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  1. The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia.

    Science.gov (United States)

    Sloane, Philip D; Mitchell, C Madeline; Weisman, Gerald; Zimmerman, Sheryl; Foley, Kristie M Long; Lynn, Mary; Calkins, Margaret; Lawton, M Powell; Teresi, Jeanne; Grant, Leslie; Lindeman, David; Montgomery, Rhonda

    2002-03-01

    To develop an observational instrument that describes the ability of physical environments of institutional settings to address therapeutic goals for persons with dementia. A National Institute on Aging workgroup identified and subsequently revised items that evaluated exit control, maintenance, cleanliness, safety, orientation/cueing, privacy, unit autonomy, outdoor access, lighting, noise, visual/tactile stimulation, space/seating, and familiarity/homelikeness. The final instrument contains 84 discrete items and one global rating. A summary scale, the Special Care Unit Environmental Quality Scale (SCUEQS), consists of 18 items. Lighting items were validated using portable light meters. Concurrent criterion validation compared SCUEQS scores with the Professional Environmental Assessment Protocol (PEAP). Interrater kappa statistics for 74% of items were above.60. For another 10% of items, kappas could not be calculated due to empty cells, but interrater agreement was above 80%. The SCUEQS demonstrated an interrater reliability of.93, a test--retest reliability of.88, and an internal consistency of.81--.83. Light meter ratings correlated significantly with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) lighting items (r =.29--.38, p =.01--.04), and the SCUEQS correlated significantly with global PEAP ratings (r =.52, p TESS-NH efficiently assesses discrete elements of the physical environment and has strong reliability and validity. The SCUEQS provides a quantitative measure of environmental quality in institutional settings.

  2. First evidence on the validity and reliability of the Safety Organizing Scale-Nursing Home version (SOS-NH).

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    Ausserhofer, Dietmar; Anderson, Ruth A; Colón-Emeric, Cathleen; Schwendimann, René

    2013-08-01

    The Safety Organizing Scale is a valid and reliable measure on safety behaviors and practices in hospitals. This study aimed to explore the psychometric properties of the Safety Organizing Scale-Nursing Home version (SOS-NH). In a cross-sectional analysis of staff survey data, we examined validity and reliability of the 9-item Safety SOS-NH using American Educational Research Association guidelines. This substudy of a larger trial used baseline survey data collected from staff members (n = 627) in a variety of work roles in 13 nursing homes (NHs) in North Carolina and Virginia. Psychometric evaluation of the SOS-NH revealed good response patterns with low average of missing values across all items (3.05%). Analyses of the SOS-NH's internal structure (eg, comparative fit indices = 0.929, standardized root mean square error of approximation = 0.045) and consistency (composite reliability = 0.94) suggested its 1-dimensionality. Significant between-facility variability, intraclass correlations, within-group agreement, and design effect confirmed appropriateness of the SOS-NH for measurement at the NH level, justifying data aggregation. The SOS-NH showed discriminate validity from one related concept: communication openness. Initial evidence regarding validity and reliability of the SOS-NH supports its utility in measuring safety behaviors and practices among a wide range of NH staff members, including those with low literacy. Further psychometric evaluation should focus on testing concurrent and criterion validity, using resident outcome measures (eg, patient fall rates). Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.

  3. Resourse Use and Disease Couse in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes.

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    Røen, Irene; Selbæk, Geir; Kirkevold, Øyvind; Engedal, Knut; Testad, Ingelin; Bergh, Sverre

    2017-05-22

    Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home. We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected. Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 - 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer's disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms. Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.

  4. Multidisciplinary, Nurse-Led Psychiatric Consultation in Nursing Homes: A Pilot Study in Clinical Practice.

    Science.gov (United States)

    Koekkoek, Bauke; van Baarsen, Carlijn; Steenbeek, Mirella

    2016-07-01

    To determine the effects of multidisciplinary, nurse-led psychiatric consultation on behavioral problems of nursing home residents. Residents often suffer from psychiatric symptoms, while staff psychiatric expertise varies. A pre-post study was conducted in seven homes using the Neuropsychiatric Inventory Nursing Home version (NPI-NH). In 71 consultations during 18 months, 56-75% of residents suffered from agitation/aggression, depression, anxiety, and disinhibition. Post-intervention (n = 54), frequency, and severity of psychiatric symptoms were significantly and clinically meaningfully reduced. Also, staff suffered from less work stress. Nurse-led psychiatric consultation is valuable to both nursing home residents and staff. © 2015 Wiley Periodicals, Inc.

  5. Medical staff organization in nursing homes: scale development and validation.

    Science.gov (United States)

    Katz, Paul R; Karuza, Jurgis; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent; Caprio, Thomas; Caprio, Anthony; Dauenhauer, Jason; Lima, Julie

    2009-09-01

    To construct a multidimensional self-report scale to measure nursing home (NH) medical staff organization (NHMSO) dimensions and then pilot the scale using a national survey of medical directors to provide data on its psychometric properties. Instrument development process consisting of the proceedings from the Nursing Home Physician Workforce Conference and focus groups followed by cognitive interviews, which culminated in a survey of a random sample of American Medical Directors Association (AMDA) affiliated medical directors. Analyses were conducted on surveys matched to Online Survey Certification and Reporting (OSCAR) data from freestanding nonpediatric nursing homes. A total of 202 surveys were available for analysis and comprised the final sample. Dimensions were identified that measured the extent of medical staff organization in nursing homes and included staff composition, appointment process, commitment (physiciancohesion; leadership turnover/capability), departmentalization (physician supervision, autonomy and interdisciplinary involvement), documentation, and informal dynamics. The items developed to measure each dimension were reliable (Cronbach's alpha ranged from 0.81 to 0.65).Intercorrelations among the scale dimensions provided preliminary evidence of the construct validity of the scale. This report, for the first time ever, defines and validates NH medical staff organization dimensions, a critical first step in determining the relationship between physician practice and the quality of care delivered in the NH.

  6. What Consumers Say About Nursing Homes in Online Reviews.

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    Kellogg, Caitlyn; Zhu, Yujun; Cardenas, Valeria; Vazquez, Katalina; Johari, Kayla; Rahman, Anna; Enguidanos, Susan

    2018-04-20

    Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care. We analyzed nursing home (NH) Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned. We evaluated 264 reviews, identifying 24 codes, grouped under five categories: quality of staff care and staffing; physical facility and setting; resident safety and security; clinical care quality; and financial issues. More than half (53.41%) of Yelp reviewers posted comments related to staff attitude and caring and nearly a third (29.2%) posted comments related to staff responsiveness. Yelp reviewers also often posted about NHs' physical environment. Infrequently mentioned were the quality of health care provided and concerns about resident safety and security. Our results are consistent with those from related studies. Yelp reviewers focus on NH aspects that are not evaluated in most other NH rating systems. The federal Nursing Home Compare website, for instance, does not report measures of staff attitudes or the NH's physical setting. Rather, it reports measures of staffing levels and clinical processes and outcomes. We recommend that NH consumers consult both types of rating systems because they provide complementary information.

  7. Tess of the D'Urbervilles

    NARCIS (Netherlands)

    Hardy, Thomas

    2005-01-01

    Tess Durbeyfield, an innocent village girl, is seduced by a wealthy rake, Alec D'Urberville. Though he makes her pregnant she does not love him and and leaves him to return to her home in disgrace. Some time after the baby's death Tess meets her true love Angel Clare, but they cannot escape the

  8. Use of atypical antipsychotics in nursing homes and pharmaceutical marketing.

    Science.gov (United States)

    Pimentel, Camilla B; Donovan, Jennifer L; Field, Terry S; Gurwitz, Jerry H; Harrold, Leslie R; Kanaan, Abir O; Lemay, Celeste A; Mazor, Kathleen M; Tjia, Jennifer; Briesacher, Becky A

    2015-02-01

    To describe the current extent and type of pharmaceutical marketing in nursing homes (NHs) in one state and to provide preliminary evidence for the potential influence of pharmaceutical marketing on the use of atypical antipsychotics in NHs. Nested mixed-methods, cross-sectional study of NHs in a cluster randomized trial. Forty-one NHs in Connecticut. NH administrators, directors of nursing, and medical directors (n = 93, response rate 75.6%). Quantitative data, including prescription drug dispensing data (September 2009-August 2010) linked with Nursing Home Compare data (April 2011), were used to determine facility-level prevalence of atypical antipsychotic use, facility-level characteristics, NH staffing, and NH quality. Qualitative data, including semistructured interviews and surveys of NH leaders conducted in the first quarter of 2011, were used to determine encounters with pharmaceutical marketing. Leadership at 46.3% of NHs (n = 19) reported pharmaceutical marketing encounters, consisting of educational training, written and Internet-based materials, and sponsored training. No association was detected between level of atypical antipsychotic prescribing and reports of any pharmaceutical marketing by at least one NH leader. NH leaders frequently encounter pharmaceutical marketing through a variety of ways, although the impact on atypical antipsychotic prescribing is unclear. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  9. Extended Spectrum Beta-Lactamase Carriage State among Elderly Nursing Home Residents in Beirut

    Directory of Open Access Journals (Sweden)

    M. A. Jallad

    2015-01-01

    Full Text Available Introduction. ESBL-producing Enterobacteriaceae can cause severe infections, but they are also isolated from the stool of asymptomatic subjects. Faecal carriage of such organism is poorly understood. Methods. First phase of the study was cross-sectional with prevalence and epidemiology of ESBL faecal carriage in two nursing homes in Beirut: 57 residents in the first (NH1 and 151 residents in the second (NH2. In second phase, faecal swabs from cohort of NH1 residents were examined for carriage at six-week intervals over three-month period. Residents’ charts were reviewed to assess carriage risk factors. Results. Over 3 consecutive samplings at NH1, 81% of residents were at least one-time carriers with 50% at the first round, 60.4% at the second, and 74.5% at the last one. At NH2, 68.2% of residents were carriers. Constipation (in NH1 and antibiotic intake (in NH2 were significantly associated with higher ESBL faecal carriage while the length of stay at the nursing home (in NH2 was associated with less carriage. Conclusion. Faecal carriage of ESBL-producing Enterobacteriaceae is high among nursing home patients in Beirut. The rate of carriage changes rapidly and significantly over time either with multiple factors playing a possible role like outbreak spreading, antibiotic, and health care system exposure.

  10. Disease trajectories in nursing home patients.

    NARCIS (Netherlands)

    Husebo, B.S.; Hylen Randhoff, A.; Sandvik, R.; Omland, G.; Gysels, M.; Francke, A.; Hertogh, C.; Ribbe, M.; Deliens, L.

    2011-01-01

    Research aims: About 17 500 patients die in Norwegian nursing homes (NH) every year, 14-27% of these patients have diagnoses of cancer, 75% heart failure, and 80% dementia. Little is known about their last months and days regarding medical treatment, needs for multi-professional care, advance

  11. Understanding nurses' decisions to treat pain in nursing home residents with dementia.

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    Gilmore-Bykovskyi, Andrea L; Bowers, Barbara J

    2013-04-01

    Nursing home (NH) residents with dementia continue to receive inadequate pain treatment. The purpose of this qualitative study was to examine how nurses make decisions to pharmacologically treat pain in NH residents with dementia. Using Grounded Dimensional Analysis, 15 in-depth interviews were conducted with 13 nurses from four skilled nursing facilities in Wisconsin. Nurses experienced varying levels of certainty regarding suspected pain in response to particular resident characteristics and whether pain was perceived as visible/obvious or nonvisible/not obvious. Nurses felt highly uncertain about pain in residents with dementia. Suspected pain in residents with dementia was nearly always conceptualized as a change in behavior to which nurses responded by trialing multiple interventions in attempts to return the resident to baseline, which despite current recommendations, did not include pain relief trials. Residents with dementia were described as being at greatest risk for experiencing underassessment, undertreatment, and delayed treatment for pain Copyright 2013, SLACK Incorporated.

  12. Using conflict theory to explore the role of nursing home social workers in home- and community-based service utilization.

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    Fogler, Sarah

    2009-11-01

    Nursing home social work (NHSW) practitioners are central to home- and community-based service (HCBS) utilization. They assist residents with long-term care (LTC) decision-making and coordinate community-based LTC supports and services for older adults transitioning back into the community after a rehabilitative nursing home (NH) stay. As members of multiple groups, they must simultaneously balance the needs of NH residents, the NH organization, and social policies related to LTC. To date, policy research on HCBS has been atheoretical in that it has not accounted for the possible inherent conflicts that adversely affect the discharge planning practices of NHSW practitioners. This article applies the Conflict Theory to (a) explore the competing interests of the NH industry and the nation's government, (b) examine the potential effect of these competing interests on the effectiveness of NHSW discharge planning practices, and (c) present a conceptual framework to further investigate the relationship between NHSW and both individual LTC outcomes and national policy initiatives aimed at increasing HCBS utilization.

  13. Predictors of a nursing home placement from a non-acute geriatric hospital.

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    Aditya, B S; Sharma, J C; Allen, S C; Vassallo, M

    2003-02-01

    Identifying patients who need Nursing Home (NH) care following a hospital admission is important. To identify the factors that predispose to an NH discharge. Prospective observational study with blinded end-point evaluation. A non-acute geriatric hospital. Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness. Discharge to an NH or home. Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p factors present: 4.28% for 0-2 factors, 25.8% for 3-4 factors and 81.8% for 5-6 factors (p factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.

  14. Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

    Science.gov (United States)

    Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T

    2015-01-01

    Hospice music therapy is delivered in both homes and nursing homes (NH). No studies to date have explored differences in music therapy delivery between home and NH hospice patients. To compare music therapy referral reasons and delivery for hospice patients living in NH versus home. A retrospective, electronic medical record review was conducted from a large U.S. hospice of patients receiving music therapy between January 1, 2006, and December 31, 2010. Among the 4,804 patients, 2,930 lived in an NH and 1,847 patients lived at home. Compared to home, NH hospice patients were more likely to be female, older, unmarried, and Caucasian. For home hospice patients, the top referral reasons were patient/family emotional and spiritual support, quality of life, and isolation. The most frequent referral reasons for NH hospice patients were isolation, quality of life, and patient/family emotional and spiritual support. Differences in music therapy delivery depended mainly on patients' primary diagnosis and location of care. Results suggest differences in referral reasons and delivery based on an interaction between location of care and patient characteristics. Delivery differences are likely a result of individualized assessment and care plans developed by the music therapist and other interdisciplinary team members to address the unique needs of the patient. Thus, it is important to have professionally trained music therapists assess and provide tailored music-based interventions for patients with different referral reasons and personal characteristics. This study also supports staffing decisions based on patient need rather than average daily census. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. A new tool to adapt the treatment of Parkinson's disease patients in nursing homes.

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    Geny, Christian; Verna, Claudia; Arifi, Alexia; Ferreira, Ernestine; Boubakri, Choukri; Blain, Hubert

    2018-03-01

    Parkinson's disease (PD) is a common condition in nursing home (NH) residents. The primary treatment for Parkinson's disease is levodopa therapy to relieve motor symptoms and maximize physical function. Non-motor symptoms are highly prevalent in NH residents with Parkinson's disease and dramatically decrease quality of life. Choices in drug treatment need to take into account the complex interactions between aging, comorbidity and non-motor symptoms. Optimal management requires expertise and cooperative effort from prescribing neurologists and nursing home health professionals. The objective is to evaluate the pertinence of the CHEF, a new tool to screen daily life clinical data helpful for the management of neurologist consultants. NH nurses were asked to briefly report falls and gait problems, hallucinations, sleep disorders and motor fluctuations. Analysis of the results obtained in 26 patients showed that CHEF was perceived as a helpful complement to existing ressources. The use of this tool has the potential to enhance the quality of NH care of Parkinsonian patients.

  16. Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

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    Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

    2013-12-01

    The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

  17. Additional Cost Because of Pneumonia in Nursing Home Residents: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Resident Study.

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    Costa, Nadège; Hoogendijk, Emiel O; Mounié, Michael; Bourrel, Robert; Rolland, Yves; Vellas, Bruno; Molinier, Laurent; Cesari, Matteo

    2017-05-01

    Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period. This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study. Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included. Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5. Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded. Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia. NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs. Copyright © 2017. Published by Elsevier Inc.

  18. Stroke and Nursing Home care: a national survey of nursing homes.

    LENUS (Irish Health Repository)

    Cowman, Seamus

    2010-01-01

    BACKGROUND: Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. METHODS: A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30) efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. RESULTS: Across all nursing homes (n = 60), 18% (n = 570) of the residents had previously had a stroke. In homes (n = 30), where interviews with residents with stroke (n = 257), only 7% (n = 18) residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239) residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. CONCLUSIONS: This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care) for stroke survivors who reside in nursing homes in Ireland.

  19. Medical staff involvement in nursing homes: development of a conceptual model and research agenda.

    Science.gov (United States)

    Shield, Renée; Rosenthal, Marsha; Wetle, Terrie; Tyler, Denise; Clark, Melissa; Intrator, Orna

    2014-02-01

    Medical staff (physicians, nurse practitioners, physicians' assistants) involvement in nursing homes (NH) is limited by professional guidelines, government policies, regulations, and reimbursements, creating bureaucratic burden. The conceptual NH Medical Staff Involvement Model, based on our mixed-methods research, applies the Donabedian "structure-process-outcomes" framework to the NH, identifying measures for a coordinated research agenda. Quantitative surveys and qualitative interviews conducted with medical directors, administrators and directors of nursing, other experts, residents and family members and Minimum Data Set, the Online Certification and Reporting System and Medicare Part B claims data related to NH structure, process, and outcomes were analyzed. NH control of medical staff, or structure, affects medical staff involvement in care processes and is associated with better outcomes (e.g., symptom management, appropriate transitions, satisfaction). The model identifies measures clarifying the impact of NH medical staff involvement on care processes and resident outcomes and has strong potential to inform regulatory policies.

  20. Stroke and Nursing Home care: a national survey of nursing homes

    Directory of Open Access Journals (Sweden)

    McGee Hannah

    2010-01-01

    Full Text Available Abstract Background Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. Methods A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30 efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. Results Across all nursing homes (n = 60, 18% (n = 570 of the residents had previously had a stroke. In homes (n = 30, where interviews with residents with stroke (n = 257, only 7% (n = 18 residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239 residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. Conclusions This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care for stroke survivors who reside in nursing homes in Ireland.

  1. The 'mindless' relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer?

    Science.gov (United States)

    McCloskey, Rose

    2011-06-01

    The 'mindless' relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer? This paper explicates the long-standing and largely unquestioned adversarial relationship between nurses working in the nursing home (NH) and the emergency department (ED). Drawing on the author's own research on resident ED transfers, this paper reports on the conflict and tension that can arise when residents transfer between the two settings. The theoretical concepts of mindlessness, habitus, social capital and oppression are deployed to understand the contextual nature of the social relations that exist between NH and ED practitioners and between practitioners and residents. This theoretical discussion offers the potential to uncover the social relations that give rise to problematic transfers which may lead to alternative and more productive NH to ED transfers. © 2011 Blackwell Publishing Ltd.

  2. Nursing Homes

    Science.gov (United States)

    ... Home › Aging & Health A to Z › Nursing Homes Font size A A A Print Share Glossary Basic ... Reason For Living in A Nursing Home Some type of disability with activities of daily living (ADLs) ...

  3. The relationship between weight status and the need for health care assistance in nursing home residents

    DEFF Research Database (Denmark)

    Beck, Anne Marie

    2012-01-01

    Objective: The purpose of this study was to evaluate the relationship between underweight status and weight loss events on the need for health care assistance among a sample of Danish nursing home residents over 12-months. Design: Longitudinal, repeated measures design with three data collection...... points at baseline (2004) and six and 12 months post baseline. Setting: 11 Danish nursing home facilities. Participants: 441 Danish nursing home residents over the age of 65. Measurements: Resident Assessment Instrument (RAI-NH) data were abstracted for each participant at each of three data collection...... of this study suggest that elderly nursing home residents with a low BMI or weight loss may add to the substantial and costly burden of nursing home care due to the associated need for higher levels of ADL assistance....

  4. Nursing home policies regarding advance care planning in Flanders, Belgium

    NARCIS (Netherlands)

    de Gendt, C.; Bilsen, J.; van der Stichele, R.; Deliens, L.

    2010-01-01

    Background: The aim of this study is to discover how many nursing homes (NHs) in Flanders (Belgium) have policies on advance care planning (ACP) and their content regarding different medical end-of-life decisions. Methods: A structured mail questionnaire was sent to the NH administrators of all 594

  5. "Make Me Feel at Ease and at Home": Differential Care Preferences of Nursing Home Residents.

    Science.gov (United States)

    Bangerter, Lauren R; Van Haitsma, Kimberly; Heid, Allison R; Abbott, Katherine

    2016-08-01

    Assessing and honoring older adults' preferences is a fundamental step in providing person-centered care in long-term care facilities. Researchers and practitioners have begun to develop measures to assess nursing home (NH) residents' everyday preferences. However, little is known about how residents interpret and conceptualize their preferences and what specific clinical response may be needed to balance health and safety concerns with preferences. We used content analysis to examine interview responses on a subset of eight open-ended items from the Preferences of Every-day Living Inventory for Nursing Home (PELI-NH) residents with 337 NH residents (mean age 81). We considered how residents self-define various preferences of care and the associated importance of these preferences. Residents identified preferences for interpersonal interactions (greetings, staff showing care, and staff showing respect), coping strategies, personal care (bathroom needs, setting up bedding), and healthcare discussions. Respondents highlighted specific qualities and characteristics about care interactions that are necessary to fully meeting their everyday preferences. Results contribute to an emergent body of research that utilizes patient preferences to achieve the goals of person-centered care. The complexity of these responses substantiates the use of qualitative inquiry to thoroughly assess and integrate NH resident preferences into the delivery of person-centered care. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.

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    Monroe, Todd B; Misra, Sumathi; Habermann, Ralf C; Dietrich, Mary S; Bruehl, Stephen P; Cowan, Ronald L; Newhouse, Paul A; Simmons, Sandra F

    2015-10-01

    Despite evidence that many nursing home residents' pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., "Do you have any pain right now?"), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  7. Meals in nursing homes

    DEFF Research Database (Denmark)

    Kofod, Jens Erik; Birkemose, A.

    2004-01-01

    Undernutrition is present among 33% of nursing home residents in Denmark. Hence, it is relevant to examine the meal situation at nursing homes to single out factors that may increase or reduce the residents' food intake. in the ongoing Danish nursing home debate it is claimed that a new type...... of nursing home improves the residents' meal situation with a positive effect on nutrition. The aim of this work is to test the general hypothesis that (i) residents appreciate the meal situation in these nursing homes and (ii) nutritional status of the residents is improved in this type of nursing home....... This study was carried out in four Danish nursing homes at various locations in Denmark. The methods used are qualitative interviews and observations at four nursing homes in combination with measurement of body mass index (BMI) at two of the four nursing homes. Undernutrition is defined as a BMI below 20...

  8. Nursing students' attitudes about home health nursing.

    Science.gov (United States)

    Prestia, Mindy; Murphy, Susan; Yoder, Marian

    2008-09-01

    In an effort to address the home care nursing shortage, this pilot study was designed to measure nursing students' attitudes toward home health nursing and to test the Home Health Attitude Questionnaire developed specifically for this study based on the Theory of Planned Behavior. Senior undergraduate nursing students and registered nursing to bachelor of science in nursing students completed the questionnaire.

