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Behrens LL, Boltz M, Sciegaj M, Kolanowski A, Jones JR, Paudel A, Van Haitsma K. Nursing Staff Perceptions of Outcomes Related to Honoring Residents' "Risky" Preferences. Res Gerontol Nurs 2022; 15:271-281. [PMID: 36214738 PMCID: PMC10189806 DOI: 10.3928/19404921-20220930-01] [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] [Indexed: 11/20/2022]
Abstract
Nursing homes (NHs) are challenged to consistently deliver person-centered care (PCC), or care based on residents' values and preferences. NH staff associate certain resident preferences with risk. However, there are limited evidence-based person-centered risk management strategies to assist NH staff with risky resident preferences. The purpose of the current study was to explore NH staff perceptions of health and safety outcomes associated with honoring NH residents' risky preferences to inform intervention development. This descriptive, qualitative study used sequential focus groups and content analysis, revealing that nursing staff perceive negative and positive outcomes for staff and residents when seeking to honor residents' risky preferences. This finding is supported by three themes: Potential Harms to Staff, Potential Harms to Residents, and Positive Shared Outcomes. These results contribute a set of nurse-driven quality of life and quality of care outcomes for NH staff and residents associated with PCC delivery in NHs. [Research in Gerontological Nursing, 15(6), 271-281.].
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Handor R, Persoon A, van Lieshout F, Lovink M, Vermeulen H. The Required Competencies of Bachelor- and Master-Educated Nurses in Facilitating the Development of an Effective Workplace Culture in Nursing Homes: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12324. [PMID: 36231624 PMCID: PMC9564543 DOI: 10.3390/ijerph191912324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is currently no comprehensive overview of what competencies this requires. OBJECTIVES To identify what competencies are required from BNs/MNs in facilitating the development of an effective workplace culture in nursing homes. METHODS AND DESIGN We conducted an integrative review (IR) using Whittemore and Knafl's method. We searched the PubMed, CINAHL, and PsycINFO databases for studies published between January 2010 and December 2021 in English. Two independent reviewers determined whether studies met inclusion: bachelor- or master-educated nurse; nursing home; professional competencies; and mixed methods or qualitative and qualitative studies. We applied the CASP appraisal tool and analyzed the data by applying content analysis. RESULTS Sixteen articles were included. Five themes were identified representing required competencies for BNs/MNs facilitating: (1) learning cultures in nursing practice; (2) effective work relationships within teams; (3) leadership capability within teams; (4) implementation of guidelines, standards, and protocols; (5) a work environment acknowledging grief and loss of residents within teams. CONCLUSIONS It shows that the BN/MN applies five competencies associated with a facilitator role to promote the development of an effective workplace culture to achieve a safe, high-level quality of care, satisfaction, and well-being. An overarching leadership as a change champion will support teams to achieve a quality that should guide the transformation in nursing care.
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Affiliation(s)
- Rachida Handor
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Famke van Lieshout
- Department of People and Health Studies, Fontys University of Applied Sciences, 5600 AH Eindhoven, The Netherlands
| | - Marleen Lovink
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
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Dellefield ME, Madrigal CB, Verkaaik C, Close J. Nursing surveillance and immediate jeopardy in Veteran Health Administration community living centers unannounced survey program 2018 to 2019. Nurs Outlook 2021; 69:182-192. [PMID: 33541725 DOI: 10.1016/j.outlook.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents. PURPOSE To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services. METHODS Using CLC survey data consisting of 200 statements of deficiency (SODs) for 2018 to 2019, we collected a SOD sample (n = 20) of immediate jeopardy events. They were described using descriptive statistics and discourse content analysis. FINDINGS We identified clinical events, their duration, work shift, and nursing skill mix for each SOD. Most to least common themes about failures in nursing surveillance were acquisition/transfer of information; decision-making; and early recognition of problems. DISCUSSION Our analysis of nursing surveillance failures in CLC immediate jeopardy SODs provides insight into opportunities for registered nurses and the nursing skill mix to reduce avoidable harms.
