understanding older adults’ decision-making related … · web viewjennifer baumbusch, rn, phd,...

InspireNetePoster Presentation

Abstract Booklet

Connect 2012:Making Research Partnerships Work:

What does it take?

November 5, 2012, Vancouver

Details: http://www.inspirenet.ca/Connect-2012

http://www.inspirenet.ca/Connect-2012

Table of Contents: e-Poster Titles & Presenters

Understanding Older Adults’ Decision-Making Related to Undergoing an Innovative, Minimally-Invasive Cardiac Procedure..............................................................4

Leslie Achtem, BSN, RN, CCN(C) Sandra Lauck , MSN, RN, CCN(C) Jacqueline Forman, BSN, RN Jennifer Baumbusch, RN, PhD, Assistant Professor & Michael Smith Foundation for

Health Research Scholar, UBC School of Nursing Kristin Kernaghan, BA Annes Song, BSc

Optimal bariatric obstetrical care: investigating existing practices and women's and health care providers' perspectives....................................................................................5

Helen Brown, Assistant Professor University of British Columbia School of Nursing Amy Cronmiller, Clinical Nurse Specialist, Maternity, St. Paul’s Hospital, Vancouver Stephanie Gee, RN, Maternity, St. Paul’s Hospital, Vancouver Jenna Baumgartner, RN, Maternity, St. Paul’s Hospital, Vancouver

Exploration of staffs’ perceptions of the use of bed alarms on the Aspen unit at St. Vincent’s Langara Residential Care......................................................................................6

Karima Kurji, Clinical Nurse Leader for Aspen unit at St. Vincent’s Langara Bina Randhawa, Registered Nurse for Aspen unit at St. Vincent’s Langara Jane Wong, Registered Nurse for Aspen unit at St. Vincent’s Langara Jo-Ann Tait, Operations Leader for Youville Residence and mentor

Promoting Positive Body Image in Adolescents: A Literature Review.........................7

Leah Wilson, Masters’ Student, School of Nursing, University of Victoria, British Columbia, Canada

Anastasia A. Mallidou, Assistant Professor (Limited Term), School of Nursing, University of Victoria, British Columbia, Canada

Optimizing Nursing Roles in Primary Care Settings..............................................................8

InspireNet Connect 2012 :: e-Poster Abstract Booklet 1

Nelly D. Oelke PhD RN, Assistant Professor, School of Nursing, University of British Columbia, Okanagan Campus

Amanda Wilhelm MA, Research and Evaluation Consultant; Karen Jackson MEd RN, Senior Research and Evaluation Consultant; Esther Suter, Director, Workforce Research and Evaluation Workforce Research and

Evaluation, Alberta Health Services

Women’s Lived Experiences with Heart Disease in Northwestern Ontario (NWO).................................................................................................9

Paulette Lacroix, RN, HBScN, MPH, PC Lacroix Consulting Inc., President, Xi Eta Chapter of STTI

Simulated Education Approaches to Enhance Collaborative Healthcare: A Best Practices Review................................................................................................................10

Natalie L. Murdoch BSc, RN, MSN , Instructor, School of Nursing ,University British Columbia Okanagan

Qualitative exploration of St. Vincent’s Hospitals, Langara Residential Interdisciplinary Team Admission (“moving in”) Process......11

Paramjit Kalkat, Occupational Therapist St. Vincent’s Hospitals, Langara Residence Kit Chan, Clinical Dietitian, St. Vincent’s Hospitals, Langara Residence Vashti Timmermans, Clinical Dietitian, St. Paul’s Hospital, Diabetes Centre Karima Kurji, Registered Nurse, St. Vincent’s Hospitals, Langara Residence Maura MacPhee (mentor), Assistant Professor, UBC/Applied Science/Nursing

Social Media in Healthcare: Creation of a Social Media Policy to Guide Appropriate Usage..................................12

Tom Ying. BSc, BSN, RN, Masters in Nursing and Masters in Health Informatics Candidate-2014. Co-op student, Professional Practice Office, Providence Health Care.

Val Cartmel. MA, RN. Practice Consultant, Clinical Informatics Professional Practice Office, Providence Health Care.

Justin Karasick. BBA. Communications & Public Affairs Director, Providence Health Care

Systematic Reviews: The Joanne Briggs Institute Model...........................................................................................13

Anastasia A. Mallidou, Assistant Professor (Limited Term), School of Nursing, University of Victoria, British Columbia, Canada.


