Page 574 - Encyclopedia of Nursing Research

WATSOn’S TheORy OF huMAn CARInG n 541

psychosocial environment to prevent unsafe neuroleptics (American Geriatric Society
wandering. Areas of study have included Clinical Practice Committee, 2003). One
environmental modifications, exercise pro- comparative study found slightly fewer side W–Z
grams, and medication reviews. The use of effects with risperidone than with olanzap-
physical restraints is universally labeled an ine in a sample of 730 adults with dementia
unacceptable strategy because of the poten- (Martin, Slyk, Deymann, & Cornacchione,
tial for harm by the restraints and the ethi- 2003). Cholinesterase inhibitors are reported
cal issues raised by their use. environmental to improve function for some persons with
strategies have included the creation of safe Alzheimer’s disease, especially in the early
walking areas that offer sensory stimulation, stage, and may also reduce behavioral dis-
the use of visual illusions to discourage walk- turbances (Daly, Falk, & Brown, 2001).
ing beyond certain limits, concealment of In summary, research on wandering
exits, doorknobs, and so forth, and the use of continues to elucidate variables and char-
alarms and tracking devices. Assuming that acteristics associated with wandering.
wandering might represent a need for more Common acceptance of a single definition
physical activity, some investigators have of wandering is needed to allow evidence
implemented regular exercise programs. of best practices to accumulate. emphasis
Despite the array of studies, it remains dif- on interventions to maintain safety with-
ficult to generalize findings because of the out undue restrictions is receiving increased
variations in definitions, measurement attention. Continued efforts to identify and
instruments, and samples studied. meet underlying needs are warranted. Other
The limited intervention studies located suggested topics for future studies might
focused on environmental adaptations, focus on (a) assessment and management in
caregiver approaches, and pharmacologic various settings including acute care, tran-
management. In relation to environmental sitional settings, assisted living, and private
conditions, wandering was found to increase residences, and (b) strategies for locating lost
in the presence of a low noise level and with wanderers.
normal lighting and temperature (Cohen-
Mansfield & Werner, 1995; Cohen-Mansfield, Adrianne D. Linton
Werner, Marx, & Freedman, 1991). Limited
research on visual illusions shows that they
work with some, but not all, patients (Price,
hermans, & Grimley, 2001). Differences in Watson’s theory of
patient responses to specific adaptations
could be attributed to differences in cog- human Caring
nitive skills that characterize each stage of
dementia among study subjects.
Increased tolerance of wandering, mea- Watson’s Theory of human Caring has its
sures to create safer wandering environ- origins in 1975 through 1979 (Watson, 1979)
ments, and caregiver education have made as an “attempt to bring meaning and focus
drug therapy a last resort in most cases. to nursing as an emerging discipline and dis-
When wandering is accompanied by agi- tinct health profession with its own unique
tation, neuroleptics sometimes are used. A values, knowledge, and practices, with its
major adverse effect with neuroleptics is own ethic and mission to society” (Watson,
orthostatic hypotension. The atypical antip- 2001, p. 344). Watson (1996, p. 142) proposed
sychotics such as risperidone and olanzap- that her early work could be viewed as a
ine are preferred for older adults because “philosophy, ethic, or even a paradigm or
they have fewer side effects than most older worldview” that embraces the art and science