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Affiliation(s)
- Mary Ellen Dellefield
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA.
| | - Caroline B Madrigal
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center, Providence, RI
| | - Catherine Verkaaik
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA
| | - Jackie Close
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA
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Boltz M, Lee KH, Shuluk J, Secic M. Development of the Care Environment Scale-Long-Term Care. Clin Nurs Res 2018; 29:169-176. [PMID: 30227722 DOI: 10.1177/1054773818801485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A critical dimension of Quality Assurance and Performance Improvement (QAPI) activity in long-term care is an analysis of the care environment, that is, the way care and services are organized. The purpose of this study was to develop and pilot test a psychometrically sound tool that long-term care staff could use to assess the care environment and guide performance improvement activity. Focus groups with 57 interdisciplinary participants in five nursing homes developed initial items, with excellent content validity (item content validity index = 1.0) evaluated by an expert panel. Pilot testing of internal consistency of the Care Environment Scale-Long-Term Care (CES-LTC) was conducted in a web-based administration of the items by 425 interdisciplinary staff members in 30 nursing homes and four assisted living facilities. The CES-LTC is internally consistent (Cronbach's alpha = .90) and accounts for approximately 71.6% of the total variance. The three factors extracted from the exploratory factor analysis are Institutional Values (k = 6), Access to Resources (k = 10), and Person-Centered Approaches (k = 12). Intrarater reliability in a subsample of 66 registered nurses revealed good test-retest results (overall intraclass correlation coefficients [ICC] = 0.78). The CES-LTC appears to be a valid and reliable measure of staff perceptions of the care environment and may be used to actively engage staff in QAPI endeavors including root cause analyses and improvement activity.
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Affiliation(s)
- Marie Boltz
- The Pennsylvania State University College of Nursing, University Park, PA, USA
| | | | - Joseph Shuluk
- University of Florida College of Medicine, Jacksonville, FL, USA
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McElligott M, Welham G, Pop-Vicas A, Taylor L, Crnich CJ. Antibiotic Stewardship in Nursing Facilities. Infect Dis Clin North Am 2018; 31:619-638. [PMID: 29079152 DOI: 10.1016/j.idc.2017.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Misuse and overuse of antibiotic therapy is a frequent cause of resident harm in nursing facilities. As a result, newly released policy and regulatory initiatives will require antibiotic stewardship programs (ASPs) in nursing facilities. Although implementing ASPs can be challenging, improving the quality of antibiotic prescribing is achievable in this setting. The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process.
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Affiliation(s)
- Miranda McElligott
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Grace Welham
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Aurora Pop-Vicas
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Lyndsay Taylor
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Christopher J Crnich
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospital and Clinics, Madison, WI, USA; William S. Middleton Veterans Affairs Hospital, Madison, WI, USA.
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Dellefield ME, Corazzini K. Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices. Healthcare (Basel) 2015; 3:1031-53. [PMID: 27417811 PMCID: PMC4934629 DOI: 10.3390/healthcare3041031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
Abstract
Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework-the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP's efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse's educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.
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Affiliation(s)
- Mary Ellen Dellefield
- Hahn School of Nursing and Health Sciences, University of San Diego, San Diego, CA 92110, USA.
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Crnich CJ, Jump R, Trautner B, Sloane PD, Mody L. Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement. Drugs Aging 2015; 32:699-716. [PMID: 26316294 PMCID: PMC4579247 DOI: 10.1007/s40266-015-0292-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges to implementation of effective antibiotic stewardship. Nevertheless, an emerging body of research points towards ways to improve antibiotic prescribing practices in nursing homes. This review summarizes the findings of this research and presents ways in which antibiotic stewardship can be implemented and optimized in the nursing home setting.
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Affiliation(s)
- Christopher J Crnich
- School of Medicine and Public Health, University of Wisconsin, 1685 Highland Avenue, MFCB 5217, Madison, WI, 53705, USA.
- William S. Middleton Veterans Affairs Hospital, Madison, WI, USA.
| | - Robin Jump
- Geriatric Research, Education and Clinical Center, Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
- Division of Infectious Disease, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Trautner
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lona Mody
- Division of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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