Lynne Young, Professor, School of Nursing, University of Victoria, British Columbia, Canada

Kathryn Paul, Librarian, University of Victoria, British Columbia, Canada

Rates of Depression on an Inpatient HIV Unit......................................................................14

Jane McCall MSN, RN, Nurse educator, HIV Program, St. Paul's Hospital, Providence Health Care

The Evidence Informed Practice Innovations (EVIP-In) Study: Bring practice and research communities together through action research........15

Katrina Plamondon, Interior Health Linda Gomez, Selkirk College Shannon Shah, Selkirk College Eileen Smith, Interior Health Ann Ungaro, Interior Health

Bed-sharing in Infancy....................................................................................................................16

Cammie Lewis, RN, BSN, Masters’ Student (Nurse Practitioner), School of Nursing, University of Victoria, British Columbia, Canada



Understanding Older Adults’ Decision-Making Related to Undergoing an Innovative, Minimally-Invasive Cardiac Procedure

Leslie Achtem, BSN, RN, CCN(C) Sandra Lauck , MSN, RN, CCN(C) Jacqueline Forman, BSN, RN Jennifer Baumbusch, RN, PhD, Assistant Professor & Michael Smith Foundation for

Health Research Scholar, UBC School of Nursing Kristin Kernaghan, BA Annes Song, BSc

Introduction and Background: Transcatheter aortic valve implantation (TAVI) is emerging as a viable, safe and beneficial therapeutic intervention for patients with severe aortic stenosis at excessive risk for surgical valve replacement. Growing evidence supports the availability of TAVI for a carefully selected group of higher risk patients. Methods: The purpose of this study was to explore factors that influence older adults’ (80+) perceptions of the risks and benefits, and their motivation to undergo TAVI eligibility assessment. Informed by the Health Belief Model, we conducted a series of semi-structured interviews with individuals referred for TAVI eligibility assessment at a quaternary cardiac centre.

Findings: The decision to undergo TAVI is shaped by multiple, intersecting factors. These factors include: symptom burden, expectations, obligations and responsibilities, logistical issues (e.g. transportation), and access to both formal and informal supports.

Discussion & Implications: The findings of this nursing study illuminated the multi-faceted issues that contribute to older adults’ decisions to undergo TAVI. These findings will be used to inform the development of patient education materials, guide the practice of the TAVI clinicians, and provide a beginning understanding to develop a patient-reported outcome instrument specific to the goals of people living with severe aortic stenosis.

Acknowledgements: This study was funded by the Providence Healthcare Practice-Based Research Challenge


Optimal bariatric obstetrical care: investigating existing practices and women's and health care providers' perspectives

Helen Brown, Assistant Professor University of British Columbia School of Nursing Amy Cronmiller, Clinical Nurse Specialist, Maternity, St. Paul’s Hospital, Vancouver Stephanie Gee, RN, Maternity, St. Paul’s Hospital, Vancouver Jenna Baumgartner, RN, Maternity, St. Paul’s Hospital, Vancouver

Introduction and Background: Obesity and pregnancy create risks for women, fetus and infants on many levels simultaneously. For childbearing women, the need to reduce fetal and maternal risks and facilitate positive outcomes is giving rise to a new medical specialty, “bariatric obstetrics.” The issues of critical concern care to health care providers include the need to: (a) identify women in the antenatal period; (b) connect women with appropriate consultations; (c) generate effective and individualized care planning; (d) liaise across departments; (e) ensure appropriate weight and size equipment for assessment and care during labour.

Methods: The research will be conducted using a qualitative design informed by the principles of Interpretive Description. The study will employ qualitative methods to collect and analyze retrospective data from women and Health Care Professionals during individual interviews. Data collection and analysis for investigating existing Canadian bariatric obstetrical practices will employ telephone interviews and document analysis.

Results/Findings: Data collection is currently underway and we will share our findings.

Discussion/implications: This study will inform care to reduce maternal and fetal risk, facilitate interdisciplinary collaboration, enhance postnatal outcomes and ensure all women receive safe, competent and ethical care with the Maternity Centre at St. Paul's Hospital.


