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Zeng BT, Jin Y, Cheng SD, Ding YM, Du JW. Administration approaches of nursing assistants in hospitals: a scoping review. BMJ Open 2022; 12:e063100. [PMID: 36428023 PMCID: PMC9703314 DOI: 10.1136/bmjopen-2022-063100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The administration of nursing assistants (NAs) is closely associated with patient outcomes, but studies evaluating intrahospital administration of NAs are limited. This study aimed to identify existing literature on intrahospital NAs' administration approaches. DESIGN Scoping review. DATA SOURCES PubMed, Embase, CINAHL, Scopus, ProQuest, CNKI, APA PsycInfo, Wanfang Med, SinoMed, Ovid Emcare, NICE, AHRQ, CADTH, JBI EBP and Cochrane DSR were searched for articles published between January 2011 and March 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative or mixed-method studies and evidence syntheses that evaluate administration approaches, models and appraisal tools of intrahospital NAs were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers conducted search, data selection and data extraction according to Joanna Briggs Institute guidance and methodology for scoping review. The quality of included studies was assessed using Mixed Methods Appraisal Tool or AMSTAR V.2. Data were synthesised using narrative methods and frequency effect size analysis. RESULTS Thirty-six studies were eligible, with acceptable quality. We identified 1 administration model, 9 administration methods, 15 educational programmes and 7 appraisal tools from the included studies. The frequency effect size analysis yielded 15 topics of the main focus at four levels, suggesting that included articles were mainly (33%) focused on the competency of NAs, and the lectures were the most (80%) used strategy in quality improvement projects. Evidence from the studies was of low-to-moderate quality, indicating huge gaps between evidence-based research and management practice. CONCLUSIONS Practical intrahospital administration approaches were revealed, and fifteen primarily focused topics were identified. We should explore this area more thoroughly using structured frameworks and standardised methodology. This scoping review will help managers find more effective ways to improve the quality of care. Researchers may focus more on evidence-based practice in NA administration using the 15 topics as a breakthrough.
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Affiliation(s)
- Ben-Tuo Zeng
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shu-Dong Cheng
- Nursing Department, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yan-Ming Ding
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Ji-Wei Du
- Nursing Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Li M, Ao Y, Deng S, Peng P, Chen S, Wang T, Martek I, Bahmani H. A Scoping Literature Review of Rural Institutional Elder Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610319. [PMID: 36011954 PMCID: PMC9408389 DOI: 10.3390/ijerph191610319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 05/31/2023]
Abstract
Under circumstances of pervasive global aging combined with weakened traditional family elder care, an incremental demand for institutional elder care is generated. This has led to a surge in research regarding institutional elder care. Rural residents' institutional elder care is receiving more attention as a major theme in social sciences and humanities research. Based on 94 articles related to rural institutional elder care, this study identified the most influential articles, journals and countries in rural institutional elder care research since 1995. This was done using science mapping methods through a three-step workflow consisting of bibliometric retrieval, scoping analysis and qualitative discussion. Keywords revealed five research mainstreams in this field: (1) the cognition and mental state of aged populations, (2) the nursing quality and service supply of aged care institutions, (3) the aged care management systems' establishment and improvements, (4) the risk factors of admission and discharge of aged care institutions, and (5) deathbed matters regarding the aged population. A qualitative discussion is also provided for 39 urban and rural comparative research papers and 55 pure rural research papers, summarizing the current research progress status regarding institutional elder care systems in rural areas. Gaps within existing research are also identified to indicate future research trends (such as the multi-dimensional and in-depth comparative research on institutional elder care, new rural institutional elder care model and technology, and correlative policy planning and development), which provides a multi-disciplinary guide for future research.
