1
|
Song Y, Bolt S, Thorne T, Norton P, Poss J, Fu F, Squires J, Cummings G, Estabrooks CA. Nursing assistants' use of best practices and pain in older adults living in nursing homes. J Am Geriatr Soc 2023; 71:3413-3423. [PMID: 37565426 DOI: 10.1111/jgs.18527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/15/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels. METHODS We performed a cross-sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument-Minimum Data Set [RAI-MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI-MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self-report scales and aggregated to the unit level. Two-level random-intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home. RESULTS Of the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01-1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents. CONCLUSIONS We observed that higher unit-level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.
Collapse
Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Sascha Bolt
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Jeff Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Fangfang Fu
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Greta Cummings
- College of Health Sciences, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
2
|
Xu L, Sharma H. Effect of Medicaid Expansion on Health Insurance for Low-Income Nursing Home Aides. J Appl Gerontol 2023; 42:231-240. [PMID: 36206172 DOI: 10.1177/07334648221132121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We examine how the Affordable Care Act Medicaid expansion affected the insurance coverage and the sources of coverage among low-income nursing home aides using the 2010-2019 American Community Survey data. Insurance coverage for low-income nursing home aides increased from about 60% to nearly 90% in expansion states but rose to only about 80% in nonexpansion states. Using a difference-in-differences regression design, we find that Medicaid expansion was associated with a 5.1 percentage-point increase in overall insurance coverage. Expansion states had a 12.2 percentage-point gain in Medicaid that was partially offset by a 6.4 percentage-point reduction in private insurance coverage. Our results show that ACA Medicaid expansion increased insurance coverage for low-income nursing home aides; however, there was substantial crowd-out of private insurance coverage in this population. Policymakers should consider expanding Medicaid while incentivizing affordable private health insurance options for low-income nursing home aides to improve insurance coverage.
Collapse
Affiliation(s)
- Lili Xu
- Department of Health Management and Policy, College of Public Health, 4083University of Iowa, Iowa City, IA, USA
| | - Hari Sharma
- Department of Health Management and Policy, College of Public Health, 4083University of Iowa, Iowa City, IA, USA
| |
Collapse
|
3
|
Franzosa E, Mak W, R Burack O, Hokenstad A, Wiggins F, Boockvar KS, Reinhardt JP. Perspectives of certified nursing assistants and administrators on staffing the nursing home frontline during the COVID-19 pandemic. Health Serv Res 2022; 57:905-913. [PMID: 35274293 PMCID: PMC9111312 DOI: 10.1111/1475-6773.13954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To identify best practices to support and grow the frontline nursing home workforce based on the lived experience of certified nursing assistants (CNAs) and administrators during COVID‐19. Study setting Primary data collection with CNAs and administrators in six New York metro area nursing homes during fall 2020. Study design Semi‐structured interviews and focus groups exploring staffing challenges during COVID‐19, strategies used to address them, and recommendations moving forward. Data collection We conducted interviews with 6 administrators and held 10 focus groups with day and evening shift CNAs (n = 56) at 6 nursing homes. Data were recorded and transcribed verbatim and analyzed through directed content analysis using a combined inductive and deductive approach to compare perceptions across sites and roles. Principal findings CNAs and administrators identified chronic staffing shortages that affected resident care and staff burnout as a primary concern moving forward. CNAs who felt most supported and confident in their continued ability to manage their work and the pandemic described leadership efforts to support workers' emotional health and work–life balance, teamwork across staff and management, and accessible and responsive leadership. However, not all CNAs felt these strategies were in place. Conclusions Based on priorities identified by CNAs and administrators, we recommend several organizational/industry and policy‐level practices to support retention for this workforce. Practices to stabilize the workforce should include 1) teamwork and person‐centered operational practices including transparent communication; 2) increasing permanent staff to avoid shortages; and 3) evaluating and building on successful COVID‐related innovations (self‐managed teams and flexible benefits). Policy and regulatory changes to promote these efforts are necessary to developing industry‐wide structural practices that target CNA recruitment and retention.
