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Francis L, Ghafurian M. Preserving the self with artificial intelligence using VIPCare-a virtual interaction program for dementia caregivers. FRONTIERS IN SOCIOLOGY 2024; 9:1331315. [PMID: 38375150 PMCID: PMC10875992 DOI: 10.3389/fsoc.2024.1331315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
Introduction Assistive technology is increasingly used to support the physical needs of differently abled persons but has yet to make inroads on support for cognitive or psychological issues. This gap is an opportunity to address another-the lack of contribution from theoretical social science that can provide insights into problems that cannot be seen. Using Affect Control Theory (ACT), the current project seeks to close that gap with an artificially intelligent application to improve interaction and affect for people with Alzheimer's Disease and Related Dementias (ADRD). Using sociological theory, it models interactions with persons with ADRD based on self-sentiments, rather than cognitive memory, and informs a cellphone-based assistive tool called VIPCare for supporting caregivers. Methods Staff focus groups and interviews with family members of persons with ADRD in a long-term residential care facility collected residents' daily needs and personal histories. Using ACT's evaluation, potency, and activity dimensions, researchers used these data to formulate a self-sentiment profile for each resident and programmed that profile into the VIPCare application. VIPCare used that profile to simulate affectively intelligent social interactions with each unique resident that reduce deflection from established sentiments and, thus, negative emotions. Results We report on the data collection to design the application, develop self-sentiment profiles for the resident, and generate assistive technology that applies a sociological theory of affect to real world management of interaction, emotion, and mental health. Discussion By reducing trial and error in learning to engage people with dementia, this tool has potential to smooth interaction and improve wellbeing for a population vulnerable to distress.
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Affiliation(s)
- Linda Francis
- Department of Criminology and Sociology, Cleveland State University, Cleveland, OH, United States
| | - Moojan Ghafurian
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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Camacho-Conde JA, Muñoz-Arbona DJ. A Survey of Basic Daily Living Assistance in Dependency Units during the Morning First Period at Nursing Homes with a Healthcare Dysfunction. NURSING REPORTS 2022; 12:125-139. [PMID: 35225899 PMCID: PMC8883999 DOI: 10.3390/nursrep12010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: It is important to evaluate the attention in the basic activities of daily life in the early hours of the day to evaluate the quality of care and to be able to increase the attention of human resources in case of observing an increase in dependency. The purpose was to improve healthcare quality in nursing homes, correctly identifying the work burden and incidents of daily planning, and completing the work plan by nursing assistant staffing. (2) Methods: The sample is based on 70 elderly people. The analysis used an observational trial every workday over a six-month period. An ad hoc sheet was prepared to collect socio-demographic data on each participant, and the Barthel Index was applied to the study subjects. A daily record of three basic activities of daily living (BADL), such as dressing, bathing, and eating, was kept. (3) Results: Our results showed a significant evolution in both units, but it was in the psychogeriatric unit in which higher compliance with the schedule and higher maintained stability was reached. (4) Conclusions: The use of some BADL registers helped us address situations of imbalance in terms of user assistance and establish an interdisciplinary communication with the nursing team as a way of achieving better organization and compliance with care protocols.
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Affiliation(s)
- José Antonio Camacho-Conde
- Department of Evolutionary and Educational Psychology, University of Granada, E-51005 Ceuta, Spain
- Correspondence:
| | - David Juan Muñoz-Arbona
- Teaching Technical Advisor for Inter-institutional Educational Programs, Provincial Office of the Ministry of Education in Ceuta, E-51005 Ceuta, Spain;
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Krein SL, Turnwald M, Anderson B, Maust DT. "Sometimes it's not about the money... it's the way you treat people...": A Qualitative Study of Nursing Home Staff Turnover. J Am Med Dir Assoc 2022; 23:1178-1184. [PMID: 34990586 DOI: 10.1016/j.jamda.2021.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better understand and compare resident family and nursing home staff experiences and perceptions of licensed and unlicensed direct care staff turnover. DESIGN Descriptive qualitative design. SETTING AND PARTICIPANTS Nursing home resident family members and direct care registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), and administrative staff. METHODS We conducted semistructured interviews with family members and nursing home staff between September 2019 and July 2020. Using a rapid analysis approach, we compared family member, direct care RNs, LPNs, CNAs, and administrative staff experiences and perceptions related to staff turnover, ways to reduce turnover, and strategies for minimizing disruptions. RESULTS We completed interviews with 17 family members, 25 direct care RNs, LPNs, and CNAs, and 6 administrative staff from 13 nursing homes primarily located in southeastern Michigan. Family members had mixed experiences with turnover, but commonly described the need for consistent, personalized care to ensure safe, high-quality resident care. Direct care RNs, LPNs, and CNAs expressed a similar viewpoint and frustration with not being able to provide the care they would like because of turnover or short staffing. Although better wages were mentioned, all groups also identified the importance of staff feeling appreciated and supported as critical for decreasing turnover. Adequate training and strategies to acclimate new staff to resident preferences were also noted as approaches for minimizing care disruptions during turnover. CONCLUSIONS AND IMPLICATIONS Our findings largely confirm those of others regarding potential contributing factors and consequences of staff turnover. However, our findings also provide a clear message about important areas on which to focus. This includes identifying ways to effectively provide consistent, person-centered care for residents in the context of staffing inconsistencies and the need for a more people-oriented work environment for nursing home staff to reduce turnover and minimize disruptions in resident care.
