in which we tested the efficacy of some psychosocial interventions in reducing the frequency of noisemaking in long-term-care residents with severe dementia. Interventions were contingent reinforcement Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 of quiet behavior and environmental stimulation tailored to individual preferences. Of the 12 patients recruited into the study, 2 died during the course of observations, 3 were not observed to be as noisy as reported Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 by staff, and 3 showed a clear reduction in noise during the intervention period. Four patients did not show any overall reduction in noisemaking during psychosocial interventions. Future research could differentiate Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 between types of interventions in successful cases and attempt to control further for the consistent application of interventions by long-term-care staff.


Dunbar JM, Neufeld RR, White HC, Libow LS. (1996). Retrain, don't Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 restrain: the educational intervention of the National Nursing Home Restraint Removal Project. Gerontologist., 36(4):539-42.
This article describes an educational program that contributed to a 90% reduction in the use of physical Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 restraints in 16 randomly selected nursing homes over a two-year period. The educational program advocated assessments by a multidisciplinary team to generate individualized, restraint-free interventions. The program consisted of a workshop, telephone and quarterly Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 on-site consultations, regional meetings, a newsletter, and written and audio-visual materials. The workshop and site visits were powerful motivators, and participants also found the video very useful. Most nursing Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 homes can easily adapt components of this project to create their own restraint-removal programs.


Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A. (2004). Visual contrast enhances food and liquid intake in advanced Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 Alzheimer's disease. Clin Nutr., 23(4):533-8.

BACKGROUND & AIMS: Patients with severe Alzheimer's disease (AD) in long-term care have deficient contrast sensitivity and poor food and liquid intake. The present study examined Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 how contrast manipulations affect these intake levels. METHODS: Participants were nine men with advanced AD. Independent variables were meal type (lunch and supper) and condition (baseline, intervention, and post-intervention). Dependent Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 variables were amount of food (grams) and liquid (ounces). Data were collected for 30 days (10 days per condition) for two meals per day. White tableware was used for the baseline and Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 post-intervention conditions, and high-contrast red tableware for the intervention condition. In a follow-up study 1 year later, other contrast conditions were examined (high-contrast blue, low-contrast red and low Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8-contrast blue). RESULTS: Mean percent increase was 25% for food and 84% for liquid for the high-contrast intervention (red) versus baseline (white) condition, with 8 of 9 participants exhibiting increased intake. In the follow-up study, the high Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8-contrast intervention (blue) resulted in significant increases in food and liquid intake; the low-contrast red and low-contrast blue interventions were ineffectual. CONCLUSIONS: Simple environmental manipulations, such as Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 contrast enhancement, can significantly increase food and liquid intake in frail demented patients with AD.


^ Eaton, S. (2000). Beyond 'Unloving Care' Linking Human Resource Management and Patient Care Quality in Nursing Homes. Journal Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 of Human Resource Management.


Eaton, S. (2001). What a difference management makes! Nursing Staff Turnover Variation within a Single Labor Market [Online]. Available: http://www.cms.hhs.gov/Medicaid/reports/rp1201-5.pdf.


^ Edwards Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 NE, Beck AM. (2002). Animal-assisted therapy and Nutrition in Alzheimer's disease. West J Nurs Res., 24(6):697-712.

This study examined the influence of animal-assisted therapy, specifically fish aquariums, on nutritional intake in Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 individuals with Alzheimer's disease (AD). Sixty-two individuals with AD who lived in specialized units were studied. Baseline nutritional data were obtained followed by a 2-week treatment period when the aquariums were introduced Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. The treatment data were collected daily for 2 weeks then weekly for 6 weeks. Nutritional intake increased significantly (21.1%; p <.001) when the aquariums were introduced and continued to increase during the 6-week weekly follow-up Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. Weight increased significantly (1.65 lbs; p < .001) over the 16-week period In addition, participants required less nutritional supplementation, resulting in health care cost savings.


Estes CL, Zulman DM, Goldberg SC, Ogawa DD. (2004). State long Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 term care ombudsman programs: factors associated with perceived effectiveness. Gerontologist., 44(1):104-15.