Collapse
Affiliation(s)
- Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Wingyun Mak
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| | - Orah R Burack
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| | - Alene Hokenstad
- Ladders to Value Workforce Investment Organization, 1199SEIU Training and Employment Funds, New York, New York, USA
| | - Faith Wiggins
- 1199SEIU Training and Employment Funds, New York, New York, USA
| | - Kenneth S Boockvar
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Joann P Reinhardt
- The New Jewish Home Research Institute on Aging, New York, New York, USA
| |
Collapse
|
4
|
Lin L, Liu X, McGilton KS, Yuan Y, Li H, Dong B, Xie C, Wang H, Li H, Tian L. Level of nurse supportive supervision and its influencing factors in long-term care facilities. Geriatr Nurs 2021; 42:1316-1322. [PMID: 34560526 DOI: 10.1016/j.gerinurse.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW's years of working, the RN's education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs.
Collapse
Affiliation(s)
- Lu Lin
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Xiaoming Liu
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China
| | - Katherine S McGilton
- Toronto Rehabilitation Institute-UHN, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - Yang Yuan
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Haixia Li
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Hong Wang
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Huiling Li
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
| |
Collapse
|
5
|
Hoben M, Ginsburg LR, Norton PG, Doupe MB, Berta WB, Dearing JW, Keefe JM, Estabrooks CA. Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study. Implement Sci 2021; 16:83. [PMID: 34425875 PMCID: PMC8381143 DOI: 10.1186/s13012-021-01151-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015-2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides' involvement in formal communications about resident care. METHODS Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019-03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention. RESULTS We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3. CONCLUSIONS Theory-informed feedback provides long-lasting improvement in care aides' involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study-as does possible post-intervention spread of our intervention to simple feedback homes.
Collapse
Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Whitney B Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - James W Dearing
- Department of Communication, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, 48824, USA
| | - Janice M Keefe
- Department of Family Studies & Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, B3M 2J6, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| |
Collapse
|
6
|
Kennedy KA, Applebaum R, Bowblis JR, Straker JK. Organizational Factors Associated With Retention of Direct Care Workers: A Comparison of Nursing Homes and Assisted Living Facilities. THE GERONTOLOGIST 2021; 61:530-539. [PMID: 32926167 DOI: 10.1093/geront/gnaa130] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Low retention of direct care workers (DCWs), either certified nursing assistants in nursing homes (NHs) or personal care assistants in assisted living (AL), continues to be an unresolved problem. While numerous studies have examined predictors of DCW retention in NHs, little attention has been paid to differences between settings of long-term care. This study compares the predictors of DCW retention rates across both settings. RESEARCH DESIGN AND METHODS The 2017 Ohio Biennial Survey of Long-Term Care Facilities provides facility-level information from NHs and ALs (NHs = 739; ALs = 465). We compare the factors that predict retention rates of DCWs utilizing regression analysis. The factors are structural, financial, resident conditions, staffing, and management characteristics, as well as retention strategies. RESULTS Average DCW retention rates were 66% and 61% in ALs and NHs, respectively. Not-for-profit status was significantly associated with higher retention rates across settings. While the percent of residents with dementia and less administrator turnover were associated with significantly higher DCW retention in NHs, these were not significant for ALs. However, in the AL context, a higher county unemployment rate and DCWs' participation in resident care planning meetings were positively related to DCW retention after controlling for all other covariates, while DCW cross-training was negatively associated. DISCUSSION AND IMPLICATIONS Retention strategies for DCWs may need to differ by setting, as a result of differing working environments, resources, and regulations.