Exploration of staffs’ perceptions of the use of bed alarms on the Aspen unit at St. Vincent’s Langara Residential Care

Karima Kurji, Clinical Nurse Leader for Aspen unit at St. Vincent’s Langara Bina Randhawa, Registered Nurse for Aspen unit at St. Vincent’s Langara Jane Wong, Registered Nurse for Aspen unit at St. Vincent’s Langara Jo-Ann Tait, Operations Leader for Youville Residence and mentor

Introduction and Background: At St. Vincent’s Langara Residential Care (SVL), falls prevention strategies include bed alarms that have been designed to automatically monitor when a resident is positioned on a bed or chair sensor pad. Staffs often find bed alarms malfunctioning, unplugged or damaged, rendering them ineffective. The purpose of this study is to explore registered nurses’ and resident care aides’ perceptions of using bed alarms in order to increase bed alarm effectiveness.

Methods: A qualitative descriptive design that consisted of 3 one hour focus groups with a convenient sample of Resident Care Aides (RCAs) and Registered Nurses (RNs) on the48 bed Aspen Unit at SVL.

Results: There were significant indications related to the equipment itself, in terms of set up and process and fewer concerns around appropriateness of the bed alarm itself.

Discussion/Implications: The study identifies that with further changes to the bed alarms in terms of education, refining current processes and re-examining equipment set up, there may be significantly reduced frustration and improved effectiveness with the use of the current bed alarm system. The results also indicate that there may be a need to explore a system that poses a lesser risk to becoming a nuisance and would address differentiating the bed alarm sounds from the call bell.


Promoting Positive Body Image in Adolescents: A Literature Review

Leah Wilson, Masters’ Student, School of Nursing, University of Victoria, British Columbia, Canada


Introduction/Background: Adolescents are particularly vulnerable to poor body image and are at risk for developing disordered eating. Disordered eating describes unhealthy attitudes about the body (e.g. poor body image) and unhealthy behaviours (e.g. skipping meals, dieting or binging and purging). Nurse Practitioners (NPs) can challenge societal values that focus on obesity prevention and preference for a thin physique.

Purpose/Objectives: The purpose of investigating the current literature on body image in adolescents is to identify factors and effects of low body image and to determine whether NPs can encourage adolescents to have positive body image regardless of their weight.

Methods: Two electronic databases (CINAHL and psycINFO) were searched for publications on adolescent body image and the role of primary health providers was conducted with a scientist librarian consultation. Thirty two studies published between 2002 and 2011 were included in the literature review.

Results/Findings: The literature review revealed that a) media messaging around obesity, body image, and diet/weight can negatively affect self-image in adolescents leading to low self-esteem and self-confidence; b) limited resources prevent NPs’ strategies to promote healthy body image because they are focused on obesity prevention; and c) primary care providers are not following recommended practices around disordered eating screening and overweight/obesity management.

Implications: The results point to the need for a) primary care providers receiving additional training to address body image, body weight and obesity in adolescents; b) full understanding of factors contributing to and effects of low body image; and c) special attention to language used around overweight and obesity as well as to the effect of public health campaigns on obesity.

Acknowledgements: We thank the librarians in the University of Victoria for their continuous assistance and support during the literature search.


Optimizing Nursing Roles in Primary Care Settings

Nelly D. Oelke PhD RN, Assistant Professor, School of Nursing, University of British Columbia, Okanagan Campus

Amanda Wilhelm MA, Research and Evaluation Consultant; Karen Jackson MEd RN, Senior Research and Evaluation Consultant; Esther Suter, Director, Workforce Research and Evaluation Workforce Research and

Evaluation, Alberta Health Services

Introduction and Background: Research suggests nurses are not using the full extent of their knowledge and skills in primary care settings. This study focused on recommendations to optimize all nursing roles in primary care settings in Alberta.

Methods: Data were collected through a national environmental scan of nursing service delivery models in primary care settings, interviews with nurses, managers, and educators, and a summit with key stakeholders (e.g., educators, managers, regulatory bodies). Qualitative thematic approaches were used for data analysis.

Results/Findings: Recommendations focused on building foundational components in primary care (e.g., patient/community engagement, funding and governance models to support nursing roles and interprofessional (IP) collaborative practice, and evaluation of nursing role optimization); defining nursing roles, responsibilities, and core competencies; supporting IP education and facilitating nursing clinical placements in primary care settings; implementing IP collaborative practice; and developing a standardized continuing education program with orientation and mentorship.