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Affiliation(s)
- Mingyang Li
- College of Management Science, Chengdu University of Technology, Chengdu 610059, China
| | - Yibin Ao
- College of Management Science, Chengdu University of Technology, Chengdu 610059, China
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Shulin Deng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Panyu Peng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Shuangzhou Chen
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Tong Wang
- Faculty of Architecture and Built Environment, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Igor Martek
- School of Architecture and Built Environment, Deakin University, Geelong 3220, Australia
| | - Homa Bahmani
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
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Working experience of certified nursing assistants in the greater New York City area during the COVID-19 pandemic: Results from a survey Study. Geriatr Nurs 2021; 42:1556-1561. [PMID: 34743039 PMCID: PMC8519779 DOI: 10.1016/j.gerinurse.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to examine the challenges and needs of certified nursing assistants (CNAs) working in nursing homes during the COVID-19 pandemic in the greater New York City area. Between September and November of 2020, a telephone survey was administered to and completed by 208 CNAs in the study area about various aspects of their working experience during COVID-19. CNAs reported significant exposure to COVID-19 and experienced additional emotional and financial strain due to the pandemic. CNAs also expressed the influence of COVID-19 on their work schedules and intent to continue working as CNAs, and strong interest in financial support and further training. This study offers empirical insights into the experiences of CNAs working in nursing homes during the pandemic, which are of unique value to inform future efforts to support CNAs and other long-term care providers in general and during public health emergencies in New York and beyond.
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Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status. Geriatr Nurs 2021; 42:1356-1361. [PMID: 34562808 PMCID: PMC8403689 DOI: 10.1016/j.gerinurse.2021.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
The purpose of the study was to examine trends in COVID-19 cases, related deaths, and staffing shortages in nursing homes (NH) by rural and urban status from May 2020 to Feb 2021. Generalized linear mixed models with state-fixed effects were used to estimate the interaction effect of study period and rural/urban status on having at least: one COVID-19 case, one related death, and/or at least one week of staffing shortage using the NH COVID-19 data spanning the 40-week period. The findings revealed shortages in staff, particularly direct care providers, were greatly accelerated in rural NHs as the pandemic wore on over time. Conversely, staffing shortages in urban NHs were relatively stable despite the fluctuating COVID-19 cases over the same time period. The findings highlight the need of identifying effective strategies that prevent rural NHs from encountering staffing deficits in response to long-lasting natural disasters such as the COVID-19 pandemic.
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Travers JL, Teitelman AM, Jenkins KA, Castle NG. Exploring social-based discrimination among nursing home certified nursing assistants. Nurs Inq 2019; 27:e12315. [PMID: 31398775 DOI: 10.1111/nin.12315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social-based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory to explore the phenomenon of social-based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social-based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower-class workers and subsequently improving resident care delivery.
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Affiliation(s)
- Jasmine L Travers
- National Clinician Scholars Program, Yale University Schools of Medicine and Nursing, New Haven, CT, USA
| | - Anne M Teitelman
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kevin A Jenkins
- Perelman School of Medicine, University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA
| | - Nicholas G Castle
- Department of Health Policy, Management and Leadership, West Virginia University, Morgantown, WV, USA
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An Approach to Recruitment and Retention of Certified Nursing Assistants Using Innovation and Collaboration. ACTA ACUST UNITED AC 2019; 49:354-358. [DOI: 10.1097/nna.0000000000000767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holley LM, Kelly CM, Deichert J, Juanes S, Wolf L. Strategic partnerships enhance resources for care of rural-dwelling older adults. QUALITY IN AGEING AND OLDER ADULTS 2018. [DOI: 10.1108/qaoa-12-2017-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to disseminate a new model that addresses the urgent social challenge of providing adequate long-term care in rural circumstances through innovative use of existing resources, and to suggest future research.
Design/methodology/approach
This paper is exploratory in and is based upon the analysis of qualitative observations (interviews and site visits) framed in the financial and operational records of the facility studied, macro- and micro-level demographics, and the scholarly and practice literatures.
Findings
Significant cost savings upon implementation, improvements in quality of care and both worker and client satisfaction were observed.
Research limitations/implications
The model has been in operation only one year; the trend has been positive, however, more research is needed to identify its stability and develop a more refined description of its components: while essential features of this innovative model can be applied in any residential long-term care situation, replicating its success is obviously linked with the skill and authority of the director. Evaluation research is currently in progress.
Practical implications
The paper suggests budget-neutral solutions to persistent challenges of caring for older adults in rural circumstances.
Social implications
Quality and financing of long-term residential care for elders is insufficient and worsening. This model addresses problems central to financing and quality of care by connecting existing resources in new ways. It does not require additional funding or changes in qualifications required for jobs.
Originality/value
The model is the original creation of a residential long-term care facility director working with a network of partnerships that he discovered and developed: partnerships include a broad range of organizations in the public and non-profit sectors, and the state university.