Collapse
Affiliation(s)
| | - Robert Applebaum
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio.,Scripps Gerontology Center, Miami University, Oxford, Ohio
| | - John R Bowblis
- Scripps Gerontology Center, Miami University, Oxford, Ohio.,Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio
| | - Jane K Straker
- Scripps Gerontology Center, Miami University, Oxford, Ohio
| |
Collapse
|
7
|
Carey N, Boersema GC, du Toit HS. Improving early detection of infection in nursing home residents in South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021; 14:100288. [PMID: 33520656 PMCID: PMC7830222 DOI: 10.1016/j.ijans.2021.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/21/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
This paper sets out key challenges related to detection and management of infection in nursing home residents, and then explores the situation in South Africa, and use of decision support tools as a mechanism to improve this area of practice. In line with global trends, concerns have been raised about the rapidly increasing aging population in South Africa and the ability of the current healthcare system to keep pace with patient demand, particularly nursing home residents. Nursing home residents, who often exhibit atypical signs and symptoms, are at increased risk of infection and unplanned admissions, which account for 65% of all bed days, and cost the US healthcare economy more than a trillion dollars a year. Evidence suggests that the current workforce in South Africa receive limited training in this area and are largely unprepared to meet the demands of the aging population. Building the capacity and skills of the workforce in South Africa is one approach that could help to improve the early detection of infection and assist the nursing home workforce to provide more effective and timely care, particularly during the current COVID-19 pandemic. Decision support tools, such as the Early Detection of Infection Scale, can help ensure consistency and ensure more timely treatment, minimising unplanned admissions and healthcare expenditure. However, the potential benefits or indeed how easily this could be integrated in to nursing homes in South Africa is unknown. An important first step, as in other parts of the world, is therefore to explore views and opinions of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes.
Collapse
Affiliation(s)
- Nicola Carey
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, Priestly Road, Surrey Research Park, Guildford, Surrey GU2 7YH, United Kingdom
| | | | - Helena S du Toit
- Department of Health Studies, University of South Africa, PO Box 392, Unisa, Pretoria, 0003, South Africa
| |
Collapse
|
8
|
Ginsburg LR, Hoben M, Easterbrook A, Andersen E, Anderson RA, Cranley L, Lanham HJ, Norton PG, Weeks LE, Estabrooks CA. Examining fidelity in the INFORM trial: a complex team-based behavioral intervention. Implement Sci 2020; 15:78. [PMID: 32938481 PMCID: PMC7493316 DOI: 10.1186/s13012-020-01039-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022] Open
Abstract
Background Fidelity in complex behavioral interventions is underexplored. This study examines the fidelity of the INFORM trial and explores the relationship between fidelity, study arm, and the trial’s primary outcome—care aide involvement in formal team communications about resident care. Methods A concurrent process evaluation of implementation fidelity was conducted in 33 nursing homes in Western Canada (Alberta and British Columbia). Study participants were from 106 clinical care units clustered in 33 nursing homes randomized to the Basic and Enhanced-Assisted Feedback arms of the INFORM trial. Results Fidelity of the INFORM intervention was moderate to high, with fidelity delivery and receipt higher than fidelity enactment for both study arms. Higher enactment teams experienced a significantly larger improvement in formal team communications between baseline and follow-up than lower enactment teams (F(1, 70) = 4.27, p = .042). Conclusions Overall fidelity enactment was associated with improvements in formal team communications, but the study arm was not. This suggests that the intensity with which an intervention is offered and delivered may be less important than the intensity with which intervention participants enact the core components of an intervention. Greater attention to fidelity assessment and publication of fidelity results through studies such as this one is critical to improving the utility of published trials.
Collapse
Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, V2C 0C8, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, 27599-7460, USA
| | - Lisa Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M5T 1P8, Canada
| | - Holly J Lanham
- University of Texas Health Science Center San Antonio, University of Texas, San Antonio, Texas, 78229, USA
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| |
Collapse
|
9
|
Hoben M, Ginsburg LR, Easterbrook A, Norton PG, Anderson RA, Andersen EA, Boström AM, Cranley LA, Lanham HJ, Weeks LE, Cummings GG, Holroyd-Leduc JM, Squires JE, Wagg AS, Estabrooks CA. Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes-the INFORM cluster-randomized controlled trial. Implement Sci 2020; 15:75. [PMID: 32912323 PMCID: PMC7488270 DOI: 10.1186/s13012-020-01038-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/31/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on goal-setting theory on improving formal staff communication in NHs. METHODS This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (translating research in elder care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4641 care aides and 1693 nurses cared for 8766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on goal-setting theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up. RESULTS Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p = 0.021) and enhanced groups ([0.01; 0.33], p = 0.035). We found no difference in this outcome between the two higher intensity groups. CONCLUSIONS Theoretically informed feedback was superior to simple feedback in improving care aides' involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02695836 ), registered on March 1, 2016.