Discussion/implications: Recommendations will help create a supportive environment to enhance nursing role effectiveness in primary care settings. This information will be of value to policy and decision-makers, nurse educators, researchers, and providers in other jurisdictions across Canada.

Acknowledgements: Funding for the study was provided by Alberta Health and Wellness.


Women’s Lived Experiences with Heart Disease in Northwestern Ontario (NWO)

Paulette Lacroix, RN, HBScN, MPH, PC Lacroix Consulting Inc., President, Xi Eta Chapter of STTI

Introduction and Background: Cardiovascular disease (CVD) is the number one killer of women in Canada. Residents in NWO have higher rates of risk factors for CVD than the provincial average, and individuals are presenting younger with multiple risk factors. Current Canadian trends suggest a 28% increase in cardiac-related deaths for women in NWO by 2016.

Methods: Purposive sample of 30 participants aged 45 to 80 years recruited from patients receiving medical care at a cardiology clinic in Thunder Bay. All women were diagnosed with CVD within the previous 3 years. Interviews were taped and transcribed. Quantitative and qualitative analyses were conducted.

Results/Findings: Participants experienced a variety of symptoms, which they perceived as atypical of heart attack and made the diagnosis seem less real to them. The women generally lacked information, resulting in unnecessary fear and risky behavior. 63% reported they did not participate in a rehabilitation program mostly due to lack of awareness. 75% of women aged 46 to 59 years rated their health as worse, while conversely older women rated their health as better than their contemporaries.

Discussion/implications: Participants reported an increased level of confidence over time in managing their health, mainly as a result of information seeking and strengthened self-advocacy with healthcare providers.

Acknowledgements (supporter): Dr. Christopher Lai, Cardiologist at the Thunder Bay Regional Health Sciences Centre


Simulated Education Approaches to Enhance Collaborative Healthcare: A Best Practices Review

Natalie L. Murdoch BSc, RN, MSN , Instructor, School of Nursing ,University British Columbia Okanagan

Interprofessional simulation can provide health profession program educators with an effective means to prepare future practitioners to engage in meaningful collaboration. This systematic literature review was conducted to identify best practices recommendations to enhance collaborative healthcare using interprofessional simulated education innovations for learners in pre-licensure nursing programs and other health profession programs. Using a systematic review methodology, 375 articles were reviewed and 17 studies met the inclusion criteria. Based on the methodological strength of the research and the impact of the simulation innovations, the following simulation techniques were recommended: high-fidelity human patient simulators, role play, and didactic lecture and audience response didactic lecture, both followed by role play with a standardized patient. One approach used in interprofessional education simulations, instructor modeling, was related to particularly positive outcomes for learners. Instructor modeling demonstrated significant results for achieving interprofessional competencies when compared to no modeling. Future research is needed to identify the optimal timing for implementing interprofessional education innovations, for the development of interprofessional collaborative evaluation tools, and to determine the effects of collaborative practice on patient care. Research on the effectiveness of interprofessional simulation would be strengthened with innovations and evaluations based on educational models and learning theories.


Qualitative exploration of St. Vincent’s Hospitals, Langara Residential Interdisciplinary Team Admission (“moving in”) Process

Paramjit Kalkat, Occupational Therapist St. Vincent’s Hospitals, Langara Residence Kit Chan, Clinical Dietitian, St. Vincent’s Hospitals, Langara Residence Vashti Timmermans, Clinical Dietitian, St. Paul’s Hospital, Diabetes Centre Karima Kurji, Registered Nurse, St. Vincent’s Hospitals, Langara Residence Maura MacPhee (mentor), Assistant Professor, UBC/Applied Science/Nursing

Introduction and Background: The Eden Alternative Philosophy (EAP) is the overarching philosophy of long term care delivery at St. Vincent’s Langara Residence (SVL). The EAP advocates staff working together to create a “home-like” environment for residents, where they are free from loneliness, helplessness and boredom. Current research is limited with respect to “how” interdisciplinary teams should conduct an EAP-based admission. This research project explores staff, resident and family perceptions of the admission process, how it reflects the EAP, what needs improving, and how Chinese residents perceive the moving in process.

Methods: Qualitative descriptive design, consisting of 4 focus groups with staff and 10 interviews with residents and/or family members. Study sample includes both English and Chinese-speaking residents and families.

