Page 174 - Encyclopedia of Nursing Research

ELECTRONiC NETWORK n 141

older adults, unexplained loss of money or adults. A key practice implication for EM is
goods, evidence of fearfulness around a the inclusion of family violence questions in
caregiver, or subjective report of abuse. it is every history with attention to and documen- E
especially difficult to evaluate the demented tation of any signs and symptoms of EM.
older adult for EM; a careful and thorough
interdisciplinary team approach is required. Terry Fulmer
The American Medical Association’s (1992) Sarah Pernikoff
Diagnostic and Treatment Guidelines on Elder
Abuse and Neglect, although more than
15 years old, provides excellent guidelines
for the assessment of EM, along with flow- ElEctronic nEtwork
charts for assessing and intervening in cases.
A summary of approaches for screening and
assessment of EM suggests a comprehen- in general, a network is composed of a min-
sive and highly methodical approach using imum of two connected points. For exam-
accepted screening instruments (Fulmer, ple, one person talking with another, face
2008). Special attention must be given to an to face, can constitute a network. Telephone
older adult who has diminished or absent networks connect at least two people using
decision-making capacity. Dementia has transceivers, wire, switches, and computers.
been documented as a risk factor for EM and Television networks connect large numbers
should automatically trigger EM assessment. of people. An electronic network is consid-
Cognitive status can only be determined ered to be the connection, or linking, of two
by rigorous clinical testing and use of vali- or more computers to allow data and infor-
dated instruments. Some have suggested a mation exchange. Electronic computer net-
two-step process to assess capacity for elders works may be as small as two computers or
suspected of self-neglect. The steps include as large as the internet, considered to be a
cognitive evaluation to determine the elders’ network of networks.
decision-making ability using a traditional The goal of networks is information
medical examination along with standard- exchange and may or may not be bidirec-
ized tests such as the Executive interview, tional. Person-to-person conversations, even
the Financial Capacity instrument, the Mini- if using some sort of intermediary like the
Mental State Examination, and the Geriatric telephone or computer, are usually bidirec-
Depression Scale, followed by an assessment tional. Television and some computer net-
of the elders’ executive ability to live inde- work applications may be unidirectional;
pendently in the community through review however, bidirectional computer networks
of reports by nurse practitioners, social ser- are the most common. Examples include local
vice professionals, occupational therapists, area networks, which may serve a depart-
and physical therapists (Naik, Lai, Kunik, & ment, larger networks called wide area net-
Dyer, 2008). works, and the internet. intranets, which are
Overzealous protection of a competent the internal deployment of internet technol-
elder is a form of ageism that infantilizes the ogies, are commonly found in business and
older individual and takes away their auton- other environments requiring information
omy. Each state has EM reporting laws or exchange among a department or other lim-
requirements that professionals should be ited amount of people.
familiar with. interdisciplinary care teams Electronic networks continue to be excit-
are especially important in the EM assess- ing tools for nursing, continuing to increase
ment process. Each team member is able to in importance for information acquisition
use their own expertise to the benefit of older and dispersion. Electronic networks, such as