Collapse
Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, NC, 27599-7460, USA
| | - Elizabeth A Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, V2C 0C8, Canada
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, SE-104 35, Stockholm, Sweden
| | - Lisa A Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M5T 1P8, Canada
| | - Holly J Lanham
- University of Texas Health Science Center San Antonio, University of Texas, San Antonio, TX, 78229, USA
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, K1H 8 M5, Canada
| | - Adrian S Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, T6G 2P4, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| |
Collapse
|
10
|
Certified Nursing Assistants’ Barriers and Facilitators to Accessing and Using Worksite Health Promotion Programs. J Occup Environ Med 2020; 62:943-952. [DOI: 10.1097/jom.0000000000002007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
11
|
Abbott KM, B K A, Straker JK, Brown JS. Resident Preferences and CNA Empowerment: Testing Validity and Reliability of a Culture Change Survey Tool. J Appl Gerontol 2019; 39:1284-1291. [PMID: 31660751 DOI: 10.1177/0733464819884862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Culture change (CC) is an innovation to improve nursing home resident quality of life. Inconsistencies in how CC is measured make the interpretation of findings inconclusive. The purpose of this study is to determine the underlying factors of CC among Ohio nursing homes to extract the core essence of CC. Data from the 2015 Ohio Biennial Survey of Long-Term Care Facilities with n = 721 nursing homes answering a CC module comprising of 21 questions are included in an exploratory factor analysis (EFA). EFA results identified two underlying factors of CC that are extracted using principal factor method. These factors include items related to resident preferences for care (RPC) and certified nursing assistant (CNA) empowerment. This study presents two valid and reliable scales to advance the measurement of CC. These scales can be used to explore both RPC and CNA empowerment components as predictors or outcomes.
Collapse
|
12
|
Developing a Training for Certified Nursing Assistants to Recognize, Communicate, and Document Discomfort in Residents With Dementia. J Hosp Palliat Nurs 2019; 20:120-126. [PMID: 30063564 DOI: 10.1097/njh.0000000000000424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nursing home residents with advanced dementia experience significant symptom burden and may be unable to articulate their needs. Observational tools, such as the Pain Assessment in Advanced Dementia (PAINAD) scale, are available to evaluate changes in behavior that may signify discomfort or pain. Studies proposing a short and effective curriculum, primarily for certified nursing assistants (CNAs) on how to use and incorporate the PAINAD in daily patient care, are scarce. This performance improvement project involves the design and implementation of a training curriculum for CNAs for using the PAINAD and discusses barriers to be considered for further projects. Certified nursing assistant perceptions of their experience with the training and the use of the tool were also assessed with a brief evaluation. Seventy-three initial PAINAD forms were completed along with 52 follow-up PAINAD forms. A paired t test (N = 52) showed a significant decrease in the PAINAD scores from initial (mean, 6.06) to follow-up (mean, 1.85) (P < .001), suggesting a reduction of patient discomfort. The process of collecting and examining these data was meant to reinforce the identification and reduction of behavioral distress through the application of this tool. The training was perceived as effective and the tool as easy to use, indicating it can be incorporated into daily care responsibilities of CNAs.
Collapse
|
13
|
Zysberg L, Band-Winterstein T, Doron I, Shulyaev K, Siegel EO, Kornas-Biela D, Zisberg A. The health care aide position in nursing homes: A comparative survey of nurses’ and aides’ perceptions. Int J Nurs Stud 2019; 94:98-106. [DOI: 10.1016/j.ijnurstu.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 01/24/2023]
|
14
|
Bethell J, Chu CH, Wodchis WP, Walker K, Stewart SC, McGilton KS. Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes. THE GERONTOLOGIST 2019; 58:953-959. [PMID: 28329826 DOI: 10.1093/geront/gnx008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
Background and Objectives To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.
