Page 573 - Encyclopedia of Nursing Research

W–Z

The etiology of wandering remains a
Wandering topic of debate. Proposed explanations range
from physical discomfort, boredom, seeking
a familiar place or person, and unmet needs
Since 1980, when Irene Burnside expressed to right parietal lobe dysfunction. Positive
dismay at the lack of a suitable definition correlations have been found between wan-
of wandering as well as the lack of nursing dering and cognitive impairment, spatial
articles or research on the topic, thousands disorientation, stress, unmet needs, reduced
of journal articles have addressed the topic. higher order cognitive and planning abili-
Although numerous definitions have been ties, and circadian rhythm disturbances. The
proposed since 1980, the common threads possibility that wandering is an extension of
are (1) locomotion and (2) cognitive impair- a person’s premorbid activity level or means
ment. One of the more comprehensive modern of reducing stress has been examined with
definitions was proposed by the International inconsistent results. One study in long-term
Consortium for Research on Wandering. It care facilities identified low extroversion
defines wandering as “a syndrome of demen- scores and negative verbalization in response
tia related locomotion behavior having a fre- to stress as two premorbid factors that pre-
quent, repetitive, temporally disordered, and/ dicted greater wandering behavior (Song
or spatially disoriented nature that is mani- & Algase, 2008). The need-driven behavior
fested in lapping, random, and/or pacing model has been used to explain wandering
patterns, some of which are associated with as the result of the interplay of background
eloping, eloping attempts, or getting lost unless (relatively fixed variable such as general
accompanied” (Algase, Moore, Vandeweerd, & health status and neurocognitive status)
Gavin-Dreschnack, 2007, p, 696). and proximal factors (dynamic individual
The prolific work of Dr. Donna Algase or environmental variables such as physio-
has illuminated the complexity of wander- logical needs) (Algase, 1999a). Aspects of the
ing behavior. Since the early 1990s, numer- physical environment that have been exam-
ous nursing studies have used observational ined include lighting, noise level, home-like
techniques to document characteristics of arrangements, and furnishings.
wanderers as well as the frequency, dura- Wandering can be viewed as meaning-
tion, and patterns of wandering. Studies of less or as an effort to fulfill felt needs that
personal characteristics of wanderers have the patient may or may not be able to com-
produced variable results. Algase’s (1999b) municate. Cohen-Mansfield and Werner
review reported no consistent relationships (1998) asserted that wandering could be both
between wandering and gender, education, adaptive and appropriate for the cognitively
or race. Factors that correlated positively with impaired elder. Despite general agreement
wandering included general health, appetite, that activity has physical benefits, wander-
fewer medications and medical diagnoses, ing is treated as a problem because of the risk
and other “agitated” behaviors. Factors that for harm from falls or becoming lost in dan-
correlated negatively with wandering were gerous places. Therefore, most intervention
pain and eating impairment. studies focus on structuring the physical or