  9. The Green House Model of Nursing Home Care in Design and Implementation.

    Science.gov (United States)

    Cohen, Lauren W; Zimmerman, Sheryl; Reed, David; Brown, Patrick; Bowers, Barbara J; Nolet, Kimberly; Hudak, Sandra; Horn, Susan

    2016-02-01

    To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH. Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014. This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation. Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach. GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers. Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes. © Health Research and Educational Trust.

  10. Does Cognitive Impairment Influence Quality of Life among Nursing Home Residents?

    Science.gov (United States)

    Abrahamson, Kathleen; Clark, Daniel; Perkins, Anthony; Arling, Greg

    2012-01-01

    Purpose: We investigated the relationship between cognitive status and quality of life (QOL) of Minnesota nursing home (NH) residents and the relationship between conventional or Alzheimer's special care unit (SCU) placement and QOL. The study may inform development of dementia-specific quality measures. Design and Methods: Data for analyses came…

  11. Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands

    NARCIS (Netherlands)

    Fosse, Anette; Zuidema, Sytse; Boersma, Froukje; Malterud, Kirsti; Schaufel, Margrethe Aase; Ruths, Sabine

    2017-01-01

    OBJECTIVES: Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family

  12. The predictive value of self-rated health in the presence of subjective memory complaints on permanent nursing home placement in elderly primary care patients over 4-year follow-up

    DEFF Research Database (Denmark)

    Nielsen, Anni Brit Sternhagen; Siersma, Volkert Dirk; Waldemar, Gunhild

    2013-01-01

    self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear.......self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear....

  13. Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs.

    Science.gov (United States)

    Halvorsen, Kjell H; Granas, Anne Gerd; Engeland, Anders; Ruths, Sabine

    2012-09-01

    To examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services. Cross-sectional study comprising 11,254 patients aged ≥ 65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug-drug interactions through a Norwegian Web-based tool. The impact of care setting on exposure to selected drug groups, potentially inappropriate medications, and drug interactions was calculated, adjusting for patients' age, gender, and number of drugs used. Patients in nursing homes and home nursing services used on average 5.7 (SD = 2.6) multidose dispensed regular drugs. Twenty-six percent used at least one potentially inappropriate medication, 31% in nursing homes and 25% in home nursing services, p nursing homes (18%) and home nursing services (9%), p nursing homes, more patients in home nursing services used cardiovascular drugs and fewer patients used psychotropic drugs. Altogether, 8615 drug-drug interactions were identified in 55% of patients, 48% in nursing homes and 57% in home nursing services, p quality of drug prescribing in nursing homes compared with home nursing services. Explanations as to why these differences exist need to be further explored. Copyright © 2011 John Wiley & Sons, Ltd.

  14. The TESS database. Use in product safety assessment.

    Science.gov (United States)

    Litovitz, T

    1998-01-01

    The Toxic Exposure Surveillance System or TESS is a comprehensive poisoning surveillance database maintained by the American Association of Poison Control Centers. It now includes data on more than 20.3 million human poison exposures reported to US poison centres. TESS data are submitted by 67 of the 75 US poison control centres, covering 87% of the US population. Reports to US poison centres included in TESS originate both from the general public and from health professionals (12.9%) and include both patients managed at home or at the site of the exposure (73.6%) and those managed in hospitals, emergency departments, or other healthcare facilities (22.8%). TESS data are used by the pharmaceutical industry to monitor or defend product safety, by regulatory agencies proposing new regulations or considering new approvals or over-the-counter switches, and by clinical researchers attempting to characterise toxicity profiles or determine treatment protocols. TESS is a key component of an effective post-marketing surveillance programme, allowing early identification of previously unsuspected hazards, and early changes in formulations, labelling, or packaging when needed, thereby minimising injuries, deaths and product liability. Deaths, severe outcomes and comparisons of poisoning outcomes and hospitalisation rates between products or product categories are used to identify safety outliers. TESS data for each case of poisoning include identification of the substances implicated (including brand and formulation where known), patient age, outcome, specific clinical effects, exposure route, reason for the exposure (unintentional, suicidal, therapeutic error, etc.), antidotes used and the level of healthcare intervention utilised. Pharmaceuticals are implicated in 42% of TESS poisoning cases. About 53% of all cases of poisoning occur in children under 6 years of age. Of the more than 2.1 million cases reported to TESS in 1996, 123,095 (5.7%) were therapeutic errors and 32

  15. Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents.

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Vernooij-Dassen, M.J.F.J.; Teerenstra, S.; Smalbrugge, M.; Koopmans, R.T.C.M.

    2012-01-01

    OBJECTIVE: This study aims to test the accuracy of the Nijmegen Observer-Rated Depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia. METHODS: This cross-sectional study with 103 residents with dementia (N = 19 depressed) and

  16. Geriatric workforce capacity: a pending crisis for nursing home residents.

    Science.gov (United States)

    Lee, Wei-Chen; Sumaya, Ciro V

    2013-07-29

    The nursing home (NH) population in the US has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification) indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

  17. Improving Elderly's Dental Hygiene Through Nursing Home Staff's Dental Health Education at the Nursing Home

    OpenAIRE

    Santoso, Bedjo; Eko Ningtyas, Endah Aryati; Fatmasari, Diyah

    2017-01-01

    Stomatitis often occurs in elderly at nursing home. They need nursing home staff assistance to maintain their dental and oral health. Therefore, nursing home staff need dental health education. Lecture or discussion methods, which are more effective to improve knowledge, attitude and skill of nursing home staff was the purpose of this research. The research design was quasi-experiment research and pretest-posttest with control group. The sample was 42 nursing home staffs and 74 elderlies, div...

  18. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol

    Directory of Open Access Journals (Sweden)

    Amélie Perrin

    2017-09-01

    Full Text Available Background: Each year, around one out of two nursing home (NH residents are hospitalized in France, and about half to the emergency department (ED. These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization. Keywords: Inappropriate transfer, Nursing home resident, Emergency department transfer, Potentially avoidable transfer, Appropriateness of transfer, Inappropriate hospitalization

  19. Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Vernooij-Dassen, M.J.; Teerenstra, S.; Smalbrugge, M.; Koopmans, R.T.

    2012-01-01

    Objective This study aims to test the accuracy of the Nijmegen Observer-Rated Depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia. Methods This cross-sectional study with 103 residents with dementia (N = 19 depressed) and 72

  20. Dementia and depression among nursing home residents in Lebanon : a pilot study

    NARCIS (Netherlands)

    Chahine, L. M.; Bijlsma, A.; Hospers, A. P. N.; Chemali, Z.

    Background The proportion of elderly in the Lebanese population is 7.1% and this is expected to increase to 10.2% by the year 2025. The nursing home (NH) population in Lebanon has not been studied. The aim of this study was to investigate the prevalence of dementia and depression among a portion of

  1. Does Assisted Living Capacity Influence Case Mix at Nursing Homes?

    Science.gov (United States)

    Clement, Jan P; Khushalani, Jaya

    2015-01-01

    Assisted living facilities (ALFs) have grown over the past few decades. If they attract residents with lower care needs away from nursing homes (NHs), NHs may be left with higher case mix residents. We study the relationship between ALF bed market capacity and NH case mix in a state (Virginia) where ALF bed capacity stabilized after a period of growth. Similarly, NH capacity and use had been stable. While it is interesting to study markets in flux, for planning purposes, it is also important to examine what happens after periods of turbulence and adaptation. Our findings show some substitution of ALF for NH care, but the relationship is not linear with ALF market capacity. Communities need to consider the interplay of ALFs and NHs in planning for long-term care services and supports. Policies supporting ALFs may enable care needs to be met in a lower cost setting than the NH.

  2. TESS Objects of Interest

    Science.gov (United States)

    Guerrero, Natalia; Glidden, Ana; Fausnaugh, Michael; TESS Team

    2018-01-01

    We describe the search for TESS Objects of Interest (TOIs), led by the MIT branch of the TESS Science Office (TSO). TSO has developed a tool called TESS Exoplanet Vetter (TEV) to facilitate this process. Individuals independently examine data validation products for each target and assign a category to the object: planet candidate, eclipsing binary, other astrophysical, stellar variability, or instrument noise/systematic. TEV assigns a preliminary follow-up priority designation to each object and allows for modification when final dispositions are decided on in a group setting. When all targets are vetted, TEV exports a catalogue of TOIs which is delivered to the TESS Follow-Up Observing Program (TFOP), working with ExoFOP-TESS, and made publicly available on the official TESS website and the Mikulski Archive for Space Telescopes (MAST).

  3. Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

    DEFF Research Database (Denmark)

    Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K

    2014-01-01

    and prognosis after OHCA in NH. METHODS: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. RESULTS: A total...... survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified....

  4. The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: a longitudinal analysis of 50 German nursing homes.

    Science.gov (United States)

    Schmidt, Sascha G; Dichter, Martin N; Bartholomeyczik, Sabine; Hasselhorn, Hans Martin

    2014-01-01

    The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses' general health, burnout and work ability. Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs. 58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses' individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability. The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources. Copyright © 2014 Mosby, Inc. All rights reserved.

  5. Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia

    NARCIS (Netherlands)

    Smeets, Claudia H. W.; Smalbrugge, Martin; Zuidema, Sytse U.; Derksen, Els; de Vries, Erica; van der Spek, Klaas; Koopmans, Raymond T. C. M.; Gerritsen, Debby L.

    2014-01-01

    Objectives: The objective of this study is to explore factors that elucidate reasons for psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home (NH) residents with dementia. Design: A qualitative study using a grounded theory approach. Setting: Twelve NHs in The

  6. Involvement in decisions about intravenous treatment for nursing home patients: nursing homes versus hospital wards.

    Science.gov (United States)

    Klomstad, Kristin; Pedersen, Reidar; Førde, Reidun; Romøren, Maria

    2018-05-08

    Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient's best interest, assessment of capacity to consent, and on the patient's own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. The patients' capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

  7. Does Assisted Living Capacity Influence Case Mix at Nursing Homes?

    Directory of Open Access Journals (Sweden)

    Jan P. Clement PhD

    2015-05-01

    Full Text Available Assisted living facilities (ALFs have grown over the past few decades. If they attract residents with lower care needs away from nursing homes (NHs, NHs may be left with higher case mix residents. We study the relationship between ALF bed market capacity and NH case mix in a state (Virginia where ALF bed capacity stabilized after a period of growth. Similarly, NH capacity and use had been stable. While it is interesting to study markets in flux, for planning purposes, it is also important to examine what happens after periods of turbulence and adaptation. Our findings show some substitution of ALF for NH care, but the relationship is not linear with ALF market capacity. Communities need to consider the interplay of ALFs and NHs in planning for long-term care services and supports. Policies supporting ALFs may enable care needs to be met in a lower cost setting than the NH.

  8. The relationship between older Americans act in-home services and low-care residents in nursing homes.

    Science.gov (United States)

    Thomas, Kali S

    2014-03-01

    The aim of the study was to investigate the relationship between supportive services provided under Title III-B of the Older Americans Act (OAA) and the prevalence of low-care residents in nursing homes (NHs). State Program Reports (state-level expenditure and utilization data for each OAA service) and NH facility-level data were analyzed using a two-way fixed effects model. Results suggest that every additional 1% of the population age 65+ that receives personal care services is associated with a 0.8% decrease in the proportion of low-care residents in NHs. Despite efforts to rebalance long-term care, there are still many NH residents who have the functional capacity to live in a less restrictive environment. This is among the first studies to suggest that states that have invested in their in-home supportive services, particularly personal care services provided through the OAA, have proportionally fewer of these people.

  9. Geriatric Workforce Capacity: A Pending Crisis for Nursing Home Residents

    Directory of Open Access Journals (Sweden)

    Wei Chen eLee

    2013-07-01

    Full Text Available Introduction: The nursing home (NH population in the U.S. has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. Methods: This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. Results: English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Conclusion: Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

  10. Does undernutrition still prevail among nursing home residents?

    Science.gov (United States)

    Törmä, Johanna; Winblad, Ulrika; Cederholm, Tommy; Saletti, Anja

    2013-08-01

    During recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. Simultaneously, the number of older adults is increasing, and the elderly care has been placed under pressure. The aim was to assess the nutritional situation and one-year mortality among nursing home (NH) residents, and compare with historical data. Mini Nutritional Assessment-Short Form (MNA-SF), ADL Barthel Index (BI), Short Portable Mental Status Questionnaire (SPMSQ), EQ-5D, Charlson Comorbidity Index (CCI), and blood samples were collected from 172 NH residents (86.3 ± 8 years, 70% women). Mortality data was taken from NH records. Nutritional data from 166 NH residents (83.8 ± 8 years, 61% women) examined in 1996 was retrieved for historical comparison. The prevalence of malnutrition was 30%, as compared to 71% in the historical data set, corresponding to a present average body mass index of 23.7 ± 5.1 compared with 22.3 ± 4.2 kg/m(2) (p prevails and is associated with deteriorated cognition, function and increased mortality. A possible improvement in nutritional status in NH residents over time was observed. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  11. Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study

    NARCIS (Netherlands)

    Hollaar, V.R.Y.; Putten, G.J. van der; Maarel-Wierink, C.D. van der; Bronkhorst, E.M.; Swart, B.J.M. de; Baat, C. de; Creugers, N.H.J.

    2017-01-01

    BACKGROUND: Nursing home-acquired pneumonia (NHAP) is a common infection among nursing home residents. There is also a high prevalence of dysphagia in nursing home residents and they suffer more often from comorbidity and multimorbidity. This puts nursing home residents at higher risk of (mortality

  12. Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge.

    Science.gov (United States)

    Noureldin, Marwa; Hass, Zachary; Abrahamson, Kathleen; Arling, Greg

    2017-09-04

    Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge. Participants in the Minnesota Return to Community Initiative who were assisted in achieving a community discharge (N = 1459) comprised the study sample. The main outcome was fall occurrence within 30 days of discharge. Factor analyses were used to estimate latent models from variables of interest. A structural equation model (SEM) was estimated to determine the relationship between the emerging latent variables and falls. Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p risk of falling post NH discharge. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Community Nursing Home (CNH)

    Data.gov (United States)

    Department of Veterans Affairs — The Community Nursing Home (CNH) database contains a list of all Community Nursing Home facilities under local contract to Veterans Health Administration (VHA). CNH...

  14. Ensuring Quality Nursing Home Care

    Science.gov (United States)

    ... cases, you can also call the Department of Health. Nursing homes are required to post information on how you ... nursing homes in your area, go to Medicare’s Nursing Home Compare website at ... information is not intended to diagnose health problems or to take the place of medical ...

  15. Patient Safety Culture and the Association with Safe Resident Care in Nursing Homes

    Science.gov (United States)

    Thomas, Kali S.; Hyer, Kathryn; Castle, Nicholas G.; Branch, Laurence G.; Andel, Ross; Weech-Maldonado, Robert

    2012-01-01

    Purpose of the study: Studies have shown that patient safety culture (PSC) is poorly developed in nursing homes (NHs), and, therefore, residents of NHs may be at risk of harm. Using Donabedian's Structure-Process-Outcome (SPO) model, we examined the relationships among top management's ratings of NH PSC, a process of care, and safety outcomes.…

  16. Emergency Department Use by Nursing Home Residents: Effect of Severity of Cognitive Impairment

    Science.gov (United States)

    Stephens, Caroline E.; Newcomer, Robert; Blegen, Mary; Miller, Bruce; Harrington, Charlene

    2012-01-01

    Purpose: To examine the 1-year prevalence and risk of emergency department (ED) use and ambulatory care-sensitive (ACS) ED use by nursing home (NH) residents with different levels of severity of cognitive impairment (CI). Design and Methods: We used multinomial logistic regression to estimate the effect of CI severity on the odds of any ED visit…

  17. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  18. Cost analysis of nursing home registered nurse staffing times.

    Science.gov (United States)

    Dorr, David A; Horn, Susan D; Smout, Randall J

    2005-05-01

    To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

  19. Advance Care Planning and Physician Orders in Nursing Home Residents With Dementia: A Nationwide Retrospective Study Among Professional Caregivers and Relatives

    NARCIS (Netherlands)

    Vandervoort, A.; Houttekier, D.; Block, L.; van der Steen, J.T.; van der Stichele, R.; Deliens, L.

    2014-01-01

    Context: Advance care planning (ACP) is key to good palliative care for nursing home (NH) residents with dementia. Objectives: We examined the extent to which the family physicians (FPs), nurses, and the relative most involved in the resident's care are informed about ACP, written advance

  20. Resident complaints about the nursing home food service: relationship to cognitive status.

    Science.gov (United States)

    Simmons, Sandra F; Cleeton, Patrick; Porchak, Tracy

    2009-05-01

    Most nursing home (NH) residents are not interviewed about their satisfaction with the food service due to cognitive impairment. The purpose of this study was to determine the proportion of NH residents able to complete a structured interview to assess food complaints when no cognitive status criteria were used to exclude residents from interview. Eighty-nine percent of 163 residents were able and willing to complete the interview, and 65% expressed complaints about the NH food service. Residents who expressed complaints ate less of their meals, had less cognitive impairment, and had more depressive symptoms than those who did not. This study shows that the majority of NH residents are able to reliably answer questions about their satisfaction with the food service, regardless of cognitive status, and the presence of complaints is related to poor meal intake and depressive symptoms.

  1. Achieving Improvement Through Nursing Home Quality Measurement

    OpenAIRE

    Harris, Yael; Clauser, Steven B.

    2002-01-01

    CMS has initiated the Nursing Home Quality Initiative (NHQI) to improve the quality of nursing home care. Central to the NHQI is the public reporting of nursing home quality measures that serve as the basis for the Initiative's communication and quality improvement program. This article provides an overview of the NHQI, focusing on the role of nursing home quality measures in achieving improvements in nursing home care. We also describe the evolution of quality measurement in nursing homes, a...

  2. Nurses' reflections on pain management in a nursing home setting.

    Science.gov (United States)

    Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

    2006-06-01

    Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

  3. Ownership conversions and nursing home performance.

    Science.gov (United States)

    Grabowski, David C; Stevenson, David G

    2008-08-01

    To examine the effects of ownership conversions on nursing home performance. Online Survey, Certification, and Reporting system data from 1993 to 2004, and the Minimum Data Set (MDS) facility reports from 1998 to 2004. Regression specification incorporating facility fixed effects, with terms to identify trends in the pre- and postconversion periods. The annual rate of nursing home conversions almost tripled between 1994 and 2004. Our regression results indicate converting facilities are generally different throughout the pre/postconversion years, suggesting little causal effect of ownership conversions on nursing home performance. Before and after conversion, nursing homes converting from nonprofit to for-profit status generally exhibit deterioration in their performance, while nursing homes converting from for-profit to nonprofit status generally exhibit improvement. Policy makers have expressed concern regarding the implications of ownership conversions for nursing home performance. Our results imply that regulators and policy makers should not only monitor the outcomes of nursing home conversions, but also the targets of these conversions.

  4. State focus on health care-associated infection prevention in nursing homes.

    Science.gov (United States)

    Cohen, Catherine C; Herzig, Carolyn T A; Carter, Eileen J; Pogorzelska-Maziarz, Monika; Larson, Elaine L; Stone, Patricia W

    2014-04-01

    Despite increased focus on health care-associated infections (HAI), between 1.6 and 3.8 million HAI occur annually among the vulnerable population residing in US nursing homes (NH). This study characterized state department of health (DOH) activities and policies intended to improve quality and reduce HAI in NH. We created a 17-item standardized data collection tool informed by 20 state DOH Web sites, reviewed by experts in the field and piloted by 2 independent reviewers (Cohen's κ .45-.73). The tool and corresponding protocol were used to systematically evaluate state DOH Web sites and related links. Three categories of data were abstracted: (1) consumer-directed information intended to increase accountability of and competition between NH, including mandatory HAI reporting and NH inspection reports; (2) surveyor training for federally-mandated NH inspections; and (3) guidance for NH providers to prevent HAI and monitor incidence. Only 5 states included HAI reporting in NH with differing HAI types and reporting requirements. State DOH information and activities focused on NH quality and reducing HAI were inconsistent. Systematically characterizing state DOH efforts to reduce HAI in NH is important to interpret the effects of these activities. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  5. Managerial Ownership in Nursing Homes: Staffing, Quality, and Financial Performance.

    Science.gov (United States)

    Huang, Sean Shenghsiu; Bowblis, John R

    2017-06-20

    Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes. We use a unique panel dataset of Ohio NHs (2005-2010) to empirically examine the relationship between managerial equity ownership and NH staffing, quality, and financial performance. We identify facility administrators as owner-managers if they have more than 5% of the equity stakes or are relatives of the owners. The statistical analysis is based on the pooled ordinary least squares and NH-fixed effect models. We find that owner-managed NHs are associated with higher nursing staff levels compared to other FP NHs. Surprisingly, despite higher staffing levels, owner-managed NHs are not associated with better quality and we find no statistically significant difference in financial performance between owner-managed and nonowner-managed FP NHs. Our results do not support the principal-agent model and we offer alternative explanations for future research. Our findings provide empirical evidence that NH ownership structures are more nuanced than simply broadly categorizing facilities as FP or NFP, and our results do not fully align with the standard principal-agent model. The role of managerial ownership should be considered in future NH research and policy discussions. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

    Science.gov (United States)

    Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

    2012-01-01

    Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

  7. Chronic kidney disease and recurrent falls in nursing home residents: a retrospective cohort study.

    Science.gov (United States)

    Hall, Rasheeda K; Landerman, Lawrence R; O'Hare, Ann M; Anderson, Ruth A; Colón-Emeric, Cathleen S

    2015-01-01

    This study examined whether chronic kidney disease (CKD) is associated with recurrent falls in older adults in nursing homes (NHs). We used data abstracted over a six month period from 510 NH residents with a history of falls. Thirty-five percent of the NH residents had CKD. In adjusted analyses, the incidence of recurrent falls was similar in those with and without CKD [fall rate ratio (FRR) 1.00, 95% confidence interval (CI) 0.97-1.02]. Orthostatic hypotension (FRR 1.52, 95% CI 1.12-2.05), history of falls during the prior six month period (FRR 1.25, 95% CI 1.05-1.49), cane or walker use (FRR 1.64, 95% CI 1.16-2.33), and ambulatory dysfunction (FRR 1.47, 95% CI 1.23-1.75) were independently associated with increased fall rate. CKD was not an important predictor of falls in this cohort of nursing home residents with prior falls. Instead, traditional fall risk factors were much more strongly associated with recurrent falls. Published by Elsevier Inc.

  8. Family caregivers' experiences in nursing homes

    DEFF Research Database (Denmark)

    Lohne, Vibeke; Høy, Bente; Wilhelm Rehnsfeldt, Arne

    2014-01-01

    This qualitative study is focusing on dignity in nursing homes from the perspective of family caregivers. Dignity is a complex concept and central to nursing. Dignity in nursing homes is a challenge, according to research. Family caregivers are frequently involved in their family members’ daily...... experiences at the nursing home. This Scandinavian application study has a descriptive and explorative design. Twenty-nine family caregivers were included. A phenomenological-hermeneutic approach was used to understand the meaning of the narrated text. The interpretations revealed two main themes: “One should......, but still important in nursing homes. It seems therefore important to further investigate experiences of family caregivers in the context of nursing homes....