Collapse
Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Charlene H Chu
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin Walker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Steven C Stewart
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| |
Collapse
|
15
|
Escrig-Pinol A, Corazzini KN, Blodgett MB, Chu CH, McGilton KS. Supervisory relationships in long-term care facilities: A comparative case study of two facilities using complexity science. J Nurs Manag 2018; 27:311-319. [DOI: 10.1111/jonm.12681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/20/2018] [Accepted: 06/10/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Astrid Escrig-Pinol
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
- University of Toronto; Dalla Lana School of Public Health; Toronto ON Canada
| | | | - Meagan B. Blodgett
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| | - Charlene H. Chu
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| | - Katherine S. McGilton
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| |
Collapse
|
16
|
Mohlman WL, Dassel K, Supiano KP, Caserta M. End-of-Life Education and Discussions With Assisted Living Certified Nursing Assistants. J Gerontol Nurs 2018; 44:41-48. [DOI: 10.3928/00989134-20180327-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/05/2018] [Indexed: 01/15/2023]
|
17
|
Hoben M, Norton PG, Ginsburg LR, Anderson RA, Cummings GG, Lanham HJ, Squires JE, Taylor D, Wagg AS, Estabrooks CA. Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial. Trials 2017; 18:9. [PMID: 28069045 PMCID: PMC5223357 DOI: 10.1186/s13063-016-1748-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. METHODS INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. DISCUSSION INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.
Collapse
Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
- Alberta Innovates-Health Solutions (AIHS) post-doctoral fellow, Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Peter G. Norton
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - Liane R. Ginsburg
- Faculty of Health, York University, School of Health Policy and Management, Toronto, Ontario Canada
| | - Ruth A. Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | | | - Holly J. Lanham
- Department of Medicine and Department of Family and Community Medicine, University of Texas, Health Science Center San Antonio, San Antonio, Texas USA
| | | | - Deanne Taylor
- Interior Health Authority, Kelowna, British Columbia Canada
| | - Adrian S. Wagg
- Faculty of Medicine and Dentistry, University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta Canada
| | | |
Collapse
|
18
|
Snellgrove S, Beck C, Green A, McSweeney JC. Putting Residents First: Strategies Developed by CNAs to Prevent and Manage Resident-to-Resident Violence in Nursing Homes. THE GERONTOLOGIST 2016; 55 Suppl 1:S99-107. [PMID: 26055786 DOI: 10.1093/geront/gnu161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Resident-to-resident violence (RRV) in nursing homes (NHs) is common and threatens the safety and quality of life of both residents and caregivers. The purpose of this portion of a larger qualitative study was to explore strategies developed by certified nurses' assistants (CNAs) to prevent and manage RRV in NHs. DESIGN AND METHODS Semistructured interviews were used to collect data. Data were analyzed utilizing content analysis and constant comparison. RESULTS Analysis revealed one overriding theme, "Putting Residents First" which the CNAs described as a conscious effort to put themselves or a beloved family member in the place of the resident while administering care. Within this theme, there were three related subthemes: (a) Knowing the Residents, (b) Keeping Residents Safe, and (c) Spending Quality Time. IMPLICATIONS Together, these themes suggest that the formulation of strategies for decreasing and managing RRV was influenced significantly by the ability of the CNAs to empathize with the residents for whom they were caring. The results indicate that in the absence of evidence-based interventions, CNAs have developed their own strategies for the management and prevention of RRV. These strategies may provide a foundation for the development and testing of interventions aimed at preventing and managing RRV in NHs.
Collapse
Affiliation(s)
| | - Cornelia Beck
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock
| | - Angela Green
- Department of Nursing Research, Arkansas Childrens' Hospital, Little Rock
| | - Jean C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock
| |
Collapse
|
19
|
Estabrooks CA, Squires JE, Hayduk L, Morgan D, Cummings GG, Ginsburg L, Stewart N, McGilton K, Kang SH, Norton PG. The influence of organizational context on best practice use by care aides in residential long-term care settings. J Am Med Dir Assoc 2015; 16:537.e1-10. [PMID: 25899110 DOI: 10.1016/j.jamda.2015.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides. SETTING AND PARTICIPANTS A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes. METHOD We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides. RESULTS At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance. CONCLUSIONS Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.
Collapse
Affiliation(s)
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Leslie Hayduk
- Department of Sociology, University of Alberta, Edmonton, Alberta, Canada
| | - Debra Morgan
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine McGilton
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Sung Hyun Kang
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
20
|
Lima Ribeiro SM, Morley JE. Dehydration is Difficult to Detect and Prevent in Nursing Homes. J Am Med Dir Assoc 2015; 16:175-6. [DOI: 10.1016/j.jamda.2014.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022]
|