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Hewko SJ, Cooper SL, Huynh H, Spiwek TL, Carleton HL, Reid S, Cummings GG. Invisible no more: a scoping review of the health care aide workforce literature. BMC Nurs 2015; 14:38. [PMID: 26203297 PMCID: PMC4511030 DOI: 10.1186/s12912-015-0090-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare aides (HCAs) are the primary caregivers for vulnerable older persons. They have many titles and are largely unregulated, which contributes to their relative invisibility. The objective of this scoping review was to evaluate the breadth and depth of the HCA workforce literature. METHODS We conducted a search of seven online bibliographic databases. Studies were included if published since 1995 in English, peer-reviewed journals. Results were iteratively synthesized within and across the following five categories: education, supply, use, demand and injury and illness. RESULTS Of 5,045 citations screened, 82 studies met inclusion criteria. Few examined HCA education; particularly trainee characteristics, program location, length and content. Results in supply indicated that the average HCA was female, 36-45 years and had an education level of high school or less. Home health HCAs were, on average, older and were more likely to be immigrants than those working in other settings. The review of studies exploring HCA use revealed that their role was unclear - variation in duties, level of autonomy and work setting make describing "the" role of an HCA near impossible. Projected increased demand for HCAs and high rates of turnover, both at the profession and facility-level, elicit predictions of future HCA shortages. Home health HCAs experienced comparatively lower job stability, earned less, worked the fewest hours and were less likely to have fringe benefits than HCAs employed in hospitals and nursing homes. The review of studies related to HCA illness and injury revealed that they were at comparatively higher risk of injury than registered nurses and licensed practical nurses. CONCLUSIONS This is the largest, most comprehensive scoping review of HCA workforce literature to date. Our results indicate that the HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective HCA workforce plans. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care. Future workforce planning and research necessitates national HCA registries, or at minimum, directories.
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Affiliation(s)
- Sarah J. Hewko
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Sarah L. Cooper
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Hanhmi Huynh
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Trish L. Spiwek
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Heather L. Carleton
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Shawna Reid
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Greta G. Cummings
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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Meyer D, Raffle H, Ware LJ. The first year: employment patterns and job perceptions of nursing assistants in a rural setting. J Nurs Manag 2012; 22:769-78. [PMID: 23406387 DOI: 10.1111/j.1365-2834.2012.01441.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to follow rural certified nursing assistants (CNAs) (n=123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs' perceptions of the LTC work experience. BACKGROUND Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. METHOD A longitudinal survey design was used to track individuals completing CNA training for 1 year. RESULTS At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. CONCLUSION While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management. This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided.
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Affiliation(s)
- Deborah Meyer
- Assistant Professor, Department of Geriatric Medicine/Gerontology, Heritage College of Osteopathic Medicine, Ohio UniversityAssistant Professor Research Associate, Voinovich School of Leadership and Public Affairs, Ohio, USA
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McConnell ES, Corazzini KN, Lekan D, Bailey DE, Sloane R, Landerman LR, Champagne MT. Diffusion of innovations in long-term care measurement battery. Res Gerontol Nurs 2011; 5:64-76. [PMID: 21702425 DOI: 10.3928/19404921-20110602-04] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 12/07/2010] [Indexed: 11/20/2022]
Abstract
Poor understanding of factors influencing integration of new practices into long-term care (LTC) hinders timely implementation of evidence-based practices (EBPs). Using the Diffusion of Innovations (DOI) framework, a new instrument measuring staff perceptions of an EBP was developed as part of a DOI-LTC measurement battery and tested in a cross-sectional survey of North Carolina LTC nursing personnel. Valid questionnaires were received from 95 licensed nurses and 102 certified nursing assistants (CNAs). Internal consistency reliability for five of seven subscales was acceptable (Cronbach's alpha coefficient = 0.77 to 0.95). Perception of innovation attributes was associated with intention to adopt the new practice (Spearman rho correlation: licensed nurses = 0.41 to 0.68, p < 0.0001; CNAs = 0.26 to 0.54, p = 0.05 to <0.0001). The DOI-LTC measurement battery represents a promising new approach to studying implementation of EBPs in LTC. Future work should examine its responsiveness to interventions that facilitate implementation of EBPs in LTC.
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