  9. Nursing Practice Environment and Registered Nurses' Job Satisfaction in Nursing Homes

    Science.gov (United States)

    Choi, JiSun; Flynn, Linda; Aiken, Linda H.

    2012-01-01

    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…

  10. Certified nursing assistants' perspectives of nursing home residents' pain experience: communication patterns, cultural context, and the role of empathy.

    Science.gov (United States)

    Dobbs, Debra; Baker, Tamara; Carrion, Iraida V; Vongxaiburana, Elizabeth; Hyer, Kathryn

    2014-03-01

    This study explored the following issues related to pain management among nursing home (NH) residents: 1) communication patterns between NH residents and certified nursing assistants (CNAs) about pain; 2) how race and ethnicity influence NH residents' pain experiences; and 3) CNAs' personal experiences with pain that may affect their empathy toward the resident's pain experience. The study consisted of a convenience sample of four focus groups (n = 28) from a NH in central Florida. A content analysis approach was used. Data were analyzed with the use of Atlas.ti version 6.2. The content analysis identified four main themes: 1) attitudes as barriers to communication about resident pain care; 2) cultural, religious, and gender influences of resident pain care by CNAs; 3) the role of empathy in CNAs care of residents with pain; and 4) worker strategies to detect pain. Attitudes among CNAs about resident cognitive status and perceived resident burden need to be recognized as barriers to the detection and reporting of pain by CNAs and should be addressed. In addition, NHs should consider a person-centered approach to pain that is culturally competent given the cultural influences of both residents and staff. Finally, educational programs for CNAs that include empathy-inducing scenarios could potentially improve the care provided by CNAs when dealing with residents' pain. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  11. Prevalence of Malnutrition in Orally and Tube-Fed Elderly Nursing Home Residents in Germany and Its Relation to Health Complaints and Dietary Intake

    OpenAIRE

    Volkert, Dorothee; Pauly, Lioba; Stehle, Peter; Sieber, Cornel C.

    2012-01-01

    Objective. To investigate the prevalence of malnutrition in orally and tube-fed nursing home (NH) residents in Germany and its relation to common health complaints and dietary intake. Methods. In 350 NH residents, subjects' characteristics, Mini Nutritional Assessment (MNA), and several health problems were inquired with the nursing staff using standardised interviews. In a subset of 122 residents, dietary intake was assessed by 3-day weighing records. Results. 7.7% of the participants were t...

  12. Chronic Kidney Disease and Recurrent Falls in Nursing Home Residents: A Retrospective Cohort Study

    OpenAIRE

    Hall, Rasheeda K.; Landerman, Lawrence R.; O'Hare, Ann M.; Anderson, Ruth A.; Colón-Emeric, Cathleen S.

    2015-01-01

    This study examined whether chronic kidney disease (CKD) is associated with recurrent falls in older adults in nursing homes (NHs). We used data abstracted over a six month period from 510 NH residents with a history of falls. Thirty-five percent of the NH residents had CKD. In adjusted analyses, the incidence of recurrent falls was similar in those with and without CKD [fall rate ratio (FRR) 1.00, 95% confidence interval (CI) 0.97-1.02]. Orthostatic hypotension (FRR 1.52, 95% CI 1.12-2.05), ...

  13. Nutritional care in a nursing home in Italy.

    Directory of Open Access Journals (Sweden)

    Lorenzo Maria Donini

    Full Text Available INTRODUCTION: Malnutrition is a clinical condition due to the imbalance among needs, intake and use of nutrients, leading to the increase of morbidity and mortality, and to the impairment of quality of life. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. A multicentric study called PIMAI (Project Iatrogenic MAlnutrition in Italy, was carried out in Italy over 2005. The aims of this study were to determine the prevalence of malnutrition in hospitals and in nursing care homes (NH, to assess the level of nutritional attention and to measure the perceived quality in food and nutritional care. This paper represents a preliminary analysis of data collected in a NH included in the PIMAI project. MATERIALS AND METHODS: A total of 100 subjects (29 males and 71 females, aged 80.2±10 years, were recruited from January to June 2005 at the Clinical Rehabilitation Institute "Villa delle Querce" in Nemi (Rome, among patients in the NH facility. All the participants underwent a multidimensional geriatric evaluation (considering nutritional, clinical, functional and cognitive parameters, and a survey on "perceived quality" of nutritional care. RESULTS AND DISCUSSION: According to nutritional status defined by the Mini Nutritional Assessment®, data analysis showed a high prevalence of malnutrition (36% especially related to advanced age, chewing, cognitive and functional impairments. Patients seemed to consider nutrition to be important for their health; on the other hand, they were not thoroughly satisfied with the quality of food. Particularly, it was observed scarce attention to nutritional status from medical and nursing staff. CONCLUSIONS: Our study confirms the need to pay greater attention to nutritional status in elderly institutionalized subjects. Medical and nursing teams need to be aware of the importance to perform an evaluation of nutritional status in

  14. Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes.

    Science.gov (United States)

    Chang, Jun-Yih; Chen, Liang-Kung; Chang, Chia-Ching

    2009-07-01

    This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Statistical significance between the two groups was observed in sex, age, and educational level (all pexpectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples' demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.

  15. Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs

    OpenAIRE

    Halvorsen, Kjell H.; Granås, Anne Gerd; Engeland, Anders; Ruths, Sabine

    2012-01-01

    Tverrsnittstudie, undersøker og sammenligner forskrivningskvaliteten hos eldre som bor i sykehjem og hjemme. Purpose: to examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services. Methods: Cross-sectional study comprising 11 254 patients aged ≥65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug–drug in...

  16. Transiting Exoplanet Survey Satellite (TESS)

    Science.gov (United States)

    Ricker, G. R.; Clampin, M.; Latham, D. W.; Seager, S.; Vanderspek, R. K.; Villasenor, J. S.; Winn, J. N.

    2012-01-01

    The Transiting Exoplanet Survey Satellite (TESS) will discover thousands of exoplanets in orbit around the brightest stars in the sky. In a two-year survey, TESS will monitor more than 500,000 stars for temporary drops in brightness caused by planetary transits. This first-ever spaceborne all-sky transit survey will identify planets ranging from Earth-sized to gas giants, around a wide range of stellar types and orbital distances. No ground-based survey can achieve this feat. A large fraction of TESS target stars will be 30-100 times brighter than those observed by Kepler satellite, and therefore TESS . planets will be far easier to characterize with follow-up observations. TESS will make it possible to study the masses, sizes, densities, orbits, and atmospheres of a large cohort of small planets, including a sample of rocky worlds in the habitable zones of their host stars. TESS will provide prime targets for observation with the James Webb Space Telescope (JWST), as well as other large ground-based and space-based telescopes of the future. TESS data will be released with minimal delay (no proprietary period), inviting immediate community-wide efforts to study the new planets. The TESS legacy will be a catalog of the very nearest and brightest main-sequence stars hosting transiting exoplanets, thus providing future observers with the most favorable targets for detailed investigations.

  17. Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

    Science.gov (United States)

    Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory

    2017-11-01

    The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. Nursing home work practices and nursing assistants' job satisfaction.

    Science.gov (United States)

    Bishop, Christine E; Squillace, Marie R; Meagher, Jennifer; Anderson, Wayne L; Wiener, Joshua M

    2009-10-01

    To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants' overall job satisfaction, controlling for personal characteristics and local labor market characteristics. Wages, benefits, and job demands, measured by the ratio of nursing assistant hours per resident day, were associated with job satisfaction. Consistent with previous studies, job satisfaction was greater when nursing assistants felt respected and valued by their employers and had good relationships with supervisors. Nursing assistants were more satisfied when they had enough time to complete their work, when their work was challenging, when they were not subject to mandatory overtime, and where food was not delivered to residents on trays. This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.

  19. Constructing a Measure of Private-pay Nursing Home Days.

    Science.gov (United States)

    Thomas, Kali S; Silver, Benjamin; Gozalo, Pedro L; Dosa, David; Grabowski, David C; Makineni, Rajesh; Mor, Vincent

    2018-05-01

    Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. To describe 2 novel measures of private-pay utilization in the NH setting, including the proportion of privately financed residents and resident days, and examine their construct validity. Retrospective descriptive analysis of US NHs in 2007-2009. We used Medicare claims, Medicare Enrollment records, and the Minimum Data Set to create measures of private-pay resident prevalence and proportion of privately financed NH days. We compared our estimates of private-pay utilization to payer data collected in the NH annual certification survey and evaluated the relationships of our measures with facility characteristics. Our measures of private-pay resident prevalence and private-pay days are highly correlated (r=0.83, Ppay residents and days in higher quality facilities. This new methodology provides estimates of private-pay resident prevalence and resident days. These measures were correlated with estimates using other data sources and validated against measures of facility quality. These data set the stage for additional work to examine questions related to NH payment, quality of care, and responses to changes in the long-term care market.

  20. Nursing home quality: a comparative analysis using CMS Nursing Home Compare data to examine differences between rural and nonrural facilities.

    Science.gov (United States)

    Lutfiyya, May Nawal; Gessert, Charles E; Lipsky, Martin S

    2013-08-01

    Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site. Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating. Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986). Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for

  1. Investigating the management of diabetes in nursing homes using a mixed methods approach.

    LENUS (Irish Health Repository)

    Hurley, L

    2017-03-21

    As populations age there is an increased demand for nursing home (NH) care and a parallel increase in the prevalence of diabetes. Despite this, there is growing evidence that the management of diabetes in NHs is suboptimal. The reasons for this are complex and poorly understood. This study aimed to identify the current level of diabetes care in NHs using a mixed methods approach.

  2. An international definition for "nursing home"

    NARCIS (Netherlands)

    Sanford, A.M.; Orrell, M.; Tolson, D.; Abbatecola, A.M.; Arai, H.; Bauer, J.M.; Cruz-Jentoft, A.J.; Dong, B.; Ga, H.; Goel, A.; Hajjar, R.; Holmerova, I.; Katz, P.R.; Koopmans, R.T.; Rolland, Y.; Visvanathan, R.; Woo, J.; Morley, J.E.; Vellas, B.

    2015-01-01

    There is much ambiguity regarding the term "nursing home" in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a

  3. Are nursing home survey deficiencies higher in facilities with greater staff turnover.

    Science.gov (United States)

    Lerner, Nancy B; Johantgen, Meg; Trinkoff, Alison M; Storr, Carla L; Han, Kihye

    2014-02-01

    To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies. The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States. This study focused on the 1151 NNHS facilities with complete deficiency data. Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models. High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10-2.13), Resident Behavior (OR 1.42, 95% CI 1.03-1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12-2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50-2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25-2.33). When both CNA turnover and licensed nurse turnover were

  4. Exploring the activity profile of health care assistants and nurses in home nursing.

    Science.gov (United States)

    De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Moons, Philip

    2015-12-01

    Are home nurses (also known as community nurses) ready for their changing role in primary care? A quantitative study was performed in home nursing in Flanders, Belgium, to explore the activity profile of home nurses and health care assistants, using the 24-hour recall instrument for home nursing. Seven dates were determined, covering each day of the week and the weekend, on which data collection would take place. All the home nurses and health care assistants from the participating organisations across Flanders were invited to participate in the study. All data were measured at nominal level. A total of 2478 home nurses and 277 health care assistants registered 336 128 (47 977 patients) and 36 905 (4558 patients) activities, respectively. Home nurses and health care assistants mainly perform 'self-care facilitation' activities in combination with 'psychosocial care' activities. Health care assistants also support home nurses in the 'selfcare facilitation' of patients who do not have a specific nursing indication.

  5. Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

    Directory of Open Access Journals (Sweden)

    Palmer Laura

    2003-05-01

    Full Text Available Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.

  6. Use of Clinical Health Information Technology in Nursing Homes: Nursing Home Characteristics and Quality Measures

    Science.gov (United States)

    Spinelli-Moraski, Carla

    2014-01-01

    This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…

  7. The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial.

    Science.gov (United States)

    Törmä, Johanna; Winblad, Ulrika; Saletti, Anja; Cederholm, Tommy

    2017-08-29

    Suboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. To compare two different implementation strategies, external facilitation (EF) and educational outreach visits (EOVs), when introducing nutritional guidelines in nursing homes (NHs), and study the impact on staff performance. A quasi-experimental study with baseline and follow-up measurements. The primary outcome was staff performance as a function of mealtime ambience and food service routines. The EF strategy was a 1-year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one-three-hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy. © 2017 Nordic College of Caring Science.

  8. Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes.

    Science.gov (United States)

    Hasson, Henna; Arnetz, Judith E

    2008-02-01

    The aims of this study were to: (1) compare older people care nursing staff's perceptions of their competence, work strain and work satisfaction in nursing homes and home-based care; and (2) to examine determinants of work satisfaction in both care settings. The shift in older people care from hospitals to community-based facilities and home care has had implications for nursing practice. Lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff in both care settings have been associated with high turnover. Few studies have compared staff perceptions of their competence and work in nursing homes as opposed to home-based care. A cross-sectional questionnaire survey. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire in 2003 in two older people care organizations in Sweden. Comparisons of all outcome variables were made between care settings both within and between the two organizations. Multiple regression analysis was used to determine predictors of work satisfaction in home care and nursing homes respectively. In general, staff in home-based care reported significantly less sufficient knowledge compared with staff in nursing homes. However, home care staff experienced significantly less physical and emotional strain compared with staff in nursing homes. Ratings of work-related exhaustion, mental energy and overall work satisfaction did not differ significantly between care settings. In both care settings, work-related exhaustion was the strongest (inverse) predictor of work satisfaction. Future interventions should focus on counteracting work-related exhaustion and improving competence development to improve work satisfaction among older people care nursing staff in both care settings. Relevance to clinical practice. Work-related exhaustion and lack of competence development may have significant negative implications for work satisfaction among

  9. Multidisciplinary nutritional support for undernutrition in nursing home and home-care

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe

    2016-01-01

    Objective To assess the effect of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care identified with the validated Eating Validation Scheme (EVS). Methods An 11 wk cluster randomized trial with a home-care (3 clusters) or nursing home (3 clusters.......3] versus 1.3 [0.5], P = 0.021) was observed. There was a almost significant difference in mortality (2% versus 13%, P = 0.079). Conclusions Multidisciplinary nutritional support in older adults in nursing home and home-care could have a positive effect on quality of life, muscle strength, and oral care....... means of EuroQol-5D-3L), physical performance (30-seconds chair stand), nutritional status (weight and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (participants from home-care), and mortality. Results Respectively, 55 (46 from 2 home...

  10. The Natural History of Nursing Home Patients.

    Science.gov (United States)

    Lewis, Mary Ann; And Others

    1985-01-01

    Former nursing home residents (N=197) were followed for 2 years after discharge. Four subgroups of patients were identified on the basis of different patterns of survival and use of health care resources: those who returned home, died in nursing homes, transferred to hospitals, or transferred to other nursing homes. (NRB)

  11. Data preparation for asteroseismology with TESS

    Directory of Open Access Journals (Sweden)

    Lund Mikkel N.

    2017-01-01

    Full Text Available The Transiting Exoplanet Survey Satellite (TESS is a NASA Astrophysics Explorer mission. Following its scheduled launch in 2017, TESS will focus on detecting exoplanets around the nearest and brightest stars in the sky, for which detailed follow-up observations are possible. TESS will, as the NASA Kepler mission, include a asteroseismic program that will be organized within the TESS Asteroseismic Science Consortium (TASC, building on the success of the Kepler Asteroseismic Science Consortium (KASC. Within TASC data for asteroseismic analysis will be prepared by the TASC Working Group 0 (WG-0, who will facilitate data to the community via the TESS Asteroseismic Science Operations Center (TASOC, again building on the success of the corresponding KASOC platform for Kepler. Here, we give an overview of the steps being taken within WG-0 to prepare for the upcoming TESS mission.

  12. Data preparation for asteroseismology with TESS

    Science.gov (United States)

    Lund, Mikkel N.; Handberg, Rasmus; Kjeldsen, Hans; Chaplin, William J.; Christensen-Dalsgaard, Jørgen

    2017-10-01

    The Transiting Exoplanet Survey Satellite (TESS) is a NASA Astrophysics Explorer mission. Following its scheduled launch in 2017, TESS will focus on detecting exoplanets around the nearest and brightest stars in the sky, for which detailed follow-up observations are possible. TESS will, as the NASA Kepler mission, include a asteroseismic program that will be organized within the TESS Asteroseismic Science Consortium (TASC), building on the success of the Kepler Asteroseismic Science Consortium (KASC). Within TASC data for asteroseismic analysis will be prepared by the TASC Working Group 0 (WG-0), who will facilitate data to the community via the TESS Asteroseismic Science Operations Center (TASOC), again building on the success of the corresponding KASOC platform for Kepler. Here, we give an overview of the steps being taken within WG-0 to prepare for the upcoming TESS mission.

  13. Registered nurse retention strategies in nursing homes: a two-factor perspective.

    Science.gov (United States)

    Hunt, Selina R; Probst, Janice C; Haddock, Kathlyn S; Moran, Robert; Baker, Samuel L; Anderson, Ruth A; Corazzini, Kirsten

    2012-01-01

    As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention. In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated. This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships. Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses. To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.

  14. Nursing perception of patient transitions from hospitals to home with home health.

    Science.gov (United States)

    Smith, Shannon Bright; Alexander, Judith W

    2012-01-01

    The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

  15. Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

    Directory of Open Access Journals (Sweden)

    Lauren J. Campbell MA

    2016-06-01

    Full Text Available Objectives: Racial/ethnic disparities in nursing homes (NHs are associated with lower quality of care, and state Medicaid payment policies may influence NH quality. However, no studies analyzing disparities in NH quality of life (QoL exist. Therefore, this study aims to estimate associations at the NH level between average number of QoL deficiencies and concentrations of racial/ethnic minority residents, and to identify effects of state Medicaid payment policies on racial/ethnic disparities. Method: Multivariable Poisson regression with NH random effects was used to determine the association between NH minority concentration in 2000 to 2010 and average number of QoL deficiencies in 2001 to 2011 at the NH level, and the effect of state NH payment policies on QoL deficiencies and racial/ethnic disparities in QoL deficiencies across NH minority concentrations. Results: Racial/ethnic disparities in QoL between high and low minority concentration NHs decrease over time, but are not eliminated. Case mix payment was associated with an increased disparity between high and low minority concentration NHs in QoL deficiencies. Discussion: NH managers and policy makers should consider initiatives targeting minority residents or low-performing NHs with higher minority concentrations for improvement to reduce disparities and address QoL deficiencies.

  16. More than communication skills: experiences of communication conflict in nursing home nurses.

    Science.gov (United States)

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Weng, Li-Chueh; Chou, Hsueh-Fen

    2013-10-01

    Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes. The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan. Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method. Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others. The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing). © 2013 John Wiley & Sons Ltd.

  17. Continuing Education Preferences, Facilitators, and Barriers for Nursing Home Nurses.

    Science.gov (United States)

    Dyck, Mary J; Kim, Myoung Jin

    2018-01-01

    The purpose of the study was to determine the continuing education needs for nursing home nurses in rural central Illinois and to determine any potential facilitators or barriers to obtaining continuing education. Data were collected using the Educational Needs Assessment questionnaire. Descriptive statistics were computed to examine continuing education preferences, facilitators, and barriers among nursing home nurses. Independent samples t tests were used to compare preferences between administrative and staff nurses. The sample included 317 nurses from 34 facilities. The five top needs were related to clinical problems. Administrative nurses had greater needs for professional issues, managerial skills, and quality improvement than staff nurses. Barriers included rural settings, need for vacation time for programs, and inadequate staffing. Continuing education needs of nursing home nurses in Illinois are similar to previous studies conducted in Arizona and North Carolina. Continuing education barriers were mostly organizational, rather than personal. J Contin Nurs Educ. 2018;49(1):26-33. Copyright 2018, SLACK Incorporated.

  18. Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.

    Science.gov (United States)

    Meesterberends, Esther; Halfens, Ruud J G; Spreeuwenberg, Marieke D; Ambergen, Ton A W; Lohrmann, Christa; Neyens, Jacques C L; Schols, Jos M G A

    2013-08-01

    To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. A prospective multicenter cohort study. Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular

  19. Fall prevention in nursing homes

    DEFF Research Database (Denmark)

    Andresen, Mette; Hauge, Johnny

    2014-01-01

    that the number of hospitalization after a fall injury will become an even greater task for the Danish hospitals, The aim of the study was to show if there is a relationship between physically frail elderly nursing home resident’s subjective evaluation of fall-risk and an objective evaluation of their balance....... Further, to suggest tools for fall prevention in nursing home settings on the basis of the results of this study and the literature. A quantitative method inspired by the survey method was used to give an overview of fall patterns, subjective and objective evaluations of fallrisk. Participants were 16...... physically frail elderly nursing home residents from three different nursing homes. Measures: a small staff-questionnaire about incidences and places where the participants had falling-episodes during a 12 month period, The Falls Effi cacy Scale Swedish version (FES(S)) and Berg Balance Scale (BBS) Results...

  20. Private investment purchase and nursing home financial health.

    Science.gov (United States)

    Orfaly Cadigan, Rebecca; Stevenson, David G; Caudry, Daryl J; Grabowski, David C

    2015-02-01

    To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998-2010. Regression specification incorporating facility and time fixed effects. We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company's real estate holdings. Private investment acquired facilities are an important feature of today's nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. © Health Research and Educational Trust.

  1. Design of nursing homes of the future

    NARCIS (Netherlands)

    Joost van Hoof

    2014-01-01

    Purpose There is an increasing call in society for improvementof the well-being of nursing home residents and support of health care professionals through a wide array of architectural and technological solutions that are available in modern nursing homes. The design of nursing home facilities calls

  2. Priorities for the professional development of registered nurses in nursing homes: a Delphi study.

    Science.gov (United States)

    Cooper, Emily; Spilsbury, Karen; McCaughan, Dorothy; Thompson, Carl; Butterworth, Tony; Hanratty, Barbara

    2017-01-08

    To establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. Two-stage, online modified Delphi study. A panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. If nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration.

  3. Nursing home safety: does financial performance matter?

    Science.gov (United States)

    Oetjen, Reid M; Zhao, Mei; Liu, Darren; Carretta, Henry J

    2011-01-01

    This study examines the relationship between financial performance and selected safety measures of nursing homes in the State of Florida. We used descriptive analysis on a total sample of 1,197. Safety information was from the Online Survey, Certification and Reporting (OSCAR) data of 2003 to 2005, while the financial performance measures were from the Medicare cost reports of 2002 to 2004. Finally, we examined the most frequently cited deficiencies as well as the relationship between financial performance and quality indicators. Nursing homes in the bottom quartile of financial performance perform poorly on most resident-safety measures of care; however, nursing homes in the top two financial categories also experienced a higher number of deficiencies. Nursing homes in the next to lowest quartile of financial performance category best perform on most of these safety measures. The results reinforce the need to monitor nursing home quality and resident safety in US nursing homes, especially among facilities with poor overall financial performance.