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Affiliation(s)
- Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Molly Turnwald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Barry Anderson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Donovan T Maust
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Iduye S, Risling T, McKibbon S, Iduye D. Optimizing the InterRAI Assessment Tool in Care Planning Processes for Long-Term Residents: A Scoping Review. Clin Nurs Res 2021; 31:5-19. [PMID: 34056955 PMCID: PMC8652361 DOI: 10.1177/10547738211020373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this review was to chart and report on existing literature that discusses how the interRAI assessment tool drives care-planning processes for residents in long-term-care settings. This scoping review was informed by the Joanna Briggs Institute guidelines for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. Relevant studies were obtained from databases search of CINAHL (EBSCO), MEDLINE (Ovid), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Embase (Elsevier), ProQuest Nursing and Allied Health Database (ProQuest), Sociological Abstracts (ProQuest), and Social Services Abstracts (ProQuest). Of the 17 included studies, five (29.4%) addressed interRAI’s minimum dataset component as a clinical data-collection tool; five (29.4%) addressed interRAI’s assessment scales and its clinical-assessment protocols as viable health-assessment tools; four (23.5%) considered interRAI’s assessment scales in terms of whether this tool is capable of predicting residents’ health risks; one (5.9%) addressed the effects of interRAI’s care plans on residents’ health outcomes; and the remaining two studies (11.8%) used interRAI’s quality-indicator function for both the performance of and improvements in the quality of care. The scoping review finds that there is no substantial evidence that supports the implementation of interRAI care plans for consistent health outcomes.
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Affiliation(s)
- Steve Iduye
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tracie Risling
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Snow AL, Loup J, Morgan RO, Richards K, Parmelee PA, Baier RR, McCreedy E, Frank B, Brady C, Fry L, McCullough M, Hartmann CW. Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program. BMC Geriatr 2021; 21:281. [PMID: 33906631 PMCID: PMC8076882 DOI: 10.1186/s12877-021-02189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. Discussion This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. Trial registration NCT04533815, ClinicalTrials.gov, August 20, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02189-8.
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Affiliation(s)
- A Lynn Snow
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA. .,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA.
| | - Julia Loup
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA.,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, USA
| | - Kathy Richards
- School of Nursing, The University of Texas at Austin, Austin, TX, 78701-1412, USA
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA
| | - Rosa R Baier
- Brown University School of Public Health, Providence, RI, 02912, USA
| | - Ellen McCreedy
- Brown University School of Public Health, Providence, RI, 02912, USA
| | | | | | - Liam Fry
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Megan McCullough
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Christine W Hartmann
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
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Baughman RA, Stanley B, Smith KE. Second Job Holding Among Direct Care Workers and Nurses: Implications for COVID-19 Transmission in Long-Term Care. Med Care Res Rev 2020; 79:151-160. [PMID: 33213282 DOI: 10.1177/1077558720974129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One reason that nursing homes are a primary source of COVID-19 infections and deaths in the United States may be that workers hold multiple jobs. We use 2010-2019 Current Population Survey data to document the rate of second jobholding among nursing and long-term care workers. On average, 6.41% of personal care and nursing aides and 6.23% of licensed practical nurses and registered nurses hold second jobs; second job holding rates are 35% and 32% higher than those of other workers, respectively. Both wages and hours in the primary job are negatively associated with the probability of holding a second job for personal care and nursing aides, while lower hours are more strongly correlated with a second job for registered nurses and licensed practical nurses. Many of these workers move across health settings from their first to second jobs, and 15% of second jobs for personal care and nursing aides are in other "essential" occupations.
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"There is no one to pick up the pieces": Sustainability of antibiotic stewardship programs in nursing homes. Infect Control Hosp Epidemiol 2020; 42:440-447. [PMID: 33100251 DOI: 10.1017/ice.2020.1217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe nursing home staff experiences and perceptions of the factors that impact the sustainability of an antibiotic stewardship program (ASP). METHODS Using a qualitative descriptive design, semistructured interviews with staff at 9 not-for-profit nursing homes with an established ASP were conducted and audio recorded. De-identified transcriptions of the interviews were coded using a sustainability framework and were analyzed to identify themes. RESULTS Interviews were conducted with 48 clinical and administrative staff to elicit their perceptions of the ASPs, and 7 themes were identified. ASPs were perceived to be resource intensive and "data driven," requiring access to and interpretation of data that are not readily available at many nursing homes. Though motivated and committed, ASP champions felt that they could not single-handedly sustain the program. Attending to daily clinical needs (ie, "fires") made it hard to progress beyond implementation and to reach step 2 of sustainability. Longstanding treatment habits by external prescribers and regulations were believed to impede ASP efforts. Partnerships with an external consultant with antibiotic stewardship expertise were considered important, as was the need for internal leadership support and collaboration across disciplinary boundaries. Participants felt that consistent and ongoing education on antibiotic stewardship at all staff levels was important. CONCLUSIONS Although many interconnected factors impact the sustainability of an ASP, nursing homes may be able to sustain an ASP by focusing on 3 critical areas: (1) explicit support by nursing home leadership, (2) external partnerships with professionals with antibiotic stewardship expertise and internal interprofessional collaborations, and (3) consistent education and training for all staff.
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Mangrum R, Stewart MD, Gifford DR, Harris Y, Ogletree AM, Bergofsky L, Perfetto D. Omissions of Care in Nursing Homes: A Uniform Definition for Research and Quality Improvement. J Am Med Dir Assoc 2020; 21:1587-1591.e2. [PMID: 32994119 DOI: 10.1016/j.jamda.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022]
Abstract
Omission of care in US nursing homes can lead to increased risk for harm or adverse outcomes, decreased quality of life for residents, and increased healthcare expenditures. However, scholars and policymakers in long-term care have taken varying approaches to defining omissions of care, which makes efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders participated in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition that is clear, meaningful, and actionable for nursing homes. The resulting definition is "Omissions of care in nursing homes encompass situations when care-either clinical or nonclinical-is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident." This concise definition is grounded in goal-concordant, resident-centered care, and can be used for a variety quality improvement purposes and for research.