PURPOSE: This article reports findings from a nationwide study on factors associated with the perceived effectiveness of state Long Term Care Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 Ombudsman Programs (LTCOPs). DESIGN AND METHODS: Researchers conducted telephone interviews with ombudsmen from the 50 state programs as well as from Washington, DC, and Puerto Rico. Data from the National Ombudsman Reporting System Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 were incorporated into the study, and statistical tests analyze associations between self-rated program effectiveness and adequacy of resources, organizational placement-autonomy, interorganizational relationships, and other variables. RESULTS: Several factors limit the perceived effectiveness Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 of state LTCOPs, including insufficient funding and insufficient LTCOP autonomy caused by organizational placement. Despite these problem areas, state ombudsmen report that their programs meet statutorily mandated requirements with Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 varying degrees of effectiveness. Findings show significant positive associations between program funding and paid and volunteer staff levels and between the ratio of long-term care beds per ombudsman and the percentage of Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 nursing facilities visited. Sufficient funding is positively associated with perceived effectiveness of work with nursing facilities. IMPLICATIONS: Sufficient resources, sufficient organizational autonomy, and a supportive political and social environment are key Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 elements in achieving varying types of perceived effectiveness in the state LTCOPs. Research is needed to extend this work to local ombudsman programs and to compare self-rated effectiveness with other outcome measures.


Faxen-Irving Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 G, Andren-Olsson B, af Geijerstam A, Basun H, Cederholm T. (2002). The effect of nutritional intervention in elderly subjects residing in group-living for the demented. Eur J Clin Nutr Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. , 56(3):221-7.

OBJECTIVES: We studied the nutritional status and the effects of nutritional intervention on body weight, cognition and activities of daily life (ADL)-function in demented individuals. DESIGN: Controlled non-randomised study. SETTING: Group-living Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 for demented elderly (GLD), ie community assisted housing. SUBJECTS AND INTERVENTIONS: Twenty-two residents living in one of two units (GLD-I), received oral liquid supplements (1720 kJ/410 kcal/day) and the personnel Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 of the GLD-I were given nutritional education. Fourteen residents in the other unit (GLD-C) served as controls. After 6 months 21 (83 (4) y, 81% women) and 12 (85 (4) y, 100% women) of the participants, respectively, were re Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8-examined according to body mass index (BMI, kg/m2), cognitive function (Mini Mental State Examination (MMSE, 0-30 p) and Clinical Dementia Rating Scale (CDR) and the Katz' ADL index. RESULTS: Body mass Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 index (BMI) < or =20 was found in 19% of the participants and 44% had BMI< or =23. BMI correlated with MMSE (r=0.43, P<0.01). The weight of the residents in the intervention group increased by 3.4 (3) kg (P=0.001) at follow-up Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8, whereas the weight remained unchanged in the control group. The cognitive function was low at the start in both groups, ie MMSE approximately 9 and no apparent positive effect of Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 the nutritional intervention was seen. In addition, the ADL functions appeared to deteriorate in both groups. CONCLUSIONS: Being underweight was common among demented elderly in group-living and was related to low cognitive Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 capacity. Five months of oral supplementation, along with education of personnel, was followed by a weight gain. In this study the nutritional treatment did not affect the rate of decline in cognitive function or Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 Katz' ADL index. SPONSORSHIP: Supported by grants from the Swedish National Board of Health and Social Welfare. Semper Foods AB provided the liquid supplements.


^ Feliciano L, Vore J, LeBlanc LA, Baker JC Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. (2004). Decreasing entry into a restricted area using a visual barrier. J Appl Behav Anal., 37(1):107-10.

Wandering is a difficult-to-manage behavior problem for individuals with cognitive impairments that can jeopardize Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 safety if an individual enters a hazardous area or becomes lost. This study investigated the effects of a cloth barrier on entry into an unsafe area. The cloth barrier reduced entry into the restricted Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 area and had high treatment acceptability.


Ferrell BA, Keeler E, Siu AL, Ahn SH, Osterweil D. (1995). Cost-effectiveness of low-air-loss beds for treatment of pressure ulcers. J Gerontol A Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 Biol Sci Med Sci., ;50(3):M141-6.
BACKGROUND. Cost-effectiveness of low-air-loss beds for the healing of pressure ulcers was analyzed in the nursing home setting. A statistical model of pressure ulcer healing Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 was used to estimate cost-effectiveness based on patient and ulcer characteristics. METHODS. Results of a previous randomized trial (84 patients from three nursing homes in Los Angeles) were reanalyzed Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 and combined with estimates of costs to calculate the cost-effectiveness in dollars per added day free of pressure ulcers achieved by the use of low-air-loss beds compared to conventional foam mattresses. RESULTS Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8. The cost-effectiveness of the low-air-loss bed was $26 per added day free of ulcers for our standard patient. Results were sensitive to low-air-loss bed lease costs Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 and patient and wound healing characteristics. Results were less sensitive to expected mortality, daily wound care costs, and time-frame of consideration. Low-air-loss beds were more cost-effective for patients Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 with good healing characteristics and mild ulcers. CONCLUSIONS. Findings support the expanded use of this technology for patients with mild pressure ulcers and good healing characteristics. For these patients, the cost Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8-effectiveness of low-air-loss beds is comparable to other accepted health treatments. For patients with severe ulcers and poor healing characteristics, low-air-loss bed cost-effectiveness compares poorly with other Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 accepted health treatments unless the lease cost can be substantially reduced, or unless life with a pressure ulcer is valued close to death.


^ Fetveit A, Skjerve A, Bjorvatn B. (2003). Bright light treatment improves sleep in Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 institutionalised elderly--an open trial. Int J Geriatr Psychiatry. 2003 Jun;18(6):520-6.
STUDY OBJECTIVES: This study evaluates the effects of bright light therapy among demented nursing home patients with sleep disturbances. DESIGN Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 AND SETTING: 11 nursing home patients with actigraphically measured sleep efficiency below 85% took part in an open, non-randomised study where the subjects served as their own control. INTERVENTION: After two weeks of Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 baseline measurements and two weeks of pretreatment measurements, patients received bright light exposure 2 h/day within the period 08:00-11:00 for two weeks. MEASUREMENTS AND RESULTS: Sleep-wake patterns during the 24-h day were evaluated by Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 nursing staff ratings and wrist-worn motor activity devices (actigraphs). Sleep improved substantially with bright light exposure. Waking time within nocturnal sleep was reduced by nearly two h, and sleep efficiency Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 improved from 73% to 86%. Corresponding improvements were found in nursing staff ratings. Effects were consistent across subjects. CONCLUSIONS: The findings add further evidence of the effectiveness of morning bright light exposure Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 in the treatment of disturbed sleep among demented nursing home patients.


Fiatarone Singh MA, Bernstein MA, Ryan AD, O'Neill EF, Clements KM, Evans WJ. (2000). The effect of oral nutritional supplements on habitual Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 dietary quality and quantity in frail elders. J Nutr Health Aging., 4(1):5-12.
BACKGROUND: Frail institutionalized elders have a high prevalence of nutritional risk factors, undernutrition, weight loss, and nutrition-related morbidity and excess Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 mortality. Little information is available on effective means to intervene in this setting. HYPOTHESES: We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 nutritional status and functional level. METHODS: Fifty nursing home residents aged 88+/-1 yr. were followed for 10 weeks in the course of a randomized controlled trial of supplementation with a multinutrient Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 liquid supplement vs. a non-nutritive placebo drink. Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention. Nutritional status was Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 further assessed with nutritional biochemistries, anthropometric measurements, and body composition analysis as well as physical and functional performance tests. RESULTS: The nutritional supplement was consumed with high compliance, but did not significantly augment total caloric Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 intake. Supplementation was associated with significant reductions in total energy, protein, fat, water, fiber, and many vitamins and minerals in the habitual diet of these nursing home residents. Nutritional status improved Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 in terms of folate levels in serum, but no other measured vitamin or mineral indices. Body composition analysis revealed a small gain in weight, increases in fat stores, but no improvement in lean Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 tissue mass associated with supplementation. No physical performance or functional gains were associated with

supplementation. CONCLUSION: Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 reduction in voluntary food intake. It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in Davies S, Powell A, Aveyard B. (2002). Developing continuing care: towards a teaching nursing home. Br J Nurs., 11(20):1320-8 this setting.

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