  4. Using spontaneous commentary of nursing home residents to develop resident-centered measurement tools: A case study.

    Science.gov (United States)

    Bangerter, Lauren R; Abbott, Katherine; Heid, Allison; Eshraghi, Karen; Van Haitsma, Kimberly

    Nursing home (NH) residents routinely complete surveys that assess their health, well-being, preferences, and care needs. Such surveys reveal important information, however, are largely based on the concerns of providers as opposed to the concerns of residents. Thus, researchers must enhance efforts to ensure that these surveys are guided by the priorities, needs, and concerns of residents. We present a case study to demonstrate how spontaneous commentary of NH residents holds particular efficacy for ensuring that measurement tools are guided by the needs, concerns, and priorities of residents. Spontaneous comments from NH residents (N = 370) collected as part of a study developing the Preferences for Everyday Living Inventory for NH residents (PELI-NH) were used to refine the PELI-NH across key phases of measurement development. This work demonstrates how the spontaneous commentary of NH residents may contribute to the refinement of NH measurement tools, and allow researchers to base these tools on the needs and priorities of NH residents. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Dental caries in Victorian nursing homes.

    Science.gov (United States)

    Silva, M; Hopcraft, M; Morgan, M

    2014-09-01

    The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services. © 2014 Australian Dental Association.

  6. Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes

    Directory of Open Access Journals (Sweden)

    Beck Barbara-Beate

    2009-12-01

    Full Text Available Abstract Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices

  7. Private Investment Purchase and Nursing Home Financial Health

    Science.gov (United States)

    Cadigan, Rebecca Orfaly; Stevenson, David G; Caudry, Daryl J; Grabowski, David C

    2015-01-01

    Objective To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company’s real estate holdings. Conclusions Private investment acquired facilities are an important feature of today’s nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. PMID:25104476

  8. Development of the International Guidelines for Home Health Nursing.

    Science.gov (United States)

    Narayan, Mary; Farris, Cindy; Harris, Marilyn D; Hiong, Fong Yoke

    2017-10-01

    Throughout the world, healthcare is increasingly being provided in home and community-based settings. There is a growing awareness that the most effective, least costly, patient-preferred setting is patients' home. Thus, home healthcare nursing is a growing nursing specialty, requiring a unique set of nursing knowledge and skills. Unlike many other nursing specialties, home healthcare nursing has few professional organizations to develop or support its practice. This article describes how an international network of home healthcare nurses developed international guidelines for home healthcare nurses throughout the world. It outlines how the guidelines for home healthcare nursing practice were developed, how an international panel of reviewers was recruited, and the process they used for reaching a consensus. It also describes the plan for nurses to contribute to future updates to the guidelines.

  9. Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations.

    Science.gov (United States)

    Siegel, Elena O; Bettega, Kristen; Bakerjian, Debra; Sikma, Suzanne

    2018-06-01

    Nursing homes use team nursing, with minimal RN presence, leaving the majority of direct care to licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP), including medication aides. The current article describes challenges faced by nursing home directors of nursing (DONs) leading and managing a team nursing approach, including consideration of scope of practice, delegation and supervision regulations, and related policy implications. A secondary data analysis was performed of qualitative data from a study to develop and test DON guidelines for delegation in nursing home practice. A convenience sample (N = 29) of current or previous DONs and other nursing home leaders with knowledge and expertise in the DON role participated in in-depth, guided interviews. The findings highlight a core concern to nursing licensure policy and regulation: knowledge and practice gaps related to scope of practice and delegation and supervision among DONs, RNs, and LPNs/LVNs, as well as administrators, and the role of nursing leaders in supporting appropriate delegation practices. The findings offer directions for research and practice in addressing challenges in aligning team nursing practices with regulatory standards as well as the related gaps in knowledge among DONs, administrators, and nursing staff. [Journal of Gerontological Nursing, 44(6), 10-14.]. Copyright 2018, SLACK Incorporated.

  10. Factors influencing home care nurse intention to remain employed.

    Science.gov (United States)

    Tourangeau, Ann; Patterson, Erin; Rowe, Alissa; Saari, Margaret; Thomson, Heather; MacDonald, Geraldine; Cranley, Lisa; Squires, Mae

    2014-11-01

    To identify factors affecting Canadian home care nurse intention to remain employed (ITR). In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors. A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis. Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions. Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR. Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members. © 2013 John Wiley & Sons Ltd.

  11. Interprofessional collaboration in nursing homes (interprof): a grounded theory study of general practitioner experiences and strategies to perform nursing home visits.

    Science.gov (United States)

    Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A

    2016-08-30

    Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.

  12. Staff Distress Improves by Treating Pain in Nursing Home Patients With Dementia: Results From a Cluster-Randomized Controlled Trial.

    Science.gov (United States)

    Aasmul, Irene; Husebo, Bettina Sandgathe; Flo, Elisabeth

    2016-12-01

    Most people with dementia develop neuropsychiatric symptoms (NPSs), which are distressing for their carers. Untreated pain may increase the prevalence and severity of NPSs and thereby staff burden. We investigated the association between NPSs and the impact of individual pain treatment on distress in nursing home staff. Nursing home (NH) units were cluster-randomized to an intervention group (33 NH units; n = 175) or control group (27 NH units; n = 177). Patients in the intervention group received individual pain treatment for eight weeks, followed by a four-week washout period; control groups received care as usual. Staff informants (n = 138) used the Neuropsychiatric Inventory-NH version (including caregiver distress) as primary outcome to assess their own distress. Other outcomes were pain (Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale) and cognitive functioning (Mini-Mental State Examination). Using hierarchical regression analysis, all NPS items at baseline were associated with staff distress (P pain treatment reduced staff distress in the intervention group compared to control group especially in regard to agitation-related symptoms and apathy. Furthermore, our results indicated a multifactorial model of staff distress, in which enhanced knowledge and understanding of NPSs and pain in people with advanced dementia may play an important role. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

    Science.gov (United States)

    Leontjevas, Ruslan; Gerritsen, Debby L; Koopmans, Raymond T C M; Smalbrugge, Martin; Vernooij-Dassen, Myrra J F J

    2012-06-01

    A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). Before effect analyses, to evaluate AiD process data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, extent to which AiD was performed), which can be used for understanding internal and external validity. In this article, a model is presented that divides process evaluation data into first- and second-order process data. Qualitative and quantitative data based on personal files of residents, interviews of nursing home professionals, and a research database were analyzed according to the following process evaluation components: sampling quality and intervention quality. Nursing home. The pattern of residents' informed consent rates differed for dementia special care units and somatic units during the study. The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant. With the exception of the first screening step (nursing staff members using a short observer-based depression scale), AiD components were not performed fully by NH staff as prescribed in the AiD protocol. Although NH staff found the program relevant and feasible and was satisfied with the program content, individual AiD components may have different feasibility. The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit, whereas the findings on intervention quality implied that, next to the type of unit, analyses should account for the extent to which individual AiD program components were performed. In general, our first-order process data evaluation confirmed internal and external validity of the AiD trial, and this evaluation enabled further statistical fine tuning. The importance of

  14. Home health care nurses' perceptions of empowerment.

    Science.gov (United States)

    Williamson, Kathleen M

    2007-01-01

    This exploratory study involved the triangulation of qualitative (interview and observation) and quantitative methods (Psychological Empowerment Instrument). This study examined the individual home care nurses' perception of empowerment and how it influences decisions in the home clinical setting. Fifteen nurses were self-selected to participate. All completed an interview, and were observed and given Likert Instrument to complete. A framework analysis was performed to identify mutually exclusive and exhaustive emergent themes and patterns within the data. Home care nurses described that enpowerment is in the interaction between nurse and patient, and nurse and health care provider. Empowered is defined as being independent, confident, trusting, and comfortable with providing quality care. Home health care nurses believe that having the ability to practice collaboratively and build professional relationships was essential. Nurses in this study perceived empowerment as having meaning, choice, and competence in their job.

  15. 38 CFR 17.57 - Use of community nursing homes.

    Science.gov (United States)

    2010-07-01

    ... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following... currently receiving VA hospital based home health services. (Authority: 38 U.S.C. 1720; sec. 108, Pub. L. 99...

  16. The hospital anxiety and depression scale--dimensionality, reliability and construct validity among cognitively intact nursing home patients.

    Science.gov (United States)

    Haugan, Gørill; Drageset, Jorunn

    2014-08-01

    Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted. To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population. Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used. The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported. Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias. Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Essential elements of the nursing practice environment in nursing homes: Psychometric evaluation.

    Science.gov (United States)

    de Brouwer, Brigitte Johanna Maria; Kaljouw, Marian J; Schoonhoven, Lisette; van Achterberg, Theo

    2017-06-01

    To develop and psychometrically test the Essentials of Magnetism II in nursing homes. Increasing numbers and complex needs of older people in nursing homes strain the nursing workforce. Fewer adequately trained staff and increased care complexity raise concerns about declining quality. Nurses' practice environment has been reported to affect quality of care and productivity. The Essentials of Magnetism II © measures processes and relationships of practice environments that contribute to productivity and quality of care and can therefore be useful in identifying processes requiring change to pursue excellent practice environments. However, this instrument was not explicitly evaluated for its use in nursing home settings so far. In a preparatory phase, a cross-sectional survey study focused on face validity of the essentials of magnetism in nursing homes. A second cross-sectional survey design was then used to further test the instrument's validity and reliability. Psychometric testing included evaluation of content and construct validity, and reliability. Nurses (N = 456) working at 44 units of three nursing homes were included. Respondent acceptance, relevance and clarity were adequate. Five of the eight subscales and 54 of the 58 items did meet preset psychometric criteria. All essentials of magnetism are considered relevant for nursing homes. The subscales Adequacy of Staffing, Clinically Competent Peers, Patient Centered Culture, Autonomy and Nurse Manager Support can be used in nursing homes without problems. The other subscales cannot be directly applied to this setting. The valid subscales of the Essentials of Magnetism II instrument can be used to design excellent nursing practice environments that support nurses' delivery of care. Before using the entire instrument, however, the other subscales have to be improved. © 2016 John Wiley & Sons Ltd.

  18. Cost-effectiveness implications based on a comparison of nursing home and home health case mix.

    OpenAIRE

    Kramer, A M; Shaughnessy, P W; Pettigrew, M L

    1985-01-01

    Case-mix differences between 653 home health care patients and 650 nursing home patients, and between 455 Medicare home health patients and 447 Medicare nursing home patients were assessed using random samples selected from 20 home health agencies and 46 nursing homes in 12 states in 1982 and 1983. Home health patients were younger, had shorter lengths of stay, and were less functionally disabled than nursing home patients. Traditional long-term care problems requiring personal care were more...

  19. Eldercare at Home: Choosing a Nursing Home

    Science.gov (United States)

    ... required, these services can be provided by a separate home health agency as directed by a doctor or ... complaints made by or on behalf of nursing home residents and work to resolve the problems. If they are unable ...

  20. Geriatric study in Europe on health effects of air quality in nursing homes (GERIE study) profile: objectives, study protocol and descriptive data.

    Science.gov (United States)

    Annesi-Maesano, Isabella; Norback, Dan; Zielinski, Jan; Bernard, Alfred; Gratziou, Cristina; Sigsgaard, Torben; Sestini, Piersante; Viegi, Giovanni

    2013-11-21

    Indoor air pollution (IAP) constitutes a major global public health problem requiring increasing efforts in research and policymaking that may have special significance for elderly that are likely to spend most of their day indoors and appear to be particularly susceptible to adverse effects of chemical pollutants and bio-contaminants. Yet, evidence existing on the effects of IAP in elderly is scanty. The Geriatric study in Europe on health effects of air quality in nursing homes (GERIE) study aimed to assess health effects of major indoor air pollutants and thermal conditions in elderly (> 70 years) living stably in nursing homes (NH) across Europe. Respiratory effects were particularly considered as airways and lung constitute the first target of air pollutants. We describe here the rationale and the methods of the GERIE Study. 8 nursing homes were randomly selected in 7 European countries. Twenty individuals were randomly selected in each nursing home. Major indoor and outdoor air chemical pollutants (PM10, PM2.5, PM0.1, formaldehyde, NO2; O3, VOC, CO2) and bio-contaminants (moulds, allergens) were assessed objectively with standardized procedures. Major health status indicators were assessed through a standardized questionnaire, non-invasive clinical tests and blood and urine biomarkers as well as saliva for ADN. The GERIE study has given the opportunity to publish two reviews on respiratory health effects of indoor and outdoor air pollution in elderly. In addition it has provided the inventory of air quality and thermal conditions in 50 nursing homes across Europe and data on respiratory health status in 600 elderly aged 82 years in mean. Major future results will include the relationships between NH environment and health in elderly. The main long-term purpose of the GERIE study is to improve the health of elderly who permanently reside in nursing homes or of those who are exposed to indoor air pollution because of reduced mobility.

  1. Effect of prospective reimbursement on nursing home costs.

    OpenAIRE

    Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

    1993-01-01

    OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and ...

  2. Malpractice paid losses and financial performance of nursing homes.

    Science.gov (United States)

    Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J

    2011-01-01

    Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

  3. Animal-Assisted Interventions in Dutch Nursing Homes: A Survey.

    Science.gov (United States)

    Schuurmans, Lonneke; Enders-Slegers, Marie-Jose; Verheggen, Theo; Schols, Jos

    2016-07-01

    Animal-assisted interventions (AAI) have become more and more popular in nursing homes in the past decade. Various initiatives for using animals in nursing homes have been developed over the years (eg, animal visiting programs, residential companion animals, petting zoos) and, on the whole, the number of nursing homes that refuse animals on their premises has declined. In this survey, we aimed to determine how many Dutch nursing homes offer AAIs, what type of interventions are used, and with what aim. We also focus on the use of underlying health, hygiene, and (animal) safety protocols. Using an online Dutch nursing home database, we invited all listed (457) nursing home organizations in the Netherlands (encompassing a total of 804 nursing home locations) to participate in our digital survey, powered by SurveyMonkey. The survey consisted of a total of 45 questions, divided into general questions about the use of animals in interventions; the targeted client population(s); and specific questions about goals, guidelines, and protocols. The results were analyzed with SPSS Statistics. In the end, 244 surveys, representing 165 organizations, were returned: 125 nursing homes used AAI in one way or another, 40 did not. Nursing homes that did not offer AAI cited allergy and hygiene concerns as the most important reasons. Most nursing homes offering AAI used visiting animals, mostly dogs (108) or rabbits (76). A smaller number of nursing homes had resident animals, either living on the ward or in a meadow outside. Almost all programs involved animal-assisted activities with a recreational purpose; none of the participating nursing homes provided animal assisted therapy with therapeutic goals. Psychogeriatric patients were most frequently invited to participate. A total of 88 nursing homes used alternatives when animals were not an option or not available. The most popular alternative was the use of stuffed animals (83) followed by FurReal Friends robotic toys (14). The

  4. Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS)

    NARCIS (Netherlands)

    Willemsen, I.; Nelson-Melching, J.; Hendriks, Y.; Mulders, A.; Verhoeff, S.; Kluytmans-Vandenbergh, M.; Kluytmans, J.

    2014-01-01

    BACKGROUND: We developed a standardised method to assess the quality of infection control in Dutch Nursing Home (NH), based on a cross-sectional survey that visualises the results. The method was called the Infection control RIsk Infection Scan (IRIS). We tested the applicability of this new tool in

  5. Introduction of assistive devices: home nurses' practices and beliefs.

    Science.gov (United States)

    Roelands, Marc; Van Oost, Paulette; Depoorter, Anne Marie; Buysse, Ann; Stevens, Veerle

    2006-04-01

    This paper reports a study describing home nurses' intention and current practices regarding introducing assistive devices, and investigating whether their practice is related to social cognitive factors (attitudes, subjective norms and self-efficacy). Home nurses not only care for patients in particular medical domains, but also educate and guide them towards more independence. Patients with age-related disabilities in mobility and self-care might benefit from the use of assistive devices. A home nurse might be the first and only person to discuss the disability and use of an assistive device. Therefore, home nurses' beliefs about the introduction of assistive devices could affect their daily practices. A cross-sectional study was conducted with a convenience sample of 64 home nurses chosen from a random sample of home nursing departments. The home nurses completed a self-administered questionnaire. The Theory of Planned Behaviour framework was used to develop the social cognitive measures regarding each of the six steps distinguished in the introduction of assistive devices. Home nurses had positive attitudes and high levels of intention, subjective norm and self-efficacy towards most steps of the decision process to introduce assistive devices. In a multiple linear regression analysis, attitude and self-efficacy predicted intention to introduce assistive devices to older clients with disabilities. Intention was correlated to home nurses' current practices. The findings suggest that conditions are present to involve home nurses more explicitly in the introduction of assistive devices to their patients. Social cognitive factors should be taken into account when developing interventions that aim to support home nurses to do this.

  6. The State of Nursing Home Information Technology Sophistication in Rural and Nonrural US Markets.

    Science.gov (United States)

    Alexander, Gregory L; Madsen, Richard W; Miller, Erin L; Wakefield, Douglas S; Wise, Keely K; Alexander, Rachel L

    2017-06-01

    To test for significant differences in information technology sophistication (ITS) in US nursing homes (NH) based on location. We administered a primary survey January 2014 to July 2015 to NH in each US state. The survey was cross-sectional and examined 3 dimensions (IT capabilities, extent of IT use, degree of IT integration) among 3 domains (resident care, clinical support, administrative activities) of ITS. ITS was broken down by NH location. Mean responses were compared across 4 NH categories (Metropolitan, Micropolitan, Small Town, and Rural) for all 9 ITS dimensions and domains. Least square means and Tukey's method were used for multiple comparisons. Methods yielded 815/1,799 surveys (45% response rate). In every health care domain (resident care, clinical support, and administrative activities) statistical differences in facility ITS occurred in larger (metropolitan or micropolitan) and smaller (small town or rural) populated areas. This study represents the most current national assessment of NH IT since 2004. Historically, NH IT has been used solely for administrative activities and much less for resident care and clinical support. However, results are encouraging as ITS in other domains appears to be greater than previously imagined. © 2016 National Rural Health Association.

  7. "I'm not sure I'm a nurse": A hermeneutic phenomenological study of nursing home nurses' work identity.

    Science.gov (United States)

    Thompson, Juliana; Cook, Glenda; Duschinsky, Robbie

    2018-03-01

    To explore nursing home nurses' experiences and views of work identity. Nursing home nurses are in a unique position as they work at the interface of health and social care. Little is known about nursing home nurses' perceptions and experiences of working within this context. Evidence suggests that using the concept of work identity can support understanding of how workers make sense of their work. Hermeneutic phenomenological study. The study was carried out in seven nursing homes in North East England. Findings are based upon literary analysis of multiple episodic interviews with 13 nursing home nurses. Participants' responses suggested that nursing "residents" is different to nursing "patients," and nursing home nurses are required to modify their care activities to account for these differences. Participants also proposed that they are isolated and excluded from the rest of the healthcare workforce group. These issues led participants to feel uncertain about work identity. Many participants attempted to strengthen their work identity by aligning their role with what they perceived the "nurse identity" to be. Nurses' work activities and professional group identity influence their work identity. When work activities and professional group identity do not align with role expectations, as can be the case for nursing home nurses, work identity may be compromised. These nurses may attempt to change work practices to strengthen their work identity. Health- and social care providers need to account for work identity factors in the organisation of care, and planning and implementation of integrated health- and social care initiatives. © 2017 John Wiley & Sons Ltd.

  8. Green House Adoption and Nursing Home Quality.

    Science.gov (United States)

    Afendulis, Christopher C; Caudry, Daryl J; O'Malley, A James; Kemper, Peter; Grabowski, David C

    2016-02-01

    To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures. Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010. Using a difference-in-differences framework, we compared changes in care quality and outcomes in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nursing homes that had not adopted the GH model. For individuals residing in GH homes, adoption of the model lowered readmissions and several MDS measures of poor quality, including bedfast residents, catheter use, and pressure ulcers, but these results were not present across the entire GH organization, suggesting possible offsetting effects for residents of non-GH "legacy" units within the GH organization. GH adoption led to improvement in rehospitalizations and certain nursing home quality measures for individuals residing in a GH home. The absence of evidence of a decline in other clinical quality measures in GH nursing homes should reassure anyone concerned that GH might have sacrificed clinical quality for improved quality of life. © Health Research and Educational Trust.

  9. Patient safety culture in Norwegian nursing homes.

    Science.gov (United States)

    Bondevik, Gunnar Tschudi; Hofoss, Dag; Husebø, Bettina Sandgathe; Deilkås, Ellen Catharina Tveter

    2017-06-20

    Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue. In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence

  10. A comparison of the nursing home evacuation experience between hurricanes katrina (2005) and gustav (2008).

    Science.gov (United States)

    Blanchard, Gary; Dosa, David

    2009-11-01

    One of the tragic legacies of Hurricane Katrina was the loss of life among Louisiana (LA) nursing home (NH) residents. Katrina revealed a staggering lack of emergency preparation and understanding of how to safely evacuate frail populations. Three years later, LA braced for Hurricane Gustav, a storm heralded to rival Katrina's power. Although its magnitude of destruction ultimately paled to Katrina, the warnings and predicted path preceding Gustav yielded a process of NH evacuations similar to Katrina. The goal of this article was to ascertain whether NH administrative directors (ADs) felt more prepared to evacuate before Gustav. In 2006, Dosa et al(5) (J Am Med Dir Assoc, 3/07), interviewed 20 NH ADs by qualitative telephone survey to evaluate their lessons learned from Katrina. Administrators at these 20 participating nursing homes were contacted and asked to participate in a follow-up survey to compare hurricane preparedness between 2005 and 2008. Specifically, ADs were asked if they evacuated before Gustav, their destination, and about logistical issues with evacuation (eg, transportation, injuries). ADs were asked to rate their confidence with state assistance, hurricane transportation, and evacuation preparedness on a 10-point scale (10=most confident) and compare their preparedness to Katrina. Sixteen of the 20 NHs that participated in 2006 agreed to be surveyed-11 of whom held the same position before Katrina. Unlike Katrina, when only 45% evacuated before the storm, all 16 NHs evacuated before Gustav (56% to another NH and 46% to a church, gym, college, or other facility). Overall, ADs rated their confidence in preparedness for Gustav as a mean of 8.3 (range 5 to 10) compared with a mean of 5.4 (range 3 to 8) for Katrina, a 54% improvement. Of the 11 ADs employed pre-Katrina, 73% reported improved collaboration with the state and 55% noted improved transportation. Nevertheless, 7 ADs noted significant logistical problems during evacuation (mostly

  11. Intergrated dental care in nursing homes

    NARCIS (Netherlands)

    Gerritsen, P.F.M.

    2015-01-01

    The thesis deals with integrated dental care in nursing homes. First, the dental treatment needs were ascertained of 432 residents in three Dutch nursing homes that offer integrated dental care. Dentist researchers intra-orally examined the residents and found that 72% required dental treatment.

  12. The TESS Input Catalog and Selection of Targets for the TESS Transit Search

    Science.gov (United States)

    Pepper, Joshua; Stassun, Keivan G.; Paegert, Martin; Oelkers, Ryan; De Lee, Nathan Michael; Torres, Guillermo; TESS Target Selection Working Group

    2018-01-01

    The TESS mission will photometrically survey millions of the brightest stars over almost the entire the sky to detect transiting exoplanets. A key step to enable that search is the creation of the TESS Input Catalog (TIC), a compiled catalog of 700 million stars and galaxies with observed and calculated parameters. From the TIC we derive the Candidate Target List (CTL) to identify target stars for the 2-minute TESS postage stamps. The CTL is designed to identify the best stars for the detection of small planets, which includes all bright cool dwarf stars in the sky. I will describe the target selection strategy, the distribution of stars in the current CTL, and how both the TIC and CTL will expand and improve going forward.