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Affiliation(s)
- Rikki Mangrum
- American Institutes for Research, Washington, DC, USA.
| | | | - David R Gifford
- American Health Care Association, Washington, DC, USA; Brown University, Providence, RI, USA
| | - Yael Harris
- American Institutes for Research, Washington, DC, USA
| | | | - Linda Bergofsky
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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9
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The burden of gastroenteritis outbreaks in long-term care settings in Philadelphia, 2009-2018. Infect Control Hosp Epidemiol 2020; 41:1310-1314. [PMID: 32799937 DOI: 10.1017/ice.2020.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Gastroenteritis causes significant morbidity and mortality in long-term care facility (LTCF) residents, a growing population within the United States. We set out to better understand gastroenteritis outbreaks in LTCF by identifying outbreak and facility characteristics associated with outbreak incidence as well as outbreak duration and size. DESIGN We conducted a retrospective cross-sectional study on LTCFs in Philadelphia County from 2009 to 2018. Outbreak characteristics and interventions were extracted from Philadelphia Department of Public Health (PDPH) database and quality data on all LTCFs was extracted from Centers for Medicare and Medicaid Services Nursing Home Compare database. RESULTS We identified 121 gastroenteritis outbreaks in 49 facilities. Numbers of affected patients ranged from 2 to 211 patients (median patient illness rate, 17%). Staff were reported ill in 94 outbreaks (median staff illness rate, 5%). Outbreak facilities were associated with higher occupancy rates (91% vs 88%; P = .033) and total bed numbers (176 vs 122; P = .071) compared to nonoutbreak facilities. Higher rates of staff illness were associated with prolonged outbreaks (13% vs 4%; P < .001) and higher patient illness rates (9% vs 4%; P = .012). Prolonged outbreaks were associated with lower frequency of cohorting for outbreak management (13% vs 41%; P = .046). CONCLUSION This study is the largest published analysis of gastroenteritis outbreaks in LTCFs. Facility characteristics and staff disease activity were associated with more severe outbreaks. Heightened surveillance for gastrointestinal symptoms among staff and increased use of cohorting might reduce the risk of prolonged gastroenteritis outbreaks in LTCF.
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Mommaerts C, Truskinovsky Y. The cyclicality of informal care. JOURNAL OF HEALTH ECONOMICS 2020; 71:102306. [PMID: 32171128 PMCID: PMC7231658 DOI: 10.1016/j.jhealeco.2020.102306] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/21/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
This paper measures the cyclicality of an important input into elderly health: informal care. Using independent survey measures of informal caregiving and care receipt over the past two decades, we find that informal care from adult children to their elderly parents is countercyclical. By contrast, informal care from spouses is procyclical among individuals in their sixties. We find little corresponding change in the use of formal care, highlighting the potential for unmet care needs across the business cycle. These findings suggest that informal health inputs may play an important role in the interpretation of the cyclicality of elderly mortality.
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Strøm BS, Engedal K, Rokstad AM. Engagement in Everyday Activities among People Living in Indian Nursing Homes: The Association with Person-Centredness. Dement Geriatr Cogn Dis Extra 2020; 10:13-26. [PMID: 32158463 PMCID: PMC7011750 DOI: 10.1159/000505396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction It has been reported that residents living in nursing homes are often inactive and lonely and are offered a limited number of activities. However, high engagement in activities has been reported to improve residents' quality of life and engagement in personalized activities can even reduce agitation and enhance positive mood. Information regarding occupational patterns and purpose in life is well established in Western countries. However, we know next to nothing about how people living in Indian nursing homes spend their days. Objective To explore the participation in everyday activities among older people in Indian nursing homes and the extent to which engagement in activities is associated with person-centred care. Methods The study was conducted in 6 nursing homes in India, comprising 147 residents. In all, 23 nursing staff took part and completed a 26-item questionnaire about resident activities based on the Multi-Dimensional Dementia Assessment Scale and the Person-Directed Care Questionnaire. Person-centredness was measured with the Person-Centred Care Assessment Tool. Results We found low participation in everyday activities among the residents. Participation in religious activities was the most frequent, whereas the least used activities were excursions, participating in cultural activities, taking part in educational programmes, visiting a restaurant and going to the cinema. A significant positive association was found between person-centred care and participation in religious activities, engagement in an activity programme and physical activity. Conclusions The most frequently attended activity was religious activities. Person-centred care was associated with participation in religious activities, engagement in an activity programme, physical activity, spending time in the garden and playing and listening to music.
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Affiliation(s)
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Department of Geriatrics, Oslo University Hospital, Tønsberg, Norway
| | - Anne Marie Rokstad
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Faculty of Health Science and Social Care, Molde University College, Molde, Norway
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Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
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Plaku-Alakbarova B, Punnett L, Gore RJ. Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes. Saf Health Work 2018; 9:408-415. [PMID: 30559988 PMCID: PMC6284169 DOI: 10.1016/j.shaw.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2017] [Accepted: 12/09/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. METHODS Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. RESULTS A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. CONCLUSION Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.
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Affiliation(s)
- Bora Plaku-Alakbarova
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPHNEW), University of Massachusetts Lowell, Lowell, MA, USA
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Mills WL, Pimentel CB, Palmer JA, Snow AL, Wewiorski NJ, Allen RS, Hartmann CW. Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model. THE GERONTOLOGIST 2018; 58:598-605. [PMID: 28651351 PMCID: PMC6281338 DOI: 10.1093/geront/gnx023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
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Affiliation(s)
- Whitney L Mills
- Center for Innovation in Quality, Effectiveness and Safety, Michael E.
DeBakey VA Medical Center, Houston, Texas
- Department of Medicine, Section of Health Services Research, Baylor College
of Medicine, Houston, Texas
| | - Camilla B Pimentel
- Department of Quantitative Health Sciences, University of Massachusetts
Medical School, Worcester
| | - Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
| | - A Lynn Snow
- Alabama Research Institute on Aging, University of Alabama, Tuscaloosa
- Department of Psychology, University of Alabama, Tuscaloosa
- Tuscaloosa Veterans Affairs Medical Center, Alabama
| | - Nancy J Wewiorski
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
| | - Rebecca S Allen
- Alabama Research Institute on Aging, University of Alabama, Tuscaloosa
- Department of Psychology, University of Alabama, Tuscaloosa
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
- Department of Health Law, Policy and Management, School of Public Health,
Boston University, Massachusetts
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Trinkoff AM, Storr CL, Lerner NB, Yang BK, Han K. CNA Training Requirements and Resident Care Outcomes in Nursing Homes. THE GERONTOLOGIST 2018; 57:501-508. [PMID: 27059825 DOI: 10.1093/geront/gnw049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/03/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes. Design and Methods Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status. Results A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes. Implications Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care.
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Affiliation(s)
- Alison M Trinkoff
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Carla L Storr
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Nancy B Lerner
- Department of Organizational Systems & Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Bo Kyum Yang
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Kihye Han
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Simmons SF, Coelho CS, Sandler A, Schnelle JF. A Quality Improvement System to Manage Feeding Assistance Care in Assisted-Living. J Am Med Dir Assoc 2018; 19:262-269. [DOI: 10.1016/j.jamda.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
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Kim Y, Han K. Longitudinal associations of nursing staff turnover with patient outcomes in long-term care hospitals in Korea. J Nurs Manag 2018; 26:518-524. [DOI: 10.1111/jonm.12576] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Yoonseo Kim
- Chung-Ang University Graduate School Department of Nursing; Seoul Korea
| | - Kihye Han
- Chung-Ang University Red Cross College of Nursing; Seoul Korea
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Backhaus R, Beerens HC, van Rossum E, Verbeek H, Hamers JPH. Editorial: Rethinking the Staff-Quality Relationship in Nursing Homes. J Nutr Health Aging 2018; 22:634-638. [PMID: 29806851 DOI: 10.1007/s12603-018-1027-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Backhaus
- Ramona Backhaus, Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD Maastricht, The Netherlands, Telephone: 0031-43 3882286,
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Norman RM, Sjetne IS. Measuring nurses' perception of work environment: a scoping review of questionnaires. BMC Nurs 2017; 16:66. [PMID: 29200962 PMCID: PMC5697362 DOI: 10.1186/s12912-017-0256-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background Nurses’ work environment has been shown to be associated with quality of care and organizational outcomes. In order to monitor the work environment, it is useful for all stakeholders to know the questionnaires that assess or evaluate conditions for delivering nursing care. The aim of this article is: to review the literature for assessed survey questionnaires that measure nurses’ perception of their work environment, make a brief assessment, and map the content domains included in a selection of questionnaires. Methods The search included electronic databases of internationally published literature, international websites, and hand searches of reference lists. Eligible papers describing a questionnaire had to be; a) suitable for nurses working in direct care in general hospitals, nursing homes or home healthcare settings; and b) constructed to measure work environment characteristics that are amenable to change and related to patient and organizational outcomes; and c) presented along with an assessment of their measurement properties. Results The search yielded 5077 unique articles. For the final synthesis, 65 articles met inclusion criteria, consisting of 34 questionnaires measuring nursing work environments in different settings. Most of the questionnaires that we found were developed, and tested, for registered nurses in a general hospital setting. Six questionnaires were developed specifically for use in nursing home settings and one for home healthcare. The content domains covered by the questionnaires were both overlapping and unique and the terminology in use was inconsistent. The most common content domains in the work environment questionnaires were supportive managers, collaborative relationships with peers, busyness, professional practice and autonomy. Conclusions The findings from this review enhance the understanding of how “work environment” can be measured by an overview of existing questionnaires and domains. Our results indicate that there are very many work environment questionnaires with varying content. Electronic supplementary material The online version of this article (10.1186/s12912-017-0256-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health (FHI), PO Box 4404 Nydalen, N-0403 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Health and Society, Department of Health Management and Health Economics, PO Box 1130 Blindern, N-0318 Oslo, Norway
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Boakye-Dankwa E, Teeple E, Gore R, Punnett L. Associations Among Health Care Workplace Safety, Resident Satisfaction, and Quality of Care in Long-Term Care Facilities. J Occup Environ Med 2017; 59:1127-1134. [PMID: 28945639 PMCID: PMC6525336 DOI: 10.1097/jom.0000000000001163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. METHODS Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. RESULTS Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. CONCLUSION The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.
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Affiliation(s)
- Ernest Boakye-Dankwa
- College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Drs Boakye-Dankwa, Teeple, Gore, Punnett); and Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia (Dr Boakye-Dankwa)
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Abstract
High levels of staff turnover of certified nursing assistants (CNAs) are costly and disruptive to patient care. A variety of factors contribute to a 36% turnover rate of CNAs nationwide (2015 Staffing Report, 2015). According to Stone and Wiener, high rates of turnover and staff vacancies have multilayered consequences; patient care suffers, cost of constantly replacing workers soars, and worker job dissatisfaction increases. This study examined the CNAs' beliefs about job satisfaction as an approach to prevent job turnover and retain high achieving staff in one acute care hospital in a south eastern region. The goal was to determine how CNAs define job satisfaction, evaluate their understanding of and gauge interest in the career options presented at information sessions as well as listen to their ideas on how they believe are the best approaches to achieve job satisfaction for the CNAs at this facility. A qualitative key informant design was used to interview a purposive sample of 9 nursing assistants who were currently employed at the hospital for at least 6 months and who attended a brief information session. Individual 20-minute face-to-face interviews of consented participants were recorded, transcribed, and coded for themes using constant comparative analysis. Four major categories emerged from the interviews: CNA views of job satisfaction, clinical ladder option, support services option, and what CNAs want.
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Trinkoff AM, Yang BK, Storr CL, Zhu S, Lerner NB, Han K. Determining the CNA Training-Hour Requirement for Quality Care in U.S. Nursing Homes. JOURNAL OF NURSING REGULATION 2017. [DOI: 10.1016/s2155-8256(17)30069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Initial Evidence for the Reliability and Validity of the Educational Needs Assessment Questionnaire. J Nurs Meas 2016; 24:442-453. [PMID: 28714449 DOI: 10.1891/1061-3749.24.3.442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the reliability and validity of the revised Educational Needs Assessment (ENA) questionnaire, a 32-item questionnaire designed to assess educational needs of nurses. METHODS Data were obtained from 317 nursing home nurses in central Illinois and underwent testing for psychometric properties. RESULTS The principal component analysis yielded a 6-factor solution that explained 65.9% of the variance and Cronbach's alpha for each factor was satisfactory. CONCLUSIONS The revised ENA can be a useful tool to measure and identify in what areas of educational needs nursing home nurses need to develop their skills to help patients more effectively.
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Gucwa AL, Dolar V, Ye C, Epstein S. Correlations between quality ratings of skilled nursing facilities and multidrug-resistant urinary tract infections. Am J Infect Control 2016; 44:1256-1260. [PMID: 27810066 DOI: 10.1016/j.ajic.2016.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine risk factors for the acquisition of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) in residents of skilled nursing facilities (SNFs). METHODS Using the informational database provided by the Centers for Medicare and Medicaid Services (CMS), a retrospective logistic regression was performed on 1,523 urine cultures from 12 SNFs located in Long Island, New York. RESULTS Of the 1,142 positive urine cultures, Escherichia coli was most prevalent. Additionally, 164 (14.4%) of the UTIs were attributed to an MDRO. In multivariate logistic regression, sex and overall quality rating predicted the occurrence of UTIs, whereas identification of MDROs was dependent on the level of nursing care received. The mean predicted probability of UTIs and receipt of contaminated samples was inversely dependent on the facility's rating, where the likelihood increased as overall quality ratings decreased. CONCLUSIONS The CMS's quality rating system may provide some insight into the status of infection control practices in SNFs. The results of this study suggest that potential consumers should focus on the overall star ratings and the competency of the nursing staff in these facilities rather than on individual quality measures.
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Chamberlain SA, Hoben M, Squires JE, Estabrooks CA. Individual and organizational predictors of health care aide job satisfaction in long term care. BMC Health Serv Res 2016; 16:577. [PMID: 27737672 PMCID: PMC5064796 DOI: 10.1186/s12913-016-1815-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/04/2016] [Indexed: 11/27/2022] Open
Abstract
Background Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. Methods We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. Results Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack—staff, organizational slack—space, and organizational slack—time. Conclusions Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.
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Affiliation(s)
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Janet E Squires
- University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, Centre for Practice-Changing Research (CPCR), 501 Smyth Road, Room 1282, Box 711, Ottawa, ON, K1H 8L6, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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Lee K, Cho E. Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care. Jpn J Nurs Sci 2016; 14:103-111. [PMID: 27390250 DOI: 10.1111/jjns.12139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 04/14/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
AIM To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long-term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care. METHODS This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants ( n = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t-test and the changes in LTCS benefit levels were compared by using the χ2 -test. RESULTS The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups CONCLUSION: All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.
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Affiliation(s)
- Kyongeun Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Eunhee Cho
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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Economic evaluation of registered nurse tenure on nursing home resident outcomes. Appl Nurs Res 2016; 29:89-95. [PMID: 26856495 DOI: 10.1016/j.apnr.2015.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/20/2015] [Accepted: 05/09/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Little is known about the economic implications of nursing home (NH) registered nurse (RN) tenure on resident outcomes. This study evaluated the cost-effectiveness of two nurse workforce scenarios focusing on RN tenure (high versus low), and the associated transfers from NH to the hospital. METHODS A decision tree was constructed to compare the incremental costs and effects of RN tenure scenarios on NH resident transfers to the hospital under two NH staffing scenarios: high versus low levels of RN tenure. Three outcomes were modeled: 1) dollars per hospitalization avoided, 2) dollars per hospitalization and death avoided, and 3) dollars per death avoided. RESULTS The total costs of care for the low tenure scenario were $34,108 per month compared to the high tenure scenario at $29,442 per month. Effectiveness of the high tenure was greater across all 3 outcomes (incremental effectiveness ranged from 0.925 to 0.974 depending on outcome), indicating that high tenure was the dominant strategy (that is less costly and more effective). CONCLUSIONS Higher RN tenure was a dominant strategy across the 3 outcomes. This was a fairly robust finding despite the variations in the model and uncertainty in the input parameters. Aligning quality outcomes with cost effectiveness is imperative to driving the direction of health policy in the United States. Better prevention of hospitalizations by having an experienced RN workforce will not only improve resident quality of care but will allow NHs to realize the value of retaining a skilled workforce.
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Miller EL, Alexander GL, Madsen RW. Effects of Staffing and Regional Location on Influenza and Pneumococcal Vaccination Rates in Nursing Home Residents. J Gerontol Nurs 2016; 42:38-44. [DOI: 10.3928/00989134-20151124-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022]
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A Critical Review of Research on Hospitalization from Nursing Homes; What is Missing? AGEING INTERNATIONAL 2015. [DOI: 10.1007/s12126-015-9232-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ellis ML, Molinari V, Dobbs D, Smith K, Hyer K. Assessing approaches and barriers to reduce antipsychotic drug use in Florida nursing homes. Aging Ment Health 2015; 19:507-16. [PMID: 25166458 DOI: 10.1080/13607863.2014.952710] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Antipsychotic medications have been federally regulated since 1987, yet research suggests they continue to be used inappropriately to alleviate behavioral symptoms associated with dementia. In 2012, the Centers of Medicare and Medicaid launched a new initiative to reduce antipsychotic medication in nursing homes by 15% nationally. The aim of this study was to examine qualitative data to explore strategies that have been implemented, to assess which strategies are evidence-based, and to make recommendations to improve upon practices to reduce antipsychotic medication use. METHOD A convenience sample of 276 nursing home professional staff members were surveyed about these topics using open-ended questions. RESULTS Theme-based content analysis yielded three main themes. The themes related to changes in practice included the following: (1) increased review of resident behavior and antipsychotic medication regimens; (2) reduction in antipsychotic medications or dosage; and (3) increased use of nonpharmacological interventions. The main themes relevant to needed assistance included the following: (1) education; (2) clinical support; and (3) increased financial resources and reimbursement. DISCUSSION Overall findings indicate that the majority of facilities are actively responding to the initiative, but challenges remain in education, finding mental health support, and in reimbursement.
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Affiliation(s)
- Michelle L Ellis
- School of Aging Studies, University of South Florida, Tampa, Florida; Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida
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Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts. Med Care 2015; 53:713-9. [PMID: 26125418 DOI: 10.1097/mlr.0000000000000390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study, we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. OBJECTIVES To answer 2 questions: (1) Were the nursing homes choosing not to participate low-quality performers relative to those who chose to participate? (2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? RESEARCH DESIGN Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes' participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes' decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. SUBJECTS A total of 424 Massachusetts nursing homes. RESULTS Sixty-seven percent of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending toward significance at the 0.10 level for all but 2). Once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures (trending toward significance at the 0.10 level in 5). CONCLUSIONS Report cards are more effective if nursing homes' participation is mandated. Nonmandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements.
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Mattingly TJ. A Review Exploring the Relationship Between Nursing Home Staffing and Antipsychotic Medication Use. Neurol Ther 2015; 4:169-75. [PMID: 26662363 PMCID: PMC4685870 DOI: 10.1007/s40120-015-0032-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Indexed: 12/02/2022] Open
Abstract
Staffing level requirements for nursing homes exist at state and federal levels in the United States. While quality of care measures may include antipsychotic (AP) prescribing, the appropriate use of APs as chemical restraints in nursing homes continues to be debated. Although the two variables appear to be related, improved research methods and availability of accurate staffing data will be needed to understand causal relationships regarding AP use for facility dwelling patients.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
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Chen MM, Grabowski DC. Intended and unintended consequences of minimum staffing standards for nursing homes. HEALTH ECONOMICS 2015; 24:822-839. [PMID: 24850410 DOI: 10.1002/hec.3063] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 04/01/2014] [Accepted: 04/14/2014] [Indexed: 06/03/2023]
Abstract
Staffing is the dominant input in the production of nursing home services. Because of concerns about understaffing in many US nursing homes, a number of states have adopted minimum staffing standards. Focusing on policy changes in California and Ohio, this paper examined the effects of minimum nursing hours per resident day regulations on nursing home staffing levels and care quality. Panel data analyses of facility-level nursing inputs and quality revealed that minimum staffing standards increased total nursing hours per resident day by 5% on average. However, because the minimum staffing standards treated all direct care staff uniformly and ignored indirect care staff, the regulation had the unintended consequences of both lowering the direct care nursing skill mix (i.e., fewer professional nurses relative to nurse aides) and reducing the absolute level of indirect care staff. Overall, the staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care.
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Affiliation(s)
- Min M Chen
- College of Business, Florida International University, Miami, FL, USA
| | - David C Grabowski
- Harvard Medical School, Department of Health Care Policy, Boston, MA, USA
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Nilsson A, Engström M. E-assessment and an e-training program among elderly care staff lacking formal competence: results of a mixed-methods intervention study. BMC Health Serv Res 2015; 15:189. [PMID: 25943436 PMCID: PMC4438631 DOI: 10.1186/s12913-015-0843-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 04/24/2015] [Indexed: 11/16/2022] Open
Abstract
Background Among staff working in elderly care, a considerable proportion lack formal competence for their work. Lack of formal competence, in turn, has been linked to higher staff ratings of stress symptoms, sleep disturbances and workload. Objectives: 1) To describe the strengths and weaknesses of an e-assessment and subsequent e-training program used among elderly care staff who lack formal competence and 2) to study the effects of an e-training program on staff members’ working life (quality of care and psychological and structural empowerment) and well-being (job satisfaction and psychosomatic health). The hypothesis was that staff who had completed the e-assessment and the e-training program would rate greater improvements in working life and well-being than would staff who had only participated in the e-assessments. Methods An intervention study with a mixed-methods approach using quantitative (2010–2011) and qualitative data (2011) was conducted in Swedish elderly care. Participants included a total of 41 staff members. To describe the strengths and weaknesses of the e-assessment and the e-training program, qualitative data were gathered using semi-structured interviews together with a study-specific questionnaire. To study the effects of the intervention, quantitative data were collected using questionnaires on: job satisfaction, psychosomatic health, psychological empowerment, structural empowerment and quality of care in an intervention and a comparison group. Results Staff who completed the e-assessments and the e-training program primarily experienced strengths associated with this approach. The results were also in line with our hypotheses: Staff who completed the e-assessment and the e-training program rated improvements in their working life and well-being. Conclusion Use of the e-assessments and e-training program employed in the present study could be one way to support elderly care staff who lack formal education by increasing their competence; increased competence, in turn, could improve their self-confidence, working life, and well-being.
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Affiliation(s)
- Annika Nilsson
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden. .,Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden. .,Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
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Seco J, Rodríguez-Pérez V, López-Rodríguez AF, Torres-Unda J, Echevarria E, Díez-Alegre MI, Ortega A, Morán P, Mendoza-Laíz N, Abecia Inchaurregui LC. Effects of Vibration Therapy on Hormone Response and Stress in Severely Disabled Patients: A Double-Blind Randomized Placebo-Controlled Clinical Trial. Rehabil Nurs 2015; 40:166-78. [DOI: 10.1002/rnj.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/09/2022]
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Rosvik J, Engedal K, Kirkevold O. Factors to make the VIPS practice model more effective in the treatment of neuropsychiatric symptoms in nursing home residents with dementia. Dement Geriatr Cogn Disord 2015; 37:335-46. [PMID: 24503517 DOI: 10.1159/000357773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS A recent cluster-randomized controlled study showed that the VIPS practice model (VPM) for person-centred care had a significant effect on neuropsychiatric symptoms in nursing home residents with dementia. The randomized controlled trial (RCT) indicated that a substantial proportion of the total variance of the effects was related to conditions in the particular unit (ward). We have explored which factors explain the variance of the effect of the VPM. METHODS The VPM subset of data from the RCT was explored using multilevel linear regression. The dependent variables were the change in scores on the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Cornell Scale for Depression in Dementia (CSDD). RESULTS The unit in which the resident was living explained 22% of the VPM's total variance of the effect on the NPI-Q and 13% of that on the CSDD. The intraclass correlation coefficient at the unit level was explained mainly by unit size on both scales and was considerably higher than at the institutional level. CONCLUSION The unit is the most influential level when implementing person-centred dementia care by use of the VPM. The unit size explains most of the variance of the effect of the VPM, and the effects were best in the small units.
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Affiliation(s)
- Janne Rosvik
- Ageing and Health, Norwegian Centre for Research, Education and Service Development, Vestfold Hospital Trust, Tønsberg, Norway
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Zimmerman S, Shier V, Saliba D. Transforming nursing home culture: evidence for practice and policy. THE GERONTOLOGIST 2014; 54 Suppl 1:S1-5. [PMID: 24443601 DOI: 10.1093/geront/gnt161] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care. This article briefly reviews the history of culture change, discusses some of the challenges related to culture change in nursing homes, and overviews the conceptualization and select models of culture change. Building from this background, it critiques current understanding, identifies critical research questions, and notes key issues arising during a workshop that addressed existing and emerging evidence in the field. This review and analysis provide a context for how 9 accompanying papers in this supplemental issue of The Gerontologist fill identified evidence gaps and provide evidence for future practice and policies that aim to transform nursing home culture.
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Affiliation(s)
- Sheryl Zimmerman
- *Address correspondence to Sheryl Zimmerman, Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590. E-mail:
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Trinkoff AM, Lerner NB, Storr CL, Han K, Johantgen ME, Gartrell K. Leadership education, certification and resident outcomes in US nursing homes: cross-sectional secondary data analysis. Int J Nurs Stud 2014; 52:334-44. [PMID: 25458802 DOI: 10.1016/j.ijnurstu.2014.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 09/16/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. OBJECTIVES To examine associations of education and certification among NHAs and DONs with resident outcomes. DESIGN Cross-sectional secondary data analysis. SETTINGS This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). PARTICIPANTS 1142 nursing homes in the survey which represented 16628 nursing homes in the US. METHODS Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. RESULTS Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. CONCLUSIONS Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.
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Affiliation(s)
| | - Nancy B Lerner
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Carla L Storr
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Kihye Han
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Kim Y, Lee JY, Kang H. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals]. J Korean Acad Nurs 2014; 44:21-30. [PMID: 24637283 DOI: 10.4040/jkan.2014.44.1.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. METHODS A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. RESULTS Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. CONCLUSION To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Eulji University, Sungnam, Korea
| | - Ji Yun Lee
- Department of Nursing, Kangwon National University, Chuncheon, Korea.
| | - Hyuncheol Kang
- Department of Informational Statistics, Hoseo University, Asan, Korea
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Lin H. Revisiting the relationship between nurse staffing and quality of care in nursing homes: an instrumental variables approach. JOURNAL OF HEALTH ECONOMICS 2014; 37:13-24. [PMID: 24887707 DOI: 10.1016/j.jhealeco.2014.04.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/10/2014] [Accepted: 04/18/2014] [Indexed: 06/03/2023]
Abstract
This paper revisits the relationship between nurse staffing and quality of care in nursing homes using an instrumental variables approach. Most prior studies rely on cross-sectional evidence, which renders causal inference problematic and policy recommendations inappropriate. We exploit legislation changes regarding minimum staffing requirements in eight states between 2000 and 2001 as exogenous shocks to nurse staffing levels. We find that registered nurse staffing has a large and significant impact on quality of care, and that there is no evidence of a significant association between nurse aide staffing and quality of care. A comparison of the IV estimation to the OLS estimation of the first-difference model suggests that ignoring endogeneity would lead to an underestimation of how nurse staffing affects quality of care in nursing homes.
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Affiliation(s)
- Haizhen Lin
- Department of Business Economics and Public Policy, Kelley School of Business, Indiana University, 1309 East Tenth Street, Bloomington, IN 47405, USA.
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Mukamel DB, Haeder SF, Weimer DL. Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards. Annu Rev Public Health 2014; 35:477-97. [DOI: 10.1146/annurev-publhealth-082313-115826] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Dana B. Mukamel
- School of Medicine and Health Policy Research Institute (HPRI), University of California, Irvine, California 92697-5800;
| | | | - David L. Weimer
- Department of Political Science,
- The La Follette School of Public Affairs, University of Wisconsin, Madison, Wisconsin 53706; ,
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Gao F, Newcombe P, Tilse C, Wilson J, Tuckett A. Models for predicting turnover of residential aged care nurses: a structural equation modelling analysis of secondary data. Int J Nurs Stud 2014; 51:1258-70. [PMID: 24529835 DOI: 10.1016/j.ijnurstu.2014.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/04/2013] [Accepted: 01/18/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nurse turnover in the residential aged care industry is a pressing issue. Researchers have shown ongoing interest in exploring how the factors that are amendable to change in aged care policy, regulation and funding and in organizational procedures (e.g. job demands, coping resources and psychological health of nurses) impact on turnover. However, the findings are mixed. OBJECTIVE This study tested two theoretical models of turnover to examine the structural relationships among job demands, coping resources, psychological health and turnover of residential aged care nurses. Although many previous studies operationalized turnover as intention to leave, the present study investigated actual turnover by following up with the same individuals over time, and thus provided more accurate predictive models of turnover behaviour. DESIGN AND METHODS The sample, 239 Australian residential aged care nurses, came from the Nurses and Midwives e-cohort Study. Job demands, coping resources, and psychological health were measured using standardized instruments. Structural equation modelling was used to test the measurement and structural models. RESULTS Controlling for a number of workforce and individual characteristics, coping resources (measured by job control, supervisor support, and co-worker support) were negatively and directly associated with turnover. Additionally, the findings supported the Job Demand-Control-Support model in that higher coping resources and lower job demands (indicated by psychological demands, physical demands, and effort) were related to better psychological health (measured by vitality, social functioning, role emotional, and mental health), and higher job demands were related to lower coping resources. CONCLUSIONS Findings suggest that aged care policy makers and service providers might consider increasing coping resources available to nurses and minimizing job demands of care work to reduce turnover and improve nurses' psychological health. Moreover, findings from this Australian study may provide valuable practical and policy implications for other developed countries.