Results/Findings: Focus group data is currently being analyzed; emerging themes include the importance of creating a welcoming environment, communication, involving family, respect, and safety/legal requirements. Resident and family interviews are currently being analyzed; expected date of research completion is Oct. 31, 2012.

Discussion/Implications: Data from this research provides valuable information on how staff, residents, and families perceive the admission process at SVL as well as recommendations on how the care delivery team can foster a more EAP-like admission process.


Social Media in Healthcare: Creation of a Social Media Policy to Guide Appropriate Usage

Tom Ying. BSc, BSN, RN, Masters in Nursing and Masters in Health Informatics Candidate-2014. Co-op student, Professional Practice Office, Providence Health Care.

Val Cartmel. MA, RN. Practice Consultant, Clinical Informatics Professional Practice Office, Providence Health Care.

Justin Karasick. BBA. Communications & Public Affairs Director, Providence Health Care

Introduction and Background: The advancement and popularity of technologies such as Web 2.0 and mobile technology has facilitated the dissemination of Social Media in healthcare (Centers for Disease Control and Prevention, 2011). Social Media can enhance collaboration and communication between individuals, healthcare providers, and patients for improved, meaningful person centered care and services, but significant privacy, confidentiality, and ethical risks exist (The Change Foundation, 2011). It is important for healthcare organizations to establish a clear policy to guide and educate staff on appropriate and responsible usage of Social Media (Barton & Skiba, 2012).

Methods: To determine best practice guidelines, data was collected from academic journals, grey literature, workshops, and conferences. A survey was created based on this data to assess Providence Health Care (PHC) staff on current behaviour, attitudes, barriers, and future intentions of use with Social Media and mobile technology – the results of this survey will be used to assist the creation and approval of a Social Media Policy for PHC. The survey will also serve as the beginning of a change management and education strategy for individuals.

Results/Findings: Survey and approval of policy is still on-going, but current results from survey indicates staff at PHC are using Social Media and mobile technologies, and that there is a increasing trend to support future adoption of these tools support practice in healthcare. There are gaps in knowledge about appropriate usage of these technologies, and individuals support the provision of clear guidance.

Discussion/implications: Social Media can improve communication, collaboration and interaction; these tools have a great potential for enhancing the quality of relationships in the healthcare setting for staff, patients, families and communities (The Change Foundation, 2011). Healthcare professionals, such as nurses, need to be aware of the privacy, confidentiality, ethical and legal risks with using these technologies in the healthcare setting (College of Registered Nurses of British Columbia, 2012).


Systematic Reviews: The Joanne Briggs Institute Model

Anastasia A. Mallidou, Assistant Professor (Limited Term), School of Nursing, University of Victoria, British Columbia, Canada.

Lynne Young, Professor, School of Nursing, University of Victoria, British Columbia, Canada

Kathryn Paul, Librarian, University of Victoria, British Columbia, Canada

Introduction and BackgroundSystematic review (SR) is an explicit and rigorous research method to identify, critically appraise, analyze, and synthesize the findings of independent primary/original studies on a specific topic. Researchers/reviewers translate and transfer existing evidence for utilization to target audiences (e.g., clinicians, managers, policy-/decision-makers, consumers). Quantitative (meta-analysis), qualitative (meta-synthesis) or both types of evidence (comprehensive/mixed-method) are synthesized in a SR examining Feasibility, Appropriateness, Meaningfulness or Effectiveness of healthcare interventions and practice (FAME). The Joanne Briggs Institute (JBI) is an international, not-for-profit, research and development, and knowledge-synthesis organization involving nursing, medical and allied health researchers, clinicians, academics and policy-/decision-makers across 47 countries and more than 60 entities in every continent. Established in 1996, the JBI (http://www.joannabriggs.edu.au) undertakes systematic reviews addressing a broad range of questions to facilitate evidence-based healthcare practices and to assist the improvement of healthcare outcomes globally. The first North American JBI Centre is located in Canada at Queen’s University: the Queen's Joanna Briggs Collaboration (http://meds.queensu.ca/qjbc).

ObjectiveTo describe the JBI model of systematic reviews using the JBI software titled, “System for the Unified Management of the Assessment and Review of Information” (SUMARI), which consists of the:

Comprehensive Review Management Software (CReMS) Qualitative Assessment and Review Instrument (QARI) Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) Narrative Opinion and Text Assessment and Review Instrument (NOTARI) Analysis of Cost Technology and Utilization Assessment and Review Instrument

(ACTUARI)


http://meds.queensu.ca/qjbc

http://www.joannabriggs.edu.au/

Rates of Depression on an Inpatient HIV Unit

Jane McCall MSN, RN, Nurse educator, HIV Program, St. Paul's Hospital, Providence Health Care

There is overwhelming evidence that HIV positive individuals experience high rates of depression. Despite this, there has been no systematic attempt to assess for depression in patients admitted to an acute care HIV unit in a Canadian hospital.

Methods: This study conducted depression surveys on patients admitted to the unit over a 12 month period. In addition to the survey, a number of demographic variables were collected.

Results: Findings from the study indicated that a significant number of the patients scored as moderate or severe for depressive symptoms on a depression inventory. There was also a statistically significant relationship between depression and illicit drug use. Despite this, relatively few of the patients were being treated for depression.

Conclusion: Recommendations from the study include conducting depression surveys on all patients diagnosed with HIV and referring affected individuals for psychiatric assessment and treatment.


The Evidence Informed Practice Innovations (EVIP-In) Study: Bring practice and research communities together through action research

Katrina Plamondon, Interior Health Linda Gomez, Selkirk College Shannon Shah, Selkirk College Eileen Smith, Interior Health Ann Ungaro, Interior Health

Background: Nascent in its infrastructure for research and evidence informed practice (EVIP), Interior Health is presented with an opportunity to strengthen these dimensions of practice through the nursing research facilitator (NRF).

Methods: EVIP-In engages frontline caregivers in four practice settings, supporting and guiding action research (AR) to develop evidence-informed responses to practice driven questions. The NRF collaborates with nurse leads and academic mentors to facilitate an egalitarian and iterative process. For every study phase, adaptive and reflexive strategies that work for staff--on their schedule, on their turf--are developed.

Findings: Early in the process, the research team is mindful of accepting and promoting trust in the process. We are discovering richness in the depth and breadth of practice questions identified by frontline caregivers and gaining valuable grassroots insights about how our health system can collaborate with local academic institutions to enhance engagement and understand health service challenges.

Impacts: The horizontal leadership inspiring this study is culminating in early, observable ownership, connectedness, and excitement. Drawing on the consistency of a structured AR process, but adapted and grounded in a commitment to flowing from front line staff, this study is making EVIP accessible and meaningful at the front lines.


Bed-sharing in Infancy

Cammie Lewis, RN, BSN, Masters’ Student (Nurse Practitioner), School of Nursing, University of Victoria, British Columbia, Canada


Background: The evolutionary practice of bed-sharing or co-sleeping is a common practice among infants and parents in North America. In recent years the safety of co-sleeping has been called into question which has led to medical recommendations against bed-sharing. Despite these recommendations, bed-sharing remains commonplace around the world.

Purpose: To identify what knowledge has already been established on the risks and benefits of co-sleeping and to determine if there is an approach to safely support the practice of co-sleeping.

Methods: A literature search was conducted with the consultation of an IHA librarian for relevant studies published after Jan. 1st 2008. The search terms included “co-sleeping”, “bed-sharing”, and “sudden infant death syndrome”. Co-sleeping and bed-sharing were defined as the practice of sharing a sleep surface between an adult and an infant. A total of 355 studies were revealed and 25 studies were included in the final review.

Results: The benefits of co-sleeping include increased rates and duration of breast-feeding and positive psychological benefits for both mother and infant. The leading risk remains the increased incidence of Sudden Infant Death Syndrome.

Conclusions/Implications: There is evidence that in the absence of other risk factors it is questionable whether bed-sharing remains an independent risk factor for infant death. Furthermore, in light of the undisputed benefits of breast-feeding one should consider how recommendations against bed-sharing could potentially negatively influence the practice of breastfeeding. I propose a future study to explore the relationship between recommendations against co-sleeping and breastfeeding rates and prevalence. Using a descriptive correlational design post-partum mother’s would be interviewed regarding the influences on choice of sleeping method; the choice of sleeping method; and the choice of feeding method.


understanding older adults’ decision-making related … · web viewjennifer baumbusch, rn, phd,...

Documents