  13. Depression in nursing homes.

    Science.gov (United States)

    Snowdon, John

    2010-11-01

    Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended. This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008-2009 were collected from three Sydney nursing homes. CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged. Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.

  14. The uniqueness of elderly care: registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care.

    Science.gov (United States)

    Carlson, Elisabeth; Bengtsson, Mariette

    2014-04-01

    The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments. © 2013.

  15. FastStats: Nursing Home Care

    Science.gov (United States)

    ... Submit What's this? Submit Button NCHS Home Nursing Home Care Recommend on Facebook Tweet Share Compartir Data are ... Person’s Health Related Links Adult Day Services Centers Home Health Care Hospice Care National Study of Long-Term Care ...

  16. Survival after Out-of-Hospital Cardiac Arrest in Nursing Homes

    DEFF Research Database (Denmark)

    Pape, Marianne; Rajan, Shahzleen; Hansen, Steen Møller

    2018-01-01

    BACKGROUND: Survival among nursing home residents who suffers out-of-hospital cardiac arrest (OHCA) is sparsely studied. Deployment of automated external defibrillators (AEDs) in nursing home facilities in Denmark is unknown. We examined 30-day survival following OHCA in nursing and private home...... residents. METHODS: This register-based, nationwide, follow-up study identified OHCA-patients ≥18 years of age with a resuscitation attempt in nursing homes and private homes using Danish Cardiac Arrest Register data from June 1, 2001 to December 31, 2014. The primary outcome measure was 30-day survival....... Multiple logistic regression analyses were used to assess factors potentially associated with survival among nursing and private home residents separately. RESULTS: Of 26,999 OCHAs, 2516 (9.3%) occurred in nursing homes, and 24,483 (90.7%) in private homes. Nursing home residents were older (median 83 (Q1...

  17. Essential elements of the nursing practice environment in nursing homes: Psychometric evaluation

    NARCIS (Netherlands)

    Brouwer, B.J.M. de; Kaljouw, M.J.; Schoonhoven, L.; Achterberg, T. van

    2017-01-01

    AIMS AND OBJECTIVES: To develop and psychometrically test the Essentials of Magnetism II in nursing homes. BACKGROUND: Increasing numbers and complex needs of older people in nursing homes strain the nursing workforce. Fewer adequately trained staff and increased care complexity raise concerns about

  18. Comparing Public Quality Ratings for Accredited and Nonaccredited Nursing Homes.

    Science.gov (United States)

    Williams, Scott C; Morton, David J; Braun, Barbara I; Longo, Beth Ann; Baker, David W

    2017-01-01

    Compare quality ratings of accredited and nonaccredited nursing homes using the publicly available Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data set. This cross-sectional study compared the performance of 711 Joint Commission-accredited (TJC-accredited) nursing homes (81 of which also had Post-Acute Care Certification) to 14,926 non-Joint Commission-accredited (non-TJC-accredited) facilities using the Nursing Home Compare data set (as downloaded on April 2015). Measures included the overall Five-Star Quality Rating and its 4 components (health inspection, quality measures, staffing, and RN staffing), the 18 Nursing Home Compare quality measures (5 short-stay measures, 13 long-stay measures), as well as inspection deficiencies, fines, and payment denials. t tests were used to assess differences in rates for TJC-accredited nursing homes versus non-TJC-accredited nursing homes for quality measures, ratings, and fine amounts. Analysis of variance models were used to determine differences in rates using Joint Commission accreditation status, nursing home size based on number of beds, and ownership type. An additional model with an interaction term using Joint Commission accreditation status and Joint Commission Post-Acute Care Certification status was used to determine differences in rates for Post-Acute Care Certified nursing homes. Binary variables (eg, deficiency type, fines, and payment denials) were evaluated using a logistic regression model with the same covariates. After controlling for the influences of facility size and ownership type, TJC-accredited nursing homes had significantly higher star ratings than non-TJC-accredited nursing homes on each of the star rating component subscales (P homes with Post-Acute Care Certification performed statistically better on the overall star rating, as well as 3 of the 4 subscales (P homes had statistically fewer deficiencies than non-TJC-accredited nursing homes (P payment denials (P homes

  19. Washington State Nursing Home Administrator Model Curriculum. Final Report.

    Science.gov (United States)

    Cowan, Florence Kelly

    The course outlines presented in this final report comprise a proposed Fort Steilacoom Community College curriculum to be used as a statewide model two-year associate degree curriculum for nursing home administrators. The eight courses described are introduction to nursing, home administration, financial management of nursing homes, nursing home…

  20. Rules of performance in the nursing home: A grounded theory of nurse-CNA communication.

    Science.gov (United States)

    Madden, Connie; Clayton, Margaret; Canary, Heather E; Towsley, Gail; Cloyes, Kristin; Lund, Dale

    This study offers an initial theoretical understanding of nurse-CNA communication processes from the perspectives of nurses and CNAs who are providing direct care to residents in nursing homes. A grounded theory approach provided an understanding of nurse-CNA communication process within the complexities of the nursing home setting. Four themes (maintaining information flow, following procedure, fostering collegiality, and showing respect) describe the "rules of performance" that intertwine in nuanced relationships to guide nurse-CNA communication processes. Understanding how these rules of performance guide nurse-CNA communication processes, and how they are positively and negatively influenced, suggests that nurse-CNA communication during direct care of nursing home residents could be improved through policy and education that is specifically designed to be relevant and applicable to direct care providers in the nursing home environment. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. [Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services].

    Science.gov (United States)

    Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee

    2015-10-01

    The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

  2. Falls documentation in nursing homes: agreement between the minimum data set and chart abstractions of medical and nursing documentation.

    Science.gov (United States)

    Hill-Westmoreland, Elizabeth E; Gruber-Baldini, Ann L

    2005-02-01

    To assess the agreement between falls as recorded in the Minimum Data Set (MDS) and fall events abstracted from chart documentation of elderly nursing home (NH) residents. Secondary analysis of data from a longitudinal panel study. Fifty-six randomly selected NHs in Maryland stratified by facility size and geographic region. Four hundred sixty-two NH residents, aged 65 and older, in NHs for 1 year. Falls were abstracted from resident charts and compared with MDS fall variables. Fall events data obtained from other sources of chart documentation were matched for the corresponding periods of 30 and 180 days before the 1-year MDS assessment date. For a 30-day period, concordance between the MDS and chart abstractions of falls occurred in 65% of cases, with a kappa coefficient of 0.29 (Pfalls the MDS missed indicated that these residents had significantly more activity of daily living impairment and significantly less unsteady gait and cane/walker use. The MDS underreported falls. Nurses completing MDS assessments must carefully review residents' medical records for falls documentation. Future studies should use caution when employing MDS data as the only indicator of falls.

  3. Is higher nursing home quality more costly?

    Science.gov (United States)

    Giorgio, L Di; Filippini, M; Masiero, G

    2016-11-01

    Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes.

  4. Effect of prospective reimbursement on nursing home costs.

    Science.gov (United States)

    Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

    1993-04-01

    This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

  5. Competence for older people nursing in care and nursing homes: An integrative review.

    Science.gov (United States)

    Kiljunen, Outi; Välimäki, Tarja; Kankkunen, Päivi; Partanen, Pirjo

    2017-09-01

    People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes. Integrative literature review. We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce. The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people. © 2016 John Wiley & Sons Ltd.

  6. Translating research into practice in nursing homes: can we close the gap?

    Science.gov (United States)

    Rahman, Anna N; Applebaum, Robert A; Schnelle, John F; Simmons, Sandra F

    2012-10-01

    A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model. The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.

  7. Registered nurses' perceptions of their professional work in nursing homes and home-based care: a focus group study.

    Science.gov (United States)

    Carlson, Elisabeth; Rämgård, Margareta; Bolmsjö, Ingrid; Bengtsson, Mariette

    2014-05-01

    In Sweden, as well as in most industrialised countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialised in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care. The aim of the present study was to illuminate how nurses, working in nursing homes and home-based care, perceived their professional work. This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analysed in line with the tradition of naturalistic inquiry. Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing. Three categories of professional work emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness. The findings are important as they represent positive alternatives to the somewhat prevailing view on elderly care as depressing and undemanding. Nurse educators might use the key aspects as good examples, thus influencing student nurses' attitudes towards elderly care in a positive way. Elderly care agencies might find them helpful when recruiting and retaining nurses to a much needed area. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Implementation of Electronic Health Records in US Nursing Homes.

    Science.gov (United States)

    Bjarnadottir, Ragnhildur I; Herzig, Carolyn T A; Travers, Jasmine L; Castle, Nicholas G; Stone, Patricia W

    2017-08-01

    While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.

  9. Influence of Nurse Aide Absenteeism on Nursing Home Quality.

    Science.gov (United States)

    Castle, Nicholas G; Ferguson-Rome, Jamie C

    2015-08-01

    In this analysis, the association of nurse aide absenteeism with quality is examined. Absenteeism is the failure of nurse aides to report for work when they are scheduled to work. Data used in this investigation came from survey responses from 3,941 nursing homes; Nursing Home Compare; the Online System for Survey, Certification and Administrative Reporting data; and the Area Resource File. Staffing characteristics, quality indicators, facility, and market information from these data sources were all measured in 2008. The specific quality indicators examined are physical restraint use, catheter use, pain management, and pressure sores using negative binomial regression. An average rate of 9.2% for nurse aide absenteeism was reported in the prior week. We find that high levels of absenteeism are associated with poor performance on all four quality indicators examined. The investigation presented, to our knowledge, is one of the first examining the implications of absenteeism in nursing homes. Absenteeism can be a costly staffing issue, one of the potential costs identified in this analysis is an impact on quality of care. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patients.

    Science.gov (United States)

    Haugan, Gørill; Innstrand, Siw T; Moksnes, Unni K

    2013-08-01

    To test the effects of nurse-patient interaction on anxiety and depression among cognitively intact nursing home patients. Depression is considered the most frequent mental disorder among the older population. Specifically, the depression rate among nursing home patients is three to four times higher than among community-dwelling older people, and a large overlap of anxiety is found. Therefore, identifying nursing strategies to prevent and decrease anxiety and depression is of great importance for nursing home patients' well-being. Nurse-patient interaction is described as a fundamental resource for meaning in life, dignity and thriving among nursing home patients. The study employed a cross-sectional design. The data were collected in 2008 and 2009 in 44 different nursing homes from 250 nursing home patients who met the inclusion criteria. A sample of 202 cognitively intact nursing home patients responded to the Nurse-Patient Interaction Scale and the Hospital Anxiety and Depression Scale. A structural equation model of the hypothesised relationships was tested by means of Lisrel 8.8 (Scientific Software International Inc., Lincolnwood, IL, USA). The SEM model tested demonstrated significant direct relationships and total effects of nurse-patient interaction on depression and a mediated influence on anxiety. Nurse-patient interaction influences depression, as well as anxiety, mediated by depression. Hence, nurse-patient interaction might be an important resource in relation to patients' mental health. Nurse-patient interaction is an essential factor of quality of care, perceived by long-term nursing home patients. Facilitating nurses' communicating and interactive skills and competence might prevent and decrease depression and anxiety among cognitively intact nursing home patients. © 2013 Blackwell Publishing Ltd.

  11. Nursing home residents' views on dying and death: nursing home employee's perspective.

    Science.gov (United States)

    Dwyer, Lise-Lotte; Hansebo, Görel; Andershed, Birgitta; Ternestedt, Britt-Marie

    2011-12-01

    To reveal nursing home employees' views on dying and death among older people they cared for. Palliative care stakeholders recently included more groups in their definition of palliative care; older people constitute one such group. Consequently, palliative care systems, which will serve a large, aging cohort, will require new skills. The first stage in skills acquisition is to gather current views on dying and death. Qualitative descriptive study that uses focus group discussions for data collection; 20 employees in 4 Swedish nursing homes participated. Data were analysed using qualitative content analysis. The following categories were conceptualised: alleviating suffering and pain; finding meaning in everyday life; revealing thoughts and attitudes about death; taking care of the dead person's body; and coping with the gap between personal ideals and reality. A deeper understanding of the palliative care philosophy is needed to further develop and tailor care for the dying persons in nursing homes. To get public support for palliative care, the silence surrounding dying and death must be broken. Employees must receive education to prepare for all aspects of their work, and management must account for employees' situation when planning the care. © 2010 Blackwell Publishing Ltd.

  12. Organization and financing of home nursing in the European Union.

    NARCIS (Netherlands)

    Kerkstra, A.; Hutten, J.B.F.

    1996-01-01

    The aim of this study was to provide an overview of the organization and financing of home nursing in the 15 member states in the European Union. Home nursing was defined as the nursing care provided at the patients' home by professional home nursing organizations. Data were gathered by means of

  13. The Judaic-Christian origin of nursing homes.

    Science.gov (United States)

    Brandeis, Gary H; Oates, Daniel J

    2007-06-01

    Many nursing homes today have a religious heritage. While governmental regulations control how much of the care is delivered, the foundations and goals of many homes predate governmental rules and payment policies. This paper explores the basis of Jewish and Christian thought in providing groundwork for religiously based nursing homes. Although the underlying principles are similar, differences in approach and execution for the formation of these homes exist.

  14. Impact of the Medicare Catastrophic Coverage Act on nursing homes.

    Science.gov (United States)

    Laliberte, L; Mor, V; Berg, K; Intrator, O; Calore, K; Hiris, J

    1997-01-01

    The Medicare Catastrophic Coverage Act (MCCA) of 1988 altered eligibility and coverage for skilled nursing facility (SNF) care and changed Medicaid eligibility rules for nursing-home residents. Detailed data on the residents of a for-profit nursing-home chain and Medicare claims for a 1 percent sample of beneficiaries were used to examine the impact of the MCCA on nursing homes. The case mix of nursing-home admissions was scrutinized, specifically for length of stay, discharge disposition, rate of hospitalization, and changes in payer source. Findings revealed that, although the proportion of Medicare-financed nursing-home care increased, as did the case-mix severity of residents during the MCCA period, there was no corollary reduction in hospital use by nursing-home residents.

  15. Some Aspects of Burnout in Nursing Homes

    OpenAIRE

    Leskovic Ljiljana; Vukovič Goran; Leskovar Robert; Goriup Jana

    2016-01-01

    Nursing personnel in nursing homes for elderly citizens are exposed to a number of factors that contribute to possible burnout syndrome. For this reason, the set objective of the research was to measure the degree of burnout, check the correlation between the burnout syndrome and satisfaction at work, and psychosomatic symptoms, as well as to figure out the main characteristics of burnout syndrome among the nursing personnel in nursing homes for the elderly in Slovenia.

  16. Swedish district nurses' attitudes to implement information and communication technology in home nursing.

    Science.gov (United States)

    Nilsson, Carina; Skär, Lisa; Söderberg, Siv

    2008-01-01

    The use of information and communication technology has increased in the society, and can be useful in nursing care. The aim of this study was to describe district nurses' attitudes regarding the implementation of information and communication technology in home nursing. The first and third authors performed five focus group discussions with 19 district nurses' from five primary healthcare centres in northern Sweden. During the focus group discussions, the following topics were discussed: the current and future use of information and communication technology in home nursing; expectations, advantages, disadvantages and hindrances in the use of information and communication technology in home nursing; and the use of information and communication technology from an ethical perspective. The transcribed focus group discussions were analysed using qualitative content analysis. The results showed that district nurses' attitudes were positive regarding the use of information and communication technology in their work. They also asked for possibilities to influence the design and its introduction. However, the use of information and communication technology in home nursing can be described as a complement to communication that could not replace human physical encounters. Improvements and risks, as well as the importance of physical presence in home nursing were considered vital. The results revealed that the use of information and communication technology requires changes in the district nurses' work situation.

  17. TESS Ground System Operations and Data Products

    Science.gov (United States)

    Glidden, Ana; Guerrero, Natalia; Fausnaugh, Michael; TESS Team

    2018-01-01

    We describe the ground system operations for processing data from the Transiting Exoplanet Survey Satellite (TESS), highlighting the role of the Science Operations Center (SOC). TESS is a spaced-based (nearly) all-sky mission, designed to find small planets around nearby bright stars using the transit method. We detail the flow of data from pixel measurements on the instrument to final products available at the Mikulski Archive for Space Telescopes (MAST). The ground system relies on a host of players to process the data, including the Payload Operations Center at MIT, the Science Processing Operation Center at NASA Ames, and the TESS Science Office, led by the Harvard-Smithsonian Center for Astrophysics and MIT. Together, these groups will deliver TESS Input Catalog, instrument calibration models, calibrated target pixels and full frame images, threshold crossing event reports, two-minute light curves, and the TESS Objects of Interest List.

  18. Experiences of technology integration in home care nursing.

    Science.gov (United States)

    Johnson, K A; Valdez, R S; Casper, G R; Kossman, S P; Carayon, P; Or, C K L; Burke, L J; Brennan, P F

    2008-11-06

    The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.

  19. Feasibility of a web-based dementia feeding skills training program for nursing home staff.

    Science.gov (United States)

    Batchelor-Murphy, Melissa; Amella, Elaine J; Zapka, Jane; Mueller, Martina; Beck, Cornelia

    2015-01-01

    Nursing home (NH) staff do not receive adequate training for providing feeding assistance to residents with dementia who exhibit aversive feeding behaviors (e.g., clamping mouth shut). The result is often low meal intake for these residents. This feasibility study tested a web-based dementia feeding skills program for staff in two United States NHs. Randomly assigned, the intervention staff received web-based dementia feeding skills training with coaching. Both groups participated in web-based pre-/post-tests assessing staff knowledge and self-efficacy; and meal observations measured NH staff and resident feeding behaviors, time for meal assistance, and meal intake. Aversive feeding behaviors increased in both groups of residents; however, the intervention NH staff increased the amount of time spent providing assistance and meal intake doubled. In the control group, less time was spent providing assistance and meal intake decreased. This study suggests that training staff to use current clinical practice guidelines improves meal intake. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Variation in psychotropic drug use in nursing homes.

    Science.gov (United States)

    Castle, N G

    1998-01-01

    Numerous studies of health service use reveal considerable variation in the degree of services provided. In this article the variation in psychotropic drug use in nursing homes is examined. First, a descriptive analysis of nursing homes with and without high levels of psychotropic drug use is provided. Second, an analysis of the determinants of high levels of psychotropic drug use in nursing homes is provided. Factors such as ownership, staffing levels, having special care units, case-mix intensity, competitiveness of the nursing home market, and the state Medicaid reimbursement rate structure are examined. The results of these analyses are discussed in terms of their policy issues.

  1. Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

    OpenAIRE

    Kissam, Stephanie; Gifford, David; Parks, Peggy; Patry, Gail; Palmer, Laura; Wilkes, Linda; Fitzgerald, Matthew; Petrulis, Alice Stollenwerk; Barnette, Leslie

    2003-01-01

    Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) tha...

  2. Triple echo steady-state (TESS) relaxometry.

    Science.gov (United States)

    Heule, Rahel; Ganter, Carl; Bieri, Oliver

    2014-01-01

    Rapid imaging techniques have attracted increased interest for relaxometry, but none are perfect: they are prone to static (B0 ) and transmit (B1 ) field heterogeneities, and commonly biased by T2 /T1 . The purpose of this study is the development of a rapid T1 and T2 relaxometry method that is completely (T2 ) or partly (T1 ) bias-free. A new method is introduced to simultaneously quantify T1 and T2 within one single scan based on a triple echo steady-state (TESS) approach in combination with an iterative golden section search. TESS relaxometry is optimized and evaluated from simulations, in vitro studies, and in vivo experiments. It is found that relaxometry with TESS is not biased by T2 /T1 , insensitive to B0 heterogeneities, and, surprisingly, that TESS-T2 is not affected by B1 field errors. Consequently, excellent correspondence between TESS and reference spin echo data is observed for T2 in vitro at 1.5 T and in vivo at 3 T. TESS offers rapid T1 and T2 quantification within one single scan, and in particular B1 -insensitive T2 estimation. As a result, the new proposed method is of high interest for fast and reliable high-resolution T2 mapping, especially of the musculoskeletal system at high to ultra-high fields. Copyright © 2013 Wiley Periodicals, Inc.

  3. The emotional context facing nursing home residents' families: a call for role reinforcement strategies from nursing homes and the community.

    Science.gov (United States)

    Bern-Klug, Mercedes

    2008-01-01

    Identify useful concepts related to the emotional context facing family members of nursing home residents. These concepts can be used in future studies to design and test interventions that benefit family caregivers. Secondary data analyses of qualitative ethnographic data. Two nursing homes in a large Midwestern city; 8 months of data collection in each. 44 family members of nursing home residents whose health was considered, "declining." Role theory was used to design and help interpret the findings. Data included transcripts of conversations between family members and researchers and were analyzed using a coding scheme developed for the secondary analysis. Comments about emotions related to the social role of family member were grouped into three categories: relief related to admission, stress, and decision making support/stress. Subcategories of stress include the role strain associated with "competing concerns" and the psychological pressures of 1) witnessing the decline of a loved one in a nursing home, and 2) guilt about placement. Decision-making was discussed as a challenge which family members did not want to face alone; support from the resident, health care professionals, and other family members was appreciated. Family members may benefit from role reinforcement activities provided by nursing home staff and community members. All nursing home staff members (in particular social workers) and physicians are called upon to provide educationa and support regarding nursing home admissions, during the decline of the resident, and especially regarding medical decision-making. Community groups are asked to support the family member by offering assistance with concrete tasks (driving, visiting, etc.) and social support.

  4. Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

    Science.gov (United States)

    Blackburn, Justin; Locher, Julie L; Kilgore, Meredith L

    2016-04-01

    To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients. A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries. After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Transforming home health nursing with telehealth technology.

    Science.gov (United States)

    Farrar, Francisca Cisneros

    2015-06-01

    Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Deprivation of Dignity in Nursing Home Residents

    DEFF Research Database (Denmark)

    Høy, Bente

    2016-01-01

    deepened knowledge in how to maintain and promote dignity in nursing home residents. The purpose of this paper is to present results concerning the question: How is nursing home residents’ dignity maintained or deprived from the perspective of close family caregivers? In this presentation we only focus...... on deprivation of dignity. Methodology: The overall design of this study is modified clinical application research. The study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods were individual research interviews. All together the sample consisted of 28...