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Affiliation(s)
- Fengsong Gao
- School of Social Work and Human Services, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Peter Newcombe
- School of Social Work and Human Services, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Cheryl Tilse
- School of Social Work and Human Services, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Jill Wilson
- School of Social Work and Human Services, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Anthony Tuckett
- School of Nursing and Midwifery, The University of Queensland, Herston Campus, Herston Road, Herston, QLD 4006, Australia; The University of Queensland/Blue Care Research and Practice Development Centre, P.O. Box 1539, Milton BC, QLD 4064, Australia.
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Trinkoff AM, Storr CL, Johantgen M, Lerner N, Han K, McElroy K. State Regulatory Oversight of Certified Nursing Assistants and Resident Outcomes. JOURNAL OF NURSING REGULATION 2013. [DOI: 10.1016/s2155-8256(15)30187-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Choi J, Flynn L, Aiken LH. Nursing practice environment and registered nurses' job satisfaction in nursing homes. THE GERONTOLOGIST 2012; 52:484-92. [PMID: 21908803 PMCID: PMC3409799 DOI: 10.1093/geront/gnr101] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 08/03/2011] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs in nursing homes. DESIGN AND METHODS The sample included 863 RNs working as staff RNs in 282 skilled nursing facilities in New Jersey. Two-level hierarchical linear modeling was used to account for the RNs nested by nursing homes. RESULTS Controlling for individual and nursing home characteristics, staff RNs' participation in facility affairs, supportive manager, and resource adequacy were positively associated with RNs' job satisfaction. Ownership status was significantly related to job satisfaction; RNs working in for-profit nursing homes were less satisfied. IMPLICATIONS A supportive practice environment is significantly associated with higher job satisfaction among RNs working in nursing homes. Unlike other nursing home characteristics, specific dimensions of the nursing practice environment can be modified through administrative actions to enhance RN job satisfaction.
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Affiliation(s)
- JiSun Choi
- National Database of Nursing Quality Indicators, School of Nursing, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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PALACIOS-CEÑA DOMINGO, CACHÓN-PÉREZ JOSÉMIGUEL, GÓMEZ-PÉREZ DANIEL, GÓMEZ-CALERO CRISTINA, BREA-RIVERO MIGUEL, FERNÁNDEZ-DE-LAS-PEÑAS CÉSAR. Is the influence of nurse care practices and nursing home organization understood? A qualitative study. J Nurs Manag 2012; 21:1044-52. [DOI: 10.1111/j.1365-2834.2012.01445.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dellefield ME, Harrington C, Kelly A. Observing How RNs Use Clinical Time in a Nursing Home: A Pilot Study. Geriatr Nurs 2012; 33:256-63. [DOI: 10.1016/j.gerinurse.2012.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
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Choi J, Johantgen M. The importance of supervision in retention of CNAs. Res Nurs Health 2012; 35:187-99. [PMID: 22262015 DOI: 10.1002/nur.21461] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2011] [Indexed: 11/06/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care in nursing homes, yet recruiting and retaining CNAs has been difficult. Retaining CNAs is important because it has been linked to the better quality of resident care in nursing homes. In this study, the investigators examined the relationships of work-related and personal factors to CNA job satisfaction and intent to leave. Linked data from the 2004 National Nursing Home Survey and the 2004 National Nursing Assistant Survey were analyzed using multilevel logistic regression. Personal factors such as age, education, and job history, were related to intent to leave but not to job satisfaction. Supportive supervision was a significant predictor of both job satisfaction and intent to leave.
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Affiliation(s)
- JiSun Choi
- National Database of Nursing Quality Indicators, University of Kansas Medical Center, School of Nursing, Kansas City, Kansas 66160, USA
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Çalıkoğlu Ş, Christmyer CS, Kozlowski BU. My eyes, your eyes--the relationship between CMS five-star rating of nursing homes and family rating of experience of care in Maryland. J Healthc Qual 2011; 34:5-12. [PMID: 22092877 DOI: 10.1111/j.1945-1474.2011.00159.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2008, the Centers for Medicaid and Medicare Services (CMS) launched the Five-Star Quality Rating System to help consumers compare nursing homes. The quality rating system consists of three domains: nursing home inspection results, staffing, and quality measures (QMs) and an overall rating calculated from the three domains. The Five-Star System has both advocates and detractors. One source of criticism about the rating system is its lack of input from consumer surveys. Although different dimensions of quality have been recognized as important by the experts and studied in the literature, how these dimensions are linked with each other is largely unknown. This article describes an analysis of the relationship between overall experience of care ratings from a family survey and ratings obtained on the CMS Five-Star Quality Rating for Maryland nursing homes. The results indicated a strong positive correlation between family experience of care score and two five-star domains, namely health inspections and nurse staffing, and no relationship with the quality domain. The lack of relationship between the quality domain and the family score may be due to inadequate risk adjustment or that each rating system measures different aspects of quality.
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Affiliation(s)
- Şule Çalıkoğlu
- Maryland Health Services Cost Review Commission, Baltimore, Maryland, USA.
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