  7. Self-transcendence and nurse-patient interaction in cognitively intact nursing home patients.

    Science.gov (United States)

    Haugan, Gørill; Rannestad, Toril; Hanssen, Brith; Espnes, Geir A

    2012-12-01

    The aim of this study was to test whether nurse-patient interaction affects cognitively intact nursing home patients' interpersonal and intrapersonal self-transcendence, as well as testing the psychometric properties of the Nurse-Patient Interaction Scale (NPIS). Self-transcendence is considered a spiritual developmental process of maturity in adulthood, and a vital resource of well-being at the end of life. The concept of self-transcendence has previously been explored in various populations, yet the nurse-patient interactions' potential influence on self-transcendence in nursing home patients has not been published previously. A cross-sectional design employing the Self-Transcendence Scale and the NPIS was adopted. A sample of 202 cognitively well-functioning nursing home patients in Norway was selected. The statistical analyses were carried out using lisrel 8.8 and structural equation modelling. Structural equation modelling-analysis indicates statistical significant effect of nurse-patient interaction on the patients' self-transcendence. Direct influence on the intrapersonal and indirect influence on the interpersonal self-transcendence aspects was disclosed. Nurse-patient interaction significantly affected both interpersonal and intrapersonal self-transcendence among cognitively intact nursing home patients. Hence, facilitating caring interventions can be significantly beneficial to older patients' self-transcendence and thereby well-being, both emotional and physical. Caring behaviour signifies the vital and ultimate qualitative nursing behaviour, which promotes self-transcendence and thereby well-being. These findings are important for clinical nursing that intends to increase patients' well-being. © 2012 Blackwell Publishing Ltd.

  8. Thomond Lodge Nursing Home, Ballymahon, Longford.

    LENUS (Irish Health Repository)

    Humphries, Niamh

    2009-01-01

    ABSTRACT: BACKGROUND: This paper presents data on the remittances sent by migrant nurses to their families "back home". It gives voice to the experiences of migrant nurses and illustrates the financial obligations they maintain while working overseas. Although the international economic recession has decreased global remittance flows, they remain resilient. Drawing on the experiences of migrant nurses in Ireland, this paper indicates how and why migrants strive to maintain remittance flows, even in an economic downturn. METHODS: A mixed-methods approach was employed, and the paper draws on data from qualitative in-depth interviews undertaken with 21 migrant nurses in addition to a quantitative survey of 336 migrant nurses in Ireland. RESULTS: The survey of migrant nurses revealed that 87% (293) of the sample sent remittances on a regular basis. According to respondents, remittances made a huge difference in the lives of their family members back home. Remittances were used to ensure that family members could obtain access to health and education services. They were also used to provide an income source for family members who were unemployed or retired.As remittances played an essential role in supporting family members back home, respondent migrant nurses were reluctant to reduce the level of their remittances, despite the onset of a global recession. Respondents noted that an increased demand for remittances from their families coincided with a reduction in their own net salaries - as a result of increased taxes and reduced availability of overtime - and this was a cause for concern for Ireland\\'s migrant nurses. CONCLUSION: This paper provides insights into the importance of remittances in funding social support for family members in home countries. It also illustrates the sacrifices made by migrant nurses to ensure continuation of the remittances, particularly in the context of an economic recession.

  9. The TESS-HERMES survey data release 1: high-resolution spectroscopy of the TESS southern continuous viewing zone

    Science.gov (United States)

    Sharma, Sanjib; Stello, Dennis; Buder, Sven; Kos, Janez; Bland-Hawthorn, Joss; Asplund, Martin; Duong, Ly; Lin, Jane; Lind, Karin; Ness, Melissa; Huber, Daniel; Zwitter, Tomaz; Traven, Gregor; Hon, Marc; Kafle, Prajwal R.; Khanna, Shourya; Saddon, Hafiz; Anguiano, Borja; Casey, Andrew R.; Freeman, Ken; Martell, Sarah; De Silva, Gayandhi M.; Simpson, Jeffrey D.; Wittenmyer, Rob A.; Zucker, Daniel B.

    2018-01-01

    The Transiting Exoplanet Survey Satellite (TESS) will provide high-precision time series photometry for millions of stars with at least a half-hour cadence. Of particular interest are the circular regions of 12° radius centred around the ecliptic poles that will be observed continuously for a full year. Spectroscopic stellar parameters are desirable to characterize and select suitable targets for TESS, whether they are focused on exploring exoplanets, stellar astrophysics or Galactic archaeology. Here, we present spectroscopic stellar parameters (Teff, log g, [Fe/H], v sin i, vmicro) for about 16 000 dwarf and subgiant stars in TESS' southern continuous viewing zone. For almost all the stars, we also present Bayesian estimates of stellar properties including distance, extinction, mass, radius and age using theoretical isochrones. Stellar surface gravity and radius are made available for an additional set of roughly 8500 red giants. All our target stars are in the range 10 using the High Efficiency and Resolution Multi-Element Spectrograph (HERMES; R ∼ 28 000) at the Anglo-Australian Telescope as part of the TESS-HERMES survey. Comparing our results with the TESS Input Catalogue (TIC) shows that the TIC is generally efficient in separating dwarfs and giants, but it has flagged more than 100 cool dwarfs (Teff < 4800 K) as giants, which ought to be high-priority targets for the exoplanet search. The catalogue can be accessed via http://www.physics.usyd.edu.au/tess-hermes/, or at Mikulski Archive for Space Telescopes (MAST).

  10. Nurses take center stage in private duty home care.

    Science.gov (United States)

    Brackett, Nicole

    2013-06-01

    The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care.

  11. How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study.

    Science.gov (United States)

    McCloskey, Rose; Donovan, Cindy; Stewart, Connie; Donovan, Alicia

    2015-09-01

    Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Examining Racial and Ethnic Differences in Nursing Home Quality.

    Science.gov (United States)

    Hefele, Jennifer Gaudet; Ritter, Grant A; Bishop, Christine E; Acevedo, Andrea; Ramos, Candi; Nsiah-Jefferson, Laurie A; Katz, Gabrielle

    2017-11-01

    Identifying racial/ethnic differences in quality is central to identifying, monitoring, and reducing disparities. Although disparities across all individual nursing home residents and disparities associated with between-nursing home differences have been established, little is known about the degree to which quality of care varies by race//ethnicity within nursing homes. A study was conducted to measure within-facility differences for a range of publicly reported nursing home quality measures. Resident assessment data on approximately 15,000 nursing homes and approximately 3 million residents (2009) were used to assess eight commonly used and publicly reported long-stay quality measures: the proportion of residents with weight loss, with high-risk and low-risk pressure ulcers, with incontinence, with depressive symptoms, in restraints daily, and who experienced a urinary tract infection or functional decline. Each measure was stratified by resident race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), and within-facility differences were examined. Small but significant differences in care on average were found, often in an unexpected direction; in many cases, white residents were experiencing poorer outcomes than black and Hispanic residents in the same facility. However, a broad range of differences in care by race/ethnicity within nursing homes was also found. The results suggest that care is delivered equally across all racial/ethnic groups in the same nursing home, on average. The results support the call for publicly reporting stratified nursing home quality measures and suggest that nursing home providers should attempt to identify racial/ethnic within-facility differences in care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  13. Nursing Home Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data that is used by the Nursing Home Compare tool can be downloaded for public use. This functionality is primarily used by health policy researchers and the...

  14. HOME CARE NURSES’ ROLES IN ENHANCING QUALITY OF NURSING CARE FOR PATIENTS AT HOME: A PHENOMENOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    Titan Ligita

    2017-08-01

    Full Text Available Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

  15. [Skin Care to Prevent Development of Pressure Ulcers in Bedridden Nursing Home Residents from Developing Pressure Ulcers in Nursing Home Residents].

    Science.gov (United States)

    Furukawa, Chie

    2015-12-01

    The purpose of this study was to clarify whether skincare products are effective in preventing development of pressure ulcers in bedridden nursing home residents. The study sample consisted of 21 nursing home residents at a nursing home in Osaka, Japan who use diapers. Participants were assigned to 3 groups and compared to a control group. None of the subjects developed a pressure ulcer and had improved skin condition around the anus.

  16. Does investor-ownership of nursing homes compromise the quality of care?

    Science.gov (United States)

    Harrington, Charlene; Woolhandler, Steffie; Mullan, Joseph; Carrillo, Helen; Himmelstein, David U

    2002-01-01

    Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

  17. Malpractice Litigation and Nursing Home Quality of Care

    Science.gov (United States)

    Konetzka, R Tamara; Park, Jeongyoung; Ellis, Robert; Abbo, Elmer

    2013-01-01

    Objective. To assess the potential deterrent effect of nursing home litigation threat on nursing home quality. Data Sources/Study Setting. We use a panel dataset of litigation claims and Nursing Home Online Survey Certification and Reporting (OSCAR) data from 1995 to 2005 in six states: Florida, Illinois, Wisconsin, New Jersey, Missouri, and Delaware, for a total of 2,245 facilities. Claims data are from Westlaw's Adverse Filings database, a proprietary legal database, on all malpractice, negligence, and personal injury/wrongful death claims filed against nursing facilities. Study Design. A lagged 2-year moving average of the county-level number of malpractice claims is used to represent the threat of litigation. We use facility fixed-effects models to examine the relationship between the threat of litigation and nursing home quality. Principal Findings. We find significant increases in registered nurse-to-total staffing ratios in response to rising malpractice threat, and a reduction in pressure sores among highly staffed facilities. However, the magnitude of the deterrence effect is small. Conclusions. Deterrence in response to the threat of malpractice litigation is unlikely to lead to widespread improvements in nursing home quality. This should be weighed against other benefits and costs of litigation to assess the net benefit of tort reform. PMID:23741985

  18. Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides

    Science.gov (United States)

    Sprangers, Suzan; Dijkstra, Katinka; Romijn-Luijten, Anna

    2015-01-01

    Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides’ communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides’ (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides’ communication, caregiver distress, and job satisfaction and residents’ psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff. PMID:25653513

  19. Rehabilitation services after the implementation of the nursing home prospective payment system: differences related to patient and nursing home characteristics.

    Science.gov (United States)

    Murray, Patrick K; Love, Thomas E; Dawson, Neal V; Thomas, Charles L; Cebul, Randall D

    2005-11-01

    The prospective payment system (PPS) for nursing homes was designed to curtail the rapid expansion of Medicare costs for skilled nursing care. This study examines the changes that occurred in nursing home patients and rehabilitation services following the PPS. Free-standing Medicare and/or Medicaid certified nursing homes in Ohio. The percent of new admissions receiving therapy and the amount of rehabilitation therapy provided. A total of 7006 first admissions in 1994-6 (pre-PPS) and 61,569 first admissions in 2000-1 (post-PPS). A logistic model predicting likelihood of rehabilitation was developed and validated in pre-PPS admissions and applied to the post-PPS patients. Rehabilitation services were compared in the pre-PPS and post-PPS cohorts overall, stratified by quintile of predicted score, diagnosis group, and by nursing home profit status. Post-PPS patients had less cognitive impairment, more depression, and more family support. The amount of rehabilitation services declined the most in the higher quintiles of predicted likelihood of rehabilitation and among patients with stroke. The percent of patients receiving rehabilitation services increased the most in the lowest quintile and among patients with medical conditions. These changes were greater in for-profit nursing homes. The implementation of the PPS in nursing homes has been associated with a decrease in the amount of rehabilitation services, targeted at those predicted to receive higher amounts and an increased frequency of providing services targeted at those predicted to be less likely to receive them. The outcomes of the changes deserve further study.

  20. The concept of restraints in nursing home practice: a mixed method study in nursing homes for people with dementia.

    NARCIS (Netherlands)

    Zwijsen, S.A.; Depla, M.F.I.A.; Niemeijer, A.R.; Francke, A.L.; Hertogh, C.M.P.M.

    2011-01-01

    Introduction: Although in most developed countries the use of restraints is regulated and restricted by law, the concept of restraint in nursing home care remains ambiguous. This study aims to explore how care professionals and family members of nursing home residents with dementia in the

  1. Job strain in nursing homes-Exploring the impact of leadership.

    Science.gov (United States)

    Backman, Annica; Sjögren, Karin; Lövheim, Hugo; Edvardsson, David

    2018-04-01

    To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes. It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts. This study had a cross-sectional design. Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted. Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain. Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff. Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff. © 2017 John Wiley & Sons Ltd.

  2. Nurses' knowledge and attitudes toward aged sexuality in Flemish nursing homes.

    Science.gov (United States)

    Mahieu, Lieslot; de Casterlé, Bernadette Dierckx; Acke, Jolien; Vandermarliere, Hanne; Van Elssen, Kim; Fieuws, Steffen; Gastmans, Chris

    2016-09-01

    Admission to a nursing home does not necessarily diminish an older person's desire for sexual expression and fulfillment. Given that nursing staff directly and indirectly influence the range of acceptable sexual expressions of nursing home residents, their knowledge and attitudes toward aged sexuality can have far-reaching effects on both the quality of care they provide to residents and the self-image and well-being of these residents. To investigate nursing staff's knowledge and attitudes toward aged sexuality, to determine whether certain sociodemographic factors of the nursing staff relate to their knowledge and attitudes toward later-life sexuality, and to examine the relationship between knowledge and attitudes. Descriptive cross-sectional survey study. The administered questionnaire collected sociodemographic data and data from an adapted, Dutch version of the Aging Sexual Knowledge and Attitudes Scale. Data were collected from November 2011 through April 2012. A total of 43 geographically dispersed nursing homes in Flanders, Belgium, participated. Out of a potential research sample of 2228 nursing staff respondents, 1166 participated. The study protocol was approved by the Ethics Committee of the Faculty of Medicine of the KU Leuven. Nursing staff appeared to be moderately knowledgeable about aged sexuality and displayed a rather positive attitude toward sexuality in older people. Significant relationships between various variables were found both at univariable and multivariable levels. Knowledge and attitudes proved to be positively related, indicating that a higher level of knowledge of aged sexuality is associated with a more positive attitude toward sexuality in later life. Research findings are discussed within a broader international context. There is room for improvement for both nursing staff's knowledge and attitudes toward aged sexuality. This might be aided by appropriate educational interventions. Our results identified different target groups

  3. Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.

    Science.gov (United States)

    Aaronson, W E; Zinn, J S; Rosko, M D

    1995-02-01

    This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.

  4. Predictive factors associated with death of elderly in nursing homes.

    Science.gov (United States)

    Sung, Kiwol

    2014-06-01

    An increasing elderly population reflects a great need for readily accessible, clinically useful methods to identify mortality-related factors in nursing home residents. The purpose of this study was to identify factors associated with the deaths of nursing home residents. Data was collected from a Minimal Data Set of 195 elderly nursing home residents, followed by analysis of demographic factors, disease and nursing condition factors, Activities of Daily Living (ADL), cognitive function, behavioral patterns, and dysfunctional status. Major factors associated with death among nursing home residents were identified as dyspnea (odds ratio [OR] = 4.88), problematic behaviors (OR = 3.95), and ADL (OR = 3.61). These variables accounted for 31.1% of the variance in death. Dyspnea, problematic behaviors, and ADL data were identified as the key factors associated with death among nursing home residents. Future plans for the prediction of death among nursing home residents can be made by nursing staff, factoring in these identified variables, to ensure more comfortable conditions and more responsive care. Copyright © 2014. Published by Elsevier B.V.

  5. "You're being paged!" outcomes of a nursing home on-call role-playing and longitudinal curriculum.

    Science.gov (United States)

    Yuasa, Misuzu; Bell, Christina L; Inaba, Michiko; Tamura, Bruce K; Ahsan, Samina; Saunders, Valisa; Masaki, Kamal

    2013-11-01

    Effectively handling telephone calls about nursing home (NH) residents is an important skill for healthcare professionals, but little formal training is typically provided. The objective of the current study was to describe and evaluate the effectiveness of a novel structured role-playing didactic session followed by an on-call NH longitudinal clinical experience. The effectiveness of the structured role-playing didactic session was compared in different learners, including geriatric medicine fellows (n = 10), family medicine residents and faculty (n = 14), nurse practitioner students (n = 31), and other learners (n = 7). The curriculum focused on common problems encountered while caring for NH residents during on-call periods. Learners rated themselves using an 18-item pre/post questionnaire including five attitude and 13 skills questions, using a 1-to-5 Likert scale. T-tests were used to compare means before and after sessions. Significant improvements were found in overall mean attitudes and skills scores. For all learners, the greatest improvements were seen in "comfort in managing residents at the NH," "managing feeding or gastrostomy tube dislodgement," "identifying different availability of medications, laboratory studies, and procedures in NH," and "describing steps to send NH residents to the emergency department." Geriatric medicine fellows' attitudes and skills improved significantly after the longitudinal clinical experience. The faculty survey demonstrated improved documentation, communication, and fellows' management of on-call problems after curriculum implementation. This novel curriculum used role-playing to provide training for on-call management of NH residents. This curriculum has been successfully disseminated on a national geriatrics educational resource website (POGOe) and is applicable to geriatric medicine fellowships, internal medicine and family medicine residency programs, and other training programs. © 2013, Copyright the Authors

  6. Development of pixellated Ir-TESs

    International Nuclear Information System (INIS)

    Zen, Nobuyuki; Takahashi, Hiroyuki; Kunieda, Yuichi; Dayanthi, Rathnayaka M.T.; Mori, Fumiakira; Fujita, Kaoru; Nakazawa, Masaharu; Fukuda, Daiji; Ohkubo, Masataka

    2006-01-01

    We have been developing Ir-based pixellated superconducting transition edge sensors (TESs). In the area of material or astronomical applications, the sensor with few eV energy resolution and over 1000 pixels imaging property is desired. In order to achieve this goal, we have been analyzing signals from pixellated TESs. In the case of a 20 pixel array of Ir-TESs, with 45 μmx45 μm pixel sizes, the incident X-ray signals have been classified into 16 groups. We have applied numerical signal analysis. On the one hand, the energy resolution of our pixellated TES is strongly degraded. However, using pulse shape analysis, we can dramatically improve the resolution. Thus, we consider that the pulse signal analysis will lead this device to be used as a practical photon incident position identifying TES

  7. Nursing home nurses' experiences of resident transfers to the emergency department: no empathy for our work environment difficulties.

    Science.gov (United States)

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Huang, Hsiu-Li

    2016-03-01

    To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan. The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries. Qualitative descriptive study. Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis. Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role. Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff. Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants. © 2016 John

  8. Prevalence and risk factors of depression in the elderly nursing home residents in Singapore.

    Science.gov (United States)

    Tiong, Wei Wei; Yap, Philip; Huat Koh, Gerald Choon; Phoon Fong, Ngan; Luo, Nan

    2013-01-01

    Depression is a common health problem in elderly nursing home (NH) residents and is often under-recognized and under-treated. This study aimed to determine the prevalence rates of depression and identify the risk factors associated with depression in the elderly NH population in Singapore. A sample of 375 residents in six NHs in Singapore, aged 55 years and above, was assessed with the Structural Clinical Interview (SCID), based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The association of demographic, functional and health-related characteristics with depression was examined using multivariate logistic regression analyses. Overall point prevalence for depression in the elderly NH residents was found to be 21.1% (95% confidence intervals (CI): 17.1%-25.6%). The prevalence rate for minor depression in the elderly NH residents was 14.4% (95% CI: 11.1%-18.5%) and 6.7% (95% CI: 4.5%-9.8%) for major depression. Significant risk factors that were found to be associated with depression were length of stay for more than 2 years, known history of depression, pain, and no or lack of social contact. The prevalence rates for depression were high among NH residents in Singapore. More attention is needed to care for the psychosocial needs of elderly NH residents in Singapore.

  9. Can Sepsis Be Detected in the Nursing Home Prior to the Need for Hospital Transfer?

    Science.gov (United States)

    Sloane, Philip D; Ward, Kimberly; Weber, David J; Kistler, Christine E; Brown, Benjamin; Davis, Katherine; Zimmerman, Sheryl

    2018-06-01

    To determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. Retrospective chart audit of all residents who had been hospitalized and returned to participating NHs during the study period. A total of 236 NH residents, 59 of whom returned from hospitals with a diagnosis of sepsis and 177 who had nonsepsis discharge diagnoses, from 31 community NHs that are typical of US nursing homes overall. NH documentation of vital signs, mental status change, and medical provider visits 0-12 and 13-72 hours prior to the hospitalization. The specificity and sensitivity of 5 screening tools were evaluated for their ability to detect residents with incipient sepsis during 0-12 and 13-72 hours prior to hospitalization: The Systemic Inflammatory Response Syndrome criteria, the quick Sequential Organ Failure Assessment (SOFA), the 100-100-100 Early Detection Tool, and temperature thresholds of 99.0°F and 100.2°F. In addition, to validate the hospital diagnosis of sepsis, hospital discharge records in the NHs were audited to calculate SOFA scores. Documentation of 1 or more vital signs was absent in 26%-34% of cases. Among persons with complete vital sign documentation, during the 12 hours prior to hospitalization, the most sensitive screening tools were the 100-100-100 Criteria (79%) and an oral temperature >99.0°F (51%); and the most specific tools being a temperature >100.2°F (93%), the quick SOFA (88%), the Systemic Inflammatory Response Syndrome criteria (86%), and a temperature >99.0°F (85%). Many SOFA data points were missing from the record; in spite of this, 65% of cases met criteria for sepsis. NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published

  10. Workplace Stress and Ethical Challenges Experienced by Nursing Staff in a Nursing Home

    Science.gov (United States)

    Vondras, Dean D.; Flittner, Diane; Malcore, Sylvia A.; Pouliot, Gregory

    2009-01-01

    This research explores the workplace stress and ethical challenges reported by healthcare staff in a nursing home. A brief self-report survey was administered to 44 members of the nursing staff in a not-for-profit nursing home. The survey included items that elicited identification of specific workplace stressors and ethical challenges and global…

  11. The nursing process in crisis-oriented psychiatric home care.

    Science.gov (United States)

    Boomsma, J; Dingemans, C A; Dassen, T W

    1997-08-01

    Crisis-oriented psychiatric home care is a recent development in the Dutch mental health care system. Because of the difference between psychiatric care in the home and in the hospital, an action research project was initiated. This project was directed at the nursing process and the nurses' role and skills in psychiatric home care. The main goal of the project was to describe and to standardize nursing diagnoses and interventions used in crisis-oriented and long-term psychiatric home care. The development of supporting methods of assessment and intervention were also important aspects of this project. In this article a crisis-oriented psychiatric home care programme and the first developmental research activities within this programme are described. To support the nursing process, the development of a nursing record and an assessment-format, based on Gordon's Functional Health Patterns (FHP), took place. By means of content analysis of 61 nursing records, the most frequently stated nursing diagnoses, based upon the North American Nursing Diagnosis Association (NANDA) taxonomy, were identified. The psychiatric diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were also collected. The most common categories found were those of mood disorders and schizophrenia or psychotic disorders. Seventy-five per cent of the nursing diagnoses showed up within four FHP: role-relationship, coping-stress tolerance, self-perception/self-concept and activity-exercise. The nursing diagnosis of 'ineffective individual coping' was stated most frequently. This is not surprising because of the similarities in the definitions of this nursing diagnosis and the concept of 'crisis' to which the psychiatric home care programme is oriented. Further research activities will be focused on standardization of nursing diagnosis and the interventions that nurses undertake in this type of care.

  12. The relationship between advertising, price, and nursing home quality.

    Science.gov (United States)

    Kash, Bita A; Miller, Thomas R

    2009-01-01

    Theoretically, nursing homes should engage in advertising for the following two reasons: (a) to improve awareness of the services offered in a particular market and (b) to signal high-quality services. In this study, we build upon results from prior studies of nursing home advertising activity, market competition, and quality. The purpose of this study was to examine the association between advertising expenses, price, and quality. We focused on answering the question: Do nursing homes use advertising and price to signal superior quality? The Texas Nursing Facilities Medicaid Cost Report, the Texas Quality Reporting System, and the Area Resource File were merged for the year 2003. We used three alternative measures of quality to improve the robustness of this exploratory analysis. Quality measures were examined using Bonferroni correlation coefficient analysis. Associations between advertising expenses and quality were evaluated using three regression models predicting quality. We also examined the association of the price of a private bed per day with quality. Advertising expenses were not associated with better nursing home quality as measured by three quality scales. The average price customers pay for one private bed per day was associated with better quality only in one of the three quality regression models. The price of nursing home care might be a better indicator of quality and necessary to increase as quality of care is improved in the nursing homes sector. Because more advertising expenditures are not necessarily associated with better quality, consumers could be mislead by advertisements and choose poor quality nursing homes. Nursing home administrators should focus on customer relationship management tools instead of expensive advertising. Relationship management tools are proven marketing techniques for the health services sector, usually less expensive than advertising, and help with staff retention and quality outcomes.

  13. The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures.

    Science.gov (United States)

    Rahman, Momotazur; Galarraga, Omar; Zinn, Jacqueline S; Grabowski, David C; Mor, Vincent

    2016-02-01

    Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes. © The Author(s) 2015.

  14. Does investor ownership of nursing homes compromise the quality of care?

    Science.gov (United States)

    Harrington, C; Woolhandler, S; Mullan, J; Carrillo, H; Himmelstein, D U

    2001-09-01

    Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. We analyzed 1998 data from state inspections of 13,693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.

  15. Pain and symptoms of depression in older adults living in community and in nursing homes: the role of activity restriction as a potential mediator and moderator.

    Science.gov (United States)

    López-Lopez, Almudena; González, José L; Alonso-Fernández, Miriam; Cuidad, Noelia; Matías, Borja

    2014-10-01

    Chronic pain is likely to lead to depressive symptoms, but the nature of this relationship is not completely clear. The aim of the present study is to analyze the role of activity restriction in the pain-depression relationship in older people, and to test the hypothesis that this role is more relevant in community-dwelling older people than in nursing home residents. Depressive symptoms, pain intensity, and activity restriction were measured in a sample of 208 older adults with osteoarthritis, 102 living in nursing homes (NH), and 106 in the community. Analyses were carried out using moderation and moderated mediation analyses approach, treating activity restriction as a confounder. RESULTS showed a significant confounding effect of activity restriction, interaction effect between pain intensity and activity restriction on depression, and modifying effect of pain intensity on depression by adding activity restriction into the model. These results suggest a potential mediating and moderating effects of activity restriction. Moreover, analyses suggest that, surprisingly, the strength of the mediation could be higher in nursing homes. Overall, it may be that what is really important to emotional well-being is not so much pain itself, but rather the way in which the pain alters older people's lives. The greater strength of the mediation in NH might be understood within the scope of self-determination theory. Generally speaking, the NH context has been considered as a coercive setting, promoting non-autonomous orientation. In this context, when events are objectively coercive, people may lack perceived autonomy and hence be at greater risk of depression.

  16. Nurses' Home Health Experience. Part I: The Practice Setting.

    Science.gov (United States)

    Stulginsky, Maryfran McKenzie

    1993-01-01

    Defines home health nursing as meeting the acute and chronic care needs of patients and their families in the home environment. Offers examples of situations in which home health nurses find themselves and their reactions to them. (JOW)

  17. Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.

    Science.gov (United States)

    Monroe, Todd B; Parish, Abby; Mion, Lorraine C

    2015-10-01

    Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses' assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses' cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of 'comfort' and 'quality of life' as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards "appearance of comfort." Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family's concerns. Nurses had to focus not only on the resident's comfort, but also the families' level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help

  18. Happy in a nursing home?

    NARCIS (Netherlands)

    Cretien van Campen; Debbie Verbeek-Oudijk

    2017-01-01

    Original title: Gelukkig in een verpleeghuis? Life in Dutch residential nursing and care homes is changing. The number of frail older persons in the Netherlands is increasing. Older people are increasingly living independently for longer, and only the most frail older persons move to a nursing or

  19. Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

    Science.gov (United States)

    Kang, Yu; Meng, Hongdao; Miller, Nancy A

    2011-12-01

    To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

  20. Status of the TESS Science Processing Operations Center

    Science.gov (United States)

    Jenkins, Jon Michael; Caldwell, Douglas A.; Davies, Misty; Li, Jie; Morris, Robert L.; Rose, Mark; Smith, Jeffrey C.; Tenenbaum, Peter; Ting, Eric; Twicken, Joseph D.; Wohler, Bill

    2018-06-01

    The Transiting Exoplanet Survey Satellite (TESS) was selected by NASA’s Explorer Program to conduct a search for Earth’s closest cousins starting in 2018. TESS will conduct an all-sky transit survey of F, G and K dwarf stars between 4 and 12 magnitudes and M dwarf stars within 200 light years. TESS is expected to discover 1,000 small planets less than twice the size of Earth, and to measure the masses of at least 50 of these small worlds. The TESS science pipeline is being developed by the Science Processing Operations Center (SPOC) at NASA Ames Research Center based on the highly successful Kepler science pipeline. Like the Kepler pipeline, the TESS pipeline provides calibrated pixels, simple and systematic error-corrected aperture photometry, and centroid locations for all 200,000+ target stars observed over the 2-year mission, along with associated uncertainties. The pixel and light curve products are modeled on the Kepler archive products and will be archived to the Mikulski Archive for Space Telescopes (MAST). In addition to the nominal science data, the 30-minute Full Frame Images (FFIs) simultaneously collected by TESS will also be calibrated by the SPOC and archived at MAST. The TESS pipeline searches through all light curves for evidence of transits that occur when a planet crosses the disk of its host star. The Data Validation pipeline generates a suite of diagnostic metrics for each transit-like signature, and then extracts planetary parameters by fitting a limb-darkened transit model to each potential planetary signature. The results of the transit search are modeled on the Kepler transit search products (tabulated numerical results, time series products, and pdf reports) all of which will be archived to MAST. Synthetic sample data products are available at https://archive.stsci.edu/tess/ete-6.html.Funding for the TESS Mission has been provided by the NASA Science Mission Directorate.

  1. Development of pixellated Ir-TESs

    Science.gov (United States)

    Zen, Nobuyuki; Takahashi, Hiroyuki; Kunieda, Yuichi; Damayanthi, Rathnayaka M. T.; Mori, Fumiakira; Fujita, Kaoru; Nakazawa, Masaharu; Fukuda, Daiji; Ohkubo, Masataka

    2006-04-01

    We have been developing Ir-based pixellated superconducting transition edge sensors (TESs). In the area of material or astronomical applications, the sensor with few eV energy resolution and over 1000 pixels imaging property is desired. In order to achieve this goal, we have been analyzing signals from pixellated TESs. In the case of a 20 pixel array of Ir-TESs, with 45 μm×45 μm pixel sizes, the incident X-ray signals have been classified into 16 groups. We have applied numerical signal analysis. On the one hand, the energy resolution of our pixellated TES is strongly degraded. However, using pulse shape analysis, we can dramatically improve the resolution. Thus, we consider that the pulse signal analysis will lead this device to be used as a practical photon incident position identifying TES.

  2. Terminal patients in Belgian nursing homes: a cost analysis.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Vanden Berghe, Paul; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2013-06-01

    Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients.

  3. Nurse aide decision making in nursing homes: factors affecting empowerment.

    Science.gov (United States)

    Chaudhuri, Tanni; Yeatts, Dale E; Cready, Cynthia M

    2013-09-01

    To evaluate factors affecting structural empowerment among nurse aides in nursing homes. Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment. © 2013 Blackwell Publishing Ltd.

  4. Assisted Living Facilities - MDC_NursingHome

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Label (point) feature class of Miami-Dade County Nursing Homes Facilities. As of May 2004 the Office of Emergency Management (OEM) will provide updates for Nursing...

  5. Effect of physical training on urinary incontinence: a randomized parallel group trial in nursing homes

    Directory of Open Access Journals (Sweden)

    Vinsnes AG

    2012-02-01

    Full Text Available Anne G Vinsnes1, Jorunn L Helbostad2, Signe Nyrønning3, Gene E Harkless1,4, Randi Granbo5, Arnfinn Seim61Faculty of Nursing, Sør-Trøndelag University College, 2Department of Neuroscience, Norwegian University of Science and Technology, 3Søbstad Community Hospital and Teaching Nursing Home, Trondheim, Norway; 4University of New Hampshire, College of Health and Social Services, Nursing Faculty, Durham, New Hampshire, USA; 5Department of Physiotherapy, Sør-Trøndelag University College, 6Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, NorwayBackground: Residents in nursing homes (NHs are often frail older persons who have impaired physical activity. Urinary incontinence (UI is a common complaint for residents in NHs. Reduced functional ability and residence in NHs are documented to be risk factors for UI.Objective: To investigate if an individualized training program designed to improve activity of daily living (ADL and physical capacity among residents in nursing homes has any impact on UI.Materials and methods: This randomized controlled trial was a substudy of a Nordic multicenter study. Participants had to be >65 years, have stayed in the NH for more than 3 months and in need of assistance in at least one ADL. A total of 98 residents were randomly allocated to either a training group (n = 48 or a control group (n = 50 after baseline registrations. The training program lasted for 3 months and included accommodated physical activity and ADL training. Personal treatment goals were elicited for each subject. The control group received their usual care. The main outcome measure was UI as measured by a 24-hour pad-weighing test. There was no statistically significant difference between the groups on this measure at baseline (P = 0.15. Changes were calculated from baseline to 3 months after the end of the intervention.Results: Altogether, 68 participants were included in the analysis

  6. 78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2013-07-31

    ... State homes providing nursing home and adult day health services care to Veterans. VA requires... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality...

  7. Research supporting the congruence between rehabilitation principles and home health nursing practice.

    Science.gov (United States)

    Neal, L J

    1999-01-01

    A grounded-theory study of 30 home health nurses conducted in the Washington, DC, metropolitan area used unstructured audiotaped interviews to elicit data as to how home health nurses define their practice. The purpose of the study was to develop a beginning substantive research-based theory of home health nursing practice. The model that emerged consists of three stages by which nurses attain autonomy in their practice. Adaptation was found to be the core category, in that nurses cannot function effectively or successfully in the home health arena unless they are or learn to be adaptable. Data also revealed that home health nurses either knowingly or unknowingly use rehabilitation nursing principles in their practice, thereby lending credence to the supposition that home health nursing practice is congruent with rehabilitation nursing principles.

  8. Identifying nursing home residents at risk for falling.

    Science.gov (United States)

    Kiely, D K; Kiel, D P; Burrows, A B; Lipsitz, L A

    1998-05-01

    To develop a fall risk model that can be used to identify prospectively nursing home residents at risk for falling. The secondary objective was to determine whether the nursing home environment independently influenced the development of falls. A prospective study involving 1 year of follow-up. Two hundred seventy-two nursing homes in the state of Washington. A total of 18,855 residents who had a baseline assessment in 1991 and a follow-up assessment within the subsequent year. Baseline Minimum Data Set items that could be potential risk factors for falling were considered as independent variables. The dependent variable was whether the resident fell as reported at the follow-up assessment. We estimated the extrinsic risk attributable to particular nursing home environments by calculating the annual fall rate in each nursing home and grouping them into tertiles of fall risk according to these rates. Factors associated independently with falling were fall history, wandering behavior, use of a cane or walker, deterioration of activities of daily living performance, age greater than 87 years, unsteady gait, transfer independence, wheelchair independence, and male gender. Nursing home residents with a fall history were more than three times as likely to fall during the follow-up period than residents without a fall history. Residents in homes with the highest tertile of fall rates were more than twice as likely to fall compared with residents of homes in the lowest tertile, independent of resident-specific risk factors. Fall history was identified as the strongest risk factor associated with subsequent falls and accounted for the vast majority of the predictive strength of the model. We recommend that fall history be used as an initial screener for determining eligibility for fall intervention efforts. Studies are needed to determine the facility characteristics that contribute to fall risk, independent of resident-specific risk factors.

  9. Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.

    Science.gov (United States)

    Sloane, Philip D; Huslage, Kirk; Kistler, Christine E; Zimmerman, Sheryl

    2016-01-01

    Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  10. Mobbing among care workers in nursing homes: A cross-sectional secondary analysis of the Swiss Nursing Homes Human Resources Project.

    Science.gov (United States)

    Tong, Myriam; Schwendimann, René; Zúñiga, Franziska

    2017-01-01

    As a category of bullying, mobbing is a form of violence in the workplace that damages the employing organization as well as the targeted employee. In Europe, the overall prevalence of mobbing in healthcare is estimated at 4%. However, few studies have explored mobbing among long-term care workers. This study aims to examine the frequency of mobbing in Swiss nursing homes and its relationships with care workers' (i.e. registered nurse, licensed practical nurse, assistant nurse, nurse aide) health status, job satisfaction, and intention to leave, and to explore the work environment as a contributing factor to mobbing. A cross-sectional, multi-center sub-study of the Swiss Nursing Homes Human Resource Project (SHURP). Nursing homes in Switzerland's three language regions. A total of 162 randomly selected nursing homes with 20 or more beds, including 5311 care workers with various educational levels. Controlling for facility and care worker characteristics, generalized estimation equations were used to assess the relationships between mobbing and care workers' health status, job satisfaction, and intention to leave as well as the association of work environment factors with mobbing. In Swiss nursing homes, 4.6% of surveyed care workers (n=242) reported mobbing experiences in the last 6 months. Compared to untargeted persons, those directly affected by mobbing had higher odds of health complaints (Odds Ratios (OR): 7.81, 95% CI 5.56-10.96) and intention to leave (OR: 5.12, 95% CI 3.81-6.88), and lower odds of high job satisfaction (OR: 0.19, 95% CI 0.14-0.26). Odds of mobbing occurrences increased with declining teamwork and safety climate (OR: 0.41, 95% CI 0.30-0.58), less supportive leadership (OR: 0.42, 95% CI 0.30-0.58), and higher perceived inadequacy of staffing resources (OR: 0.66, 95% CI 0.48-0.92). Mobbing experiences in Swiss nursing homes are relatively rare. Alongside teamwork and safety climate, risk factors are strongly associated with superiors

  11. The TESS-HERMES survey data release 1

    DEFF Research Database (Denmark)

    Sharma, Sanjib; Stello, Dennis; Buder, Sven

    2018-01-01

    -Australian Telescope as part of the TESS-HERMES survey. Comparing our results with the TESS Input Catalogue (TIC) shows that the TIC is generally efficient in separating dwarfs and giants, but it has flagged more than 100 cool dwarfs (T-eff

  12. 77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2012-08-01

    ... per diem to State homes providing nursing home and adult day health services care to Veterans. VA... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality...

  13. Healthcare worker influenza vaccination in Oregon nursing homes: correlates of facility characteristics.

    Science.gov (United States)

    Campbell, Lauren J; Li, Qinghua; Li, Yue

    2014-10-01

    Nursing home (NH) employee influenza vaccination is associated with reductions in morbidity and mortality among residents. Little is known regarding associations between NH characteristics and employee influenza vaccination rates (EVRs). This study identifies NH characteristics that may be associated with EVRs. Data on employee vaccination rates and programs were gathered from the Office for Oregon Health Policy and Research reports for 3 influenza seasons from 2009 to 2012 and merged with Online Survey, Certification, and Reporting files, from which facility characteristics were obtained. Market controls were obtained from the 2010 Area Health Resource File. Multivariate linear and logistic regression were used to model relationships between facility characteristics and EVR per facility per year, whether formal education for employees was conducted, and whether 2010, 2015, and 2020 Healthy People targets were met. Oregon nursing homes from 2009 to 2012. NHs reporting sufficient data to calculate an EVR were included. Based on information obtained from 2009-2010, 2010-2011, and 2011-2012 surveys, EVRs were calculated for 113/140, 129/141, and 137/140 (81%, 91%, and 98% of) NHs, respectively. Dependent variables were EVR per facility per year, whether formal education for employees was conducted, and whether 2010, 2015, and 2020 Healthy People targets were met. Independent variables included facility characteristics and market controls. On average, chain-affiliated NHs had 9% higher EVRs (P = .01) and 73% higher odds of achieving 60% EVR (2010 target, P = .05) than free-standing NHs. For-profit NHs had, on average, 8% lower EVRs (P = .04) than not-for-profit NHs. Surprisingly, a 10% increase in proportion of Medicaid residents was associated with a 2% increase in EVR (P = .01) and higher odds of achieving 60% (odds ratio = 1.20, P = .004) and 70% (2015 target, odds ratio = 1.14, P = .05) EVR. Given that NHs generally have low employee influenza vaccination

  14. Time to and predictors of dual incontinence in older nursing home admissions.

    Science.gov (United States)

    Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

    2018-01-01

    There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

  15. Self Conservation Trajectory in Nursing Homes

    Directory of Open Access Journals (Sweden)

    Ângela Simões

    2017-04-01

    Full Text Available Objectives: This article intends to present some of the results obtained during the research on the Promotion and Preservation of Dignity in the context of care in nursing homes, carried out in the context of the PhD in Nursing of the University of Lisbon. Methodology: Within the interpretative paradigm, Grounded Theory (GT was adopted as methodology. Data were collected through participant observation and interviews at an Nursing Home (IPSS with about 350 residents distributed through three residential structures in the county of Castelo Branco for 21 months, with residents, nurses and direct acting helpers as participants. The constant comparative analysis of the data occurred simultaneously, using the software NVivo 10® and NVivo 11®. From the data analysis it was possible to construct a middle-range theory - Promotion and Preservation of Dignity in Nursing Homes: Self Conservation. Results: A complex, unforeseen phenomenon, exposed to variability and multiple, constructed, deconstructed and reconstructed in the daily rhythms, in a continuous, systematic and dynamic manner. It follows a two-dimensional route that was called the Self Conservation Trajectory. On the one hand a personal, individual, although accompanied and promoted. On the other hand a profoundly social path. Is the first dimension of this route that will be presented in this article.

  16. Prevalence of Malnutrition in Orally and Tube-Fed Elderly Nursing Home Residents in Germany and Its Relation to Health Complaints and Dietary Intake

    Science.gov (United States)

    Volkert, Dorothee; Pauly, Lioba; Stehle, Peter; Sieber, Cornel C.

    2011-01-01

    Objective. To investigate the prevalence of malnutrition in orally and tube-fed nursing home (NH) residents in Germany and its relation to common health complaints and dietary intake. Methods. In 350 NH residents, subjects' characteristics, Mini Nutritional Assessment (MNA), and several health problems were inquired with the nursing staff using standardised interviews. In a subset of 122 residents, dietary intake was assessed by 3-day weighing records. Results. 7.7% of the participants were tube fed. 24.1% of orally nourished and 57.7% of tube-fed residents were malnourished (MNA Malnutrition was significantly related to nausea/vomiting, constipation, pressure ulcers, dehydration, infections, antibiotic use, and hospitalisation. Mean daily energy intake was 1535 ± 413 kcal and mean protein intake was 54.2 ± 0.9 g/d irrespective of the nutritional state. Conclusion. In Germany, malnutrition is widespread among NH residents and is related to common health problems. The MNA rather reflects health condition than currently reduced dietary intake. PMID:21687611

  17. What Is Nursing Home Quality and How Is It Measured?

    Science.gov (United States)

    Castle, Nicholas G.; Ferguson, Jamie C.

    2010-01-01

    Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO)…

  18. Effects of introducing a nursing guideline on depression in psychogeriatric nursing home residents.

    OpenAIRE

    Verkaik, R.; Francke, A.; Berno, M. van; Bensing, J.; Miel, R.

    2010-01-01

    Introduction: The prevalence rate of depression in psychogeriatric nursing home residents with dementia is recently estimated at 19%. Comorbid depression in dementia has been associated with decreased quality of life, greater health care utilization and higher mortality rates. The effects of introducing an evidence based nursing guideline on psychogeriatric nursing home wards were studied. Main principles of the guideline were (1) increasing individualized pleasant activities, (2) decreasing ...

  19. Higher prices, higher quality? Evidence from German nursing homes

    OpenAIRE

    Herr, Annika; Hottenrott, Hanna

    2016-01-01

    Objectives: This study investigates the relationship between prices and quality of 7,400 German nursing homes controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Method: We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, wher...

  20. Implementing guidelines in nursing homes: a systematic review.

    Science.gov (United States)

    Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte; Lund, Hans

    2016-07-25

    Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROSPERO 2014: CRD42014007664.

  1. Work-related factors influencing home care nurse intent to remain employed.

    Science.gov (United States)

    Tourangeau, Ann E; Patterson, Erin; Saari, Margaret; Thomson, Heather; Cranley, Lisa

    Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits, (c) ensuring manageable workloads to facilitate improved work-life balance, and (d) ensuring leaders are accessible and competent.

  2. Predictive Factors associated with Death of Elderly in Nursing Homes

    OpenAIRE

    Kiwol Sung, PhD, RN

    2014-01-01

    Purpose: An increasing elderly population reflects a great need for readily accessible, clinically useful methods to identify mortality-related factors in nursing home residents. The purpose of this study was to identify factors associated with the deaths of nursing home residents. Methods: Data was collected from a Minimal Data Set of 195 elderly nursing home residents, followed by analysis of demographic factors, disease and nursing condition factors, Activities of Daily Living (ADL), co...

  3. Social exchange as a framework for client-nurse interaction during public health nursing maternal-child home visits.

    Science.gov (United States)

    Byrd, Mary E

    2006-01-01

    The purpose of this paper was to develop a nursing-focused use of social exchange theory within the context of maternal-child home visiting. The nature of social exchange theory, its application to client-nurse interaction, and its fit with an existing data set from a field research investigation were examined. Resources exchanged between the nurse and clients were categorized and compared across the patterns of home visiting, nursing strategies based on exchange notions were identified, and variations in exchange were linked with client outcomes. The nurse provided resources within the categories of information, status, service, and goods. Clients provided time, access to the home, space within the home to conduct the visit, opportunities to observe maternal-child interaction, access to the infant, and information. The ease and breadth of resource exchange varied across the patterns of home visiting. The social exchange perspective was useful in categorizing resources, specifying and uncovering new resource categories, understanding nursing strategies to initiate and maintain the client-nurse relationship, and linking client-nurse interactive phenomena with client outcomes. Social exchange theory is potentially useful for understanding client-nurse interaction in the context of maternal-child home visits.

  4. Nursing Home Compare Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — These are the official datasets used on the Medicare.gov Nursing Home Compare Website provided by the Centers for Medicare and Medicaid Services. These data allow...

  5. Nursing Home Data Compendium

    Data.gov (United States)

    U.S. Department of Health & Human Services — The compendium contains figures and tables presenting data on all Medicare- and Medicaid-certified nursing homes in the United States as well as the residents in...

  6. Communication skills training in a nursing home: Effects of a brief intervention on residents and nursing aides

    NARCIS (Netherlands)

    S. Sprangers (Suzan); K. Dijkstra (Katinka); A. Romijn-Luijten (Anna)

    2015-01-01

    textabstractEffective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home

  7. Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes.

    NARCIS (Netherlands)

    Demarre, L.; Vanderwee, K.; Defloor, T.; Verhaeghe, S.; Schoonhoven, L.; Beeckman, D.

    2012-01-01

    AIMS: To gain insight into the knowledge and attitudes of nurses and nursing assistants and to study the correlation between knowledge, attitudes and the compliance with the pressure ulcer prevention guidelines provided to residents at risk of pressure ulcers in nursing homes. BACKGROUND: There is a

  8. HOME CARE NURSES’ ROLES IN ENHANCING QUALITY OF NURSING CARE FOR PATIENTS AT HOME: A PHENOMENOLOGICAL STUDY

    OpenAIRE

    Titan Ligita

    2017-01-01

    Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Metho...

  9. Comparing Sleep Quality and General Health Among the Elderly Living at Home and at Nursing Home

    Directory of Open Access Journals (Sweden)

    Mansour Beyrami

    2014-01-01

    Full Text Available Objectives: Survey about the issues and problems related to elderly in order to improve their quality of life of this increasing population has become a universal concern.This study was performed by the purpose of comparing the sleep quality and general health among the Elderly Residing at Home and Old People's Homes. Methods & Materials: This study is descriptive-analytic type. Population of this investigation consisted of elderly men and women (upper than 60 years old living at personal home and at nursing home in Tabriz. Sample group composed of 100 elderly (50 men and 50 women 50 living at home and 50 living at nursing home who were selected through available sampling method. For collecting data, Goldberg General Health Questionnaire and Pittsburgh Sleep Quality Index were used. Data were analyzed by Multivariate analysis of variance (MANOVA. Results: Findings showed that In terms of general health and its components (Physical symptoms, anxiety, social dysfunction and depression and Sleep quality and its components (Subjective quality of sleep, time for sleep, total sleep time, sleep efficiency, routine, sleep disorders, sleep medications and daily dysfunction there were significant differences between nursing home residents and elderly residents in nursing homes (P=0.001. Conclusion: Findings indicated that elderly residents in nursing home are experiencing more symptoms of anxiety, depression, physical symptoms and social dysfunction Compared with the elderly whom resident at home. Also the results showed that the elderly residents of nursing homes have poor sleep quality than ones whom residents at home. On the other hand Future development of elderly care institution is inevitable. Therefore, more attention to the living conditions of elderly residents of institutions seems necessary.

  10. Competition, information, and quality: Evidence from nursing homes.

    Science.gov (United States)

    Zhao, Xin

    2016-09-01

    Economic theory suggests that competition and information can both be important for product quality, and yet evidence on how they may interact to affect quality is sparse. This paper estimates the impact of competition between nursing homes on their quality, and how this impact varies when consumers have better access to information. The effect of competition is identified using exogenous variation in the geographical proximity of nursing homes to their potential consumers. The change in information transparency is captured by the launch of the Five-Star Quality Rating System in 2009, which improved access to the quality information of nursing homes. We find that while the effect of competition on nursing home quality is generally rather limited, this effect becomes significantly stronger with increased information transparency. The results suggest that regulations on public quality reporting and on market structure are policy complements, and should be considered jointly to best improve quality. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Higher prices, higher quality? Evidence from German nursing homes.

    Science.gov (United States)

    Herr, Annika; Hottenrott, Hanna

    2016-02-01

    This study investigates the relationship between prices and quality of 7400 German nursing homes. We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, where we instrument prices to explain their effect on quality controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Descriptive analysis shows that prices and quality do not only vary across nursing homes, but also across counties and federal states and that quality and prices correlate positively. Second, the econometric analysis, which accounts for the endogenous relation between negotiated price and reported quality, shows that quality indeed positively depends on prices. In addition, more places in nursing homes per people in need are correlated with both lower prices and higher quality. Finally, unobserved factors at the federal state level capture some of the variation of reported quality across nursing homes. Our results suggest that higher prices increase quality. Furthermore, since reported quality and prices vary substantially across federal states, we conclude that the quality and prices of long-term care facilities may well be compared within federal states but not across. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. An Education Initiative Modifies Opinions of Hemodialysis Nurses towards Home Dialysis

    Directory of Open Access Journals (Sweden)

    Matthew Phillips

    2015-04-01

    Full Text Available Background: It has been shown that in-center hemodialysis (HD nurses prefer in-center HD for patients with certain characteristics; however it is not known if their opinions can be changed. Objective: To determine if an education initiative modified the perceptions of in-center HD nurses towards home dialysis. Design: Cross-sectional survey of in-center HD nurses before and after a three hour continuing nursing education (CNE initiative. Content of the CNE initiative included a didactic review of benefits of home dialysis, common misconceptions about patient eligibility, cost comparisons of different modalities and a home dialysis patient testimonial video. Setting: All in-center HD nurses (including those working in satellite dialysis units affiliated with a single academic institution Measurements: Survey themes included perceived barriers to home dialysis, preferred modality (home versus in-center HD, ideal modality distribution in the local program, awareness of home dialysis and patient education about home modalities. Methods: Paired comparisons of responses before and after the CNE initiative. Results: Of the 115 in-center HD nurses, 100 registered for the CNE initiative and 89 completed pre and post surveys (89% response rate. At baseline, in-center HD nurses perceived that impaired cognition, poor motor strength and poor visual acuity were barriers to peritoneal dialysis and home HD. In-center HD was preferred for availability of multidisciplinary care and medical personnel in case of catastrophic events. After the initiative, perceptions were more in favor of home dialysis for all patient characteristics, and most patient/system factors. Home dialysis was perceived to be underutilized both at baseline and after the initiative. Finally, in-center HD nurses were more aware of home dialysis, felt better informed about its benefits and were more comfortable teaching in-center HD patients about home modalities after the CNE session

  13. Distress experienced by nurses in response to the challenging behaviour of residents - evidence from German nursing homes.

    Science.gov (United States)

    Schmidt, Sascha G; Dichter, Martin N; Palm, Rebecca; Hasselhorn, Hans Martin

    2012-11-01

    The aim of this research is to investigate the degree of distress experienced by nurses in response to the challenging behaviour of nursing home residents (residents' challenging behaviour) and their impact on nurses individual resources (general health, burnout and work ability). Because of the increasing and ageing population of nursing home residents, professional nursing care faces several challenges. One highly prevalent issue among nursing home residents is the so-called 'challenging behaviour'. However, to date, 'challenging behaviour' has not yet been recognised as an occupational stressor, and the extent of the impact of 'challenging behaviour' on nurses' well-being and functioning is not well understood. Cross-sectional study. Self-report questionnaire data collected from 731 registered nurses and nursing aides in 56 German nursing homes were used in a secondary data analysis. The level of residents' challenging behaviour-related distress that nurses experienced was assessed using a scale consisting of nine questions. Validated instruments were used for the assessment of individual resources. The mean score for residents' challenging behaviour-related distress was 41·3 (SD 21·2). Twenty-seven per cent of all nurses reported over 50 residents' challenging behaviour. Residents' challenging behaviour had a significant impact on all three measures of individual resources. Specifically, nurses exposed to frequent residents' challenging behaviour reported a significantly lower quality of general health, reduced workability and high burnout levels. Our findings indicate that residents' challenging behaviour-related distress is a significant work place stressor for nurses in nursing homes with a clear impact on general health, the risk of burnout and work ability. Our findings suggest that residents' challenging behaviour is a stressor for nurses in nursing homes. Further scientific and practical attention is necessary from the point of view of working

  14. Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands.

    Science.gov (United States)

    Fosse, Anette; Zuidema, Sytse; Boersma, Froukje; Malterud, Kirsti; Schaufel, Margrethe Aase; Ruths, Sabine

    2017-08-01

    Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians' perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. A cross-sectional study using an electronic questionnaire was conducted in 2015. All NH physicians in Norway (approximately 1200-1300) were invited to participate; 435 participated (response rate approximately 35%). Of the total 1664 members of the Dutch association of elderly care physicians approached, 244 participated (response rate 15%). We explored NH physicians' perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using χ 2 test and t-test. Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel, and heavy time commitment for physicians as important barriers; this was more pronounced among Dutch respondents. Approximately 30% of the respondents in both countries reported their own lack of interest in EOL care as an important barrier. Suggested improvement strategies were routines for involvement of patients' family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality EOL care according to Dutch and Norwegian NH physicians. Their perspectives were mostly similar, despite large educational and organizational differences. Key strategies for improving EOL care in their facilities comprise education and

  15. Rheumatologic care of nursing home residents with rheumatoid arthritis: a comparison of the year before and after nursing home admission.

    Science.gov (United States)

    Luque Ramos, Andres; Albrecht, Katinka; Zink, Angela; Hoffmann, Falk

    2017-12-01

    The purpose of this study was to investigate health care for patients with rheumatoid arthritis (RA) before and after admission to nursing homes. Data of a German health insurance fund from persons with diagnostic codes of RA, aged ≥65 years, admitted to a nursing home between 2010 and 2014 and continuously insured 1 year before and after admission were used. The proportion of patients with ≥1 rheumatologist visit and ≥1 prescription of biologic or conventional synthetic disease-modifying antirheumatic drugs (bDMARDs or csDMARDs), glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs) in the year before and after admission were calculated. Predictors of rheumatologic care after admission were analyzed by multivariable logistic regression. Of 75,697 nursing home residents, 2485 (3.3%) had RA (90.5% female, mean age 83.8). Treatment by rheumatologists and prescription of antirheumatic drugs decreased significantly in the year after admission (rheumatologic visits: 17.6 to 9.1%, bDMARDs: 2.1 to 1.5%, csDMARDs: 22.5 to 16.5%, glucocorticoids: 46.5 to 43.1%, NSAIDs: 47.4 to 38.5%). 60.2% of patients in rheumatologic care received csDMARDs compared with 14.5% without rheumatologic care. Rheumatologic care before admission to a nursing home strongly predicted rheumatologic care thereafter (OR 33.8, 95%-CI 23.2-49.2). Younger age and lower care level (reflecting need of help) were also associated with a higher chance of rheumatologic care. Rheumatologic care is already infrequent in old patients with RA and further decreases after admission to a nursing home. Patients without rheumatologic care are at high risk of insufficient treatment for their RA. Admission to a nursing home further increases this risk.

  16. Private equity ownership and nursing home financial performance.

    Science.gov (United States)

    Pradhan, Rohit; Weech-Maldonado, Robert; Harman, Jeffrey S; Laberge, Alex; Hyer, Kathryn

    2013-01-01

    Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performance-for instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities.

  17. Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

    Science.gov (United States)

    Poey, Judith L; Hermer, Linda; Cornelison, Laci; Kaup, Migette L; Drake, Patrick; Stone, Robyn I; Doll, Gayle

    2017-11-01

    Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents' needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents. A longitudinal, retrospective cohort study using an in-person survey. Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes. A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level. My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains. After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC. These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. Case-mix payment for nursing home care: lessons from Maryland.

    Science.gov (United States)

    Feder, J; Scanlon, W

    1989-01-01

    Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

  19. Nursing Students' Clinical Learning Environment in Norwegian Nursing Homes: Lack of Innovative Teaching and Learning Strategies

    OpenAIRE

    Berntsen, Karin; Bjørk, Ida Torunn; Brynildsen, Grethe

    2017-01-01

    Background: Nursing students hesitate to choose aged care as a career, and the aged care sectors are on an edge regarding nursing positions. Clinical learning environments may influence nursing students’ career choices. Few studies have explored learning environments in nursing homes, although students increasingly have placements there. Objectives: The aim was to produce information for developing nursing students’ learning opportunities in nursing homes. Design: A cross-sectional survey des...

  20. Technology and medication errors: impact in nursing homes.

    Science.gov (United States)

    Baril, Chantal; Gascon, Viviane; St-Pierre, Liette; Lagacé, Denis

    2014-01-01

    The purpose of this paper is to study a medication distribution technology's (MDT) impact on medication errors reported in public nursing homes in Québec Province. The work was carried out in six nursing homes (800 patients). Medication error data were collected from nursing staff through a voluntary reporting process before and after MDT was implemented. The errors were analysed using: totals errors; medication error type; severity and patient consequences. A statistical analysis verified whether there was a significant difference between the variables before and after introducing MDT. The results show that the MDT detected medication errors. The authors' analysis also indicates that errors are detected more rapidly resulting in less severe consequences for patients. MDT is a step towards safer and more efficient medication processes. Our findings should convince healthcare administrators to implement technology such as electronic prescriber or bar code medication administration systems to improve medication processes and to provide better healthcare to patients. Few studies have been carried out in long-term healthcare facilities such as nursing homes. The authors' study extends what is known about MDT's impact on medication errors in nursing homes.

  1. Improving wound and pressure area care in a nursing home.

    Science.gov (United States)

    Sprakes, Kate; Tyrer, Julie

    Wound and pressure ulcer prevention are key quality indicators of nursing care. This article describes a collaborative project between a community skin care service and a nursing home. The aim of the project was to establish whether the implementation of a wound and pressure ulcer management competency framework within a nursing home would improve patient outcomes and reduce the severity and number of wounds and pressure ulcers. Following the project's implementation, there was a reduction in the number of wounds and pressure ulcers, hospital admissions and district nursing visits. Nursing home staff also reported an increase in their knowledge and skills.

  2. [Family caregivers' adjustment to nursing home placement of older relatives].

    Science.gov (United States)

    Wang, Szu-Yao; Davies, Elizabeth

    2007-06-01

    The literature on the impact of nursing home placement of older parents on family caregivers is still incomplete. Family caregivers experience stress, shock, anxiety, fear, resistance, and guilt in the process of decision making. The literature has demonstrated that family caregivers continue to experience stress and problems after placing older relatives into a long term care facility. Cultural values impact on people's attitudes, values and expectations. Culture will therefore affect the care-giving experience. Relatively little information is available from Asian and multicultural societies. Identifying family caregiver experiences after nursing home placement can alert professionals to the need for family guidance prior to nursing home placement and assist in early identification of potential problems. This article reviews the literature and discusses the impact on family caregivers of making a decision for nursing home placement and dealing with the stress and challenges that persist after nursing home admission.

  3. Breastfeeding status and marketing practices of baby food manufactured in nursing homes.

    Science.gov (United States)

    Mathur, G P; Pandey, P K; Mathur, S; Mishra, V K; Singh, K; Bhatt, O P; Loomba, R K; Luthra, C; Taneja, S; Kapoor, R

    1993-11-01

    In January 1993 in Kanpur, India, a survey of 7 private nursing homes revealed that infant formula was given to most newborns (52.4%). The most common brands included Lactogen-I, Milk Care, Raptakos, Dexolac Special Care, and Lactodex. Staff at 5 nursing homes gave prelacteal feeds (water, glucose water, and infant formula) to newborns when they were separated from their mothers. Staff at only 2 nursing homes gave the newborn to the mother immediately after delivery. The longest period between delivery and giving the newborn to the mother was 24 hours. All but one of the nursing homes did not know about the government policy and the recent bill that bars free or low-cost infant formula supplies to hospitals. The administration of the nursing homes did not inform the procurement department, in writing, of the government policy. 4 nursing homes bought low-cost supplies of infant formula from the companies. The companies sold the infant formula to the nursing homes at a price 48.3% to 86.7% lower than the market price. Medical stores inside or outside the nursing homes sold the infant formula to parents at the other 3 homes. The nursing homes used, on average, 2-50 kg/month. Nestle (Lactogen-I) and Dalmia Industries (Milk Care) had a monopoly in infant formula in 4 and 3 nursing homes, respectively. Infant formula was in stock in 5 nursing homes. None of the nursing homes gave mothers free or low-cost infant formula at discharge. Lower than market price and increased number of calls to the hospitals and physicians by company personnel were marketing techniques used by the manufacturers to maintain market share. These results show that, despite government policy and the bill, hospitals continue to use infant formula. The government should use the mass media to increase awareness about its policy on infant foods and the concept of the Baby Friendly Hospital.

  4. Determinants of financial performance of home-visit nursing agencies in Japan.

    Science.gov (United States)

    Fukui, Sakiko; Yoshiuchi, Kazuhiro; Fujita, Junko; Ikezaki, Sumie

    2014-01-09

    Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff

  5. The effect of skill mix in non-nursing assistants on work engagements among home visiting nurses in Japan.

    Science.gov (United States)

    Naruse, Takashi; Taguchi, Atsuko; Kuwahara, Yuki; Nagata, Satoko; Sakai, Mahiro; Watai, Izumi; Murashima, Sachiyo

    2015-05-01

    This study evaluated the effect of a skill-mix programme intervention on work engagement in home visiting nurses. A skill-mix programme in which home visiting nurses are assisted by non-nursing workers is assumed to foster home visiting nurses' work engagement. Pre- and post-intervention evaluations of work engagement were conducted using self-administered questionnaires. A skill-mix programme was introduced in the intervention group of home visiting nurses. After 6 months, their pre- and post-intervention work engagement ratings were compared with those of a control group. Baseline questionnaires were returned by 174 home visiting nurses (44 in the intervention group, 130 in the control group). Post-intervention questionnaires were returned by 38 and 97 home visiting nurses from each group. The intervention group's average work engagement scores were 2.2 at baseline and 2.3 at post-intervention; the control group's were 3.3 and 2.6. Generalised linear regression showed significant between-group differences in score changes. The skill-mix programme might foster home visiting nurses' work engagement by improving the quality of care for each client. Future research is needed to explain the exact mechanisms that underlie its effectiveness. In order to improve the efficiency of services provided by home visiting nurses and foster their work engagement, skill-mix programmes might be beneficial. © 2014 John Wiley & Sons Ltd.

  6. How nursing staff spend their time on activities in a nursing home: an observational study.

    Science.gov (United States)

    Munyisia, Esther Naliaka; Yu, Ping; Hailey, David

    2011-09-01

    This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home. © 2011 Blackwell Publishing Ltd.

  7. A theoretical model of job retention for home health care nurses.

    Science.gov (United States)

    Ellenbecker, Carol Hall

    2004-08-01

    Predicted severe nursing shortages and an increasing demand for home health care services have made the retention of experienced, qualified nursing staff a priority for health care organizations. The purpose of this paper is to describe a theoretical model of job retention for home health care nurses. The theoretical model is an integration of the findings of empirical research related to intent to stay and retention, components of Neal's theory of home health care nursing practice and findings from earlier work to develop an instrument to measure home health care nurses' job satisfaction. The theoretical model identifies antecedents to job satisfaction of home health care nurses. The antecedents are intrinsic and extrinsic job characteristics. The model also proposes that job satisfaction is directly related to retention and indirectly related to retention though intent to stay. Individual nurse characteristics are indirectly related to retention through intent to stay. The individual characteristic of tenure is indirectly related to retention through autonomy, as an intrinsic characteristic of job satisfaction, and intent to stay. The proposed model can be used to guide research that explores gaps in knowledge about intent to stay and retention among home health care nurses.

  8. PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting.

    Science.gov (United States)

    Mor, Vincent; Volandes, Angelo E; Gutman, Roee; Gatsonis, Constantine; Mitchell, Susan L

    2017-04-01

    Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization

  9. Nursing home staff's views on residents' dignity: a qualitative interview study

    NARCIS (Netherlands)

    Oosterveld-Vlug, Mariska G.; Pasman, H. Roeline W.; van Gennip, Isis E.; Willems, Dick L.; Onwuteaka-Philipsen, Bregje D.

    2013-01-01

    Maintaining dignity is an important element of end-of-life care and also of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents' and staff's perspective. Little is however known about the way nursing home staff perceive and promote

  10. Understanding organizational and cultural premises for quality of care in nursing homes: an ethnographic study.

    Science.gov (United States)

    Nakrem, Sigrid

    2015-11-13

    Internationally, there are concerns about the quality of care in nursing homes. The concept of 'corporate culture' as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff's perspective and to include how the residents describe quality of care. An ethnographic design was employed. A purposive sample of four municipal public nursing homes in Norway with long-term care residents was included in the study. Data were collected by participant observation including informal conversation with the staff, and in-depth interviews with 15 residents using a narrative approach. The main findings were that organizational cultures could be seen as relatively stable corporate cultures described as 'personalities' with characteristics that were common for all nursing homes (conformity) and typical traits that were present in some nursing homes, but that they were also like no other nursing home (distinctiveness). Conformity ('Every nursing home is like all other nursing homes') meant that nursing home organizations formed their services according to a perception of what residents in general need and expect. Trait ('Every nursing home is like some other nursing homes') expressed typologies of nursing homes: residency, medical, safeguard or family orientation. The distinctness of each nursing home ('Every nursing home is like no other nursing home') was expressed in unique features of the nursing home; the characteristics of the nursing home involved certain patterns of structure, cultural assumptions and interactions that were unique in each nursing home. Nursing home residents experienced quality of care as 'The nursing home as my home' and 'Interpersonal care quality'. The resident group in the different types of nursing homes were unique, and the experience of quality of care seemed to depend on whether their unique needs and expectations

  11. Learning Opportunities for Nurses Working within Home Care

    Science.gov (United States)

    Lundgren, Solveig

    2011-01-01

    Purpose: The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment. Design/methodology/approach: The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a…

  12. Development, validation and testing of a nursing home to emergency room transfer checklist.

    Science.gov (United States)

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang

    2018-01-01

    To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults

  13. Two nursing home outbreaks of respiratory infection with Legionella sainthelensi.

    Science.gov (United States)

    Loeb, M; Simor, A E; Mandell, L; Krueger, P; McArthur, M; James, M; Walter, S; Richardson, E; Lingley, M; Stout, J; Stronach, D; McGeer, A

    1999-05-01

    To describe outbreaks of infection caused by Legionella sainthelensi occurring in older residents of two nursing homes and to determine risk factors for the development of infection. Descriptive epidemiology and a case-control study. Two nursing homes (140 beds and 254 beds in nursing homes A and B, respectively) located in southern Ontario, Canada, experiencing outbreaks of respiratory tract infection in July and August 1994. Case-residents of the two nursing homes who met clinical and laboratory criteria for Legionella infection. Control-residents were defined as those who were in the homes during the outbreaks and were asymptomatic. Active surveillance was conducted in both nursing homes to identify symptomatic residents. Residents with fever or respiratory tract symptoms had nasopharyngeal swabs taken for viral antigen detection and culture, urine for Legionella antigen detection, and acute and convalescent serology for viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella. Chest X-rays were performed, and an attempt was made to obtain blood and sputum cultures. Water samples from shower heads, faucets, and air conditioning units were collected for Legionella culture and polymerase chain reaction (PCR) assay. A case-control study was done to assess possible risk factors for legionellosis. Twenty-nine cases -- 17 in nursing home A; 12 in nursing home B - were identified. Four (14%) case-residents had documented pneumonia and four case-residents died. Univariate analysis revealed that a history of stroke (odds ratio (OR) 2.3 (95% CI, 1.0-5.3)), eating pureed food (OR 4.6 (95% CI, 1.6-12.7)), and having fluids administered with medication (OR 2.5 (95% CI, 1.0-5.9)) were significant risk factors. Cases were less likely to wear dentures (OR .4 (95% CI, .2-.9)) or to eat solid food (OR .3, (95% CI, .1-.6)). Only eating pureed food remained significant in a multivariable analysis (OR 4.6 (95% CI, 1.6-13.0, P = .01)). This report describes outbreaks of

  14. Perceived barriers to communication between hospital and nursing home at time of patient transfer.

    Science.gov (United States)

    Shah, Faraaz; Burack, Orah; Boockvar, Kenneth S

    2010-05-01

    To identify perceived barriers to communication between hospital and nursing home at the time of patient transfer and examine associations between perceived barriers and hospital and nursing home characteristics. Mailed survey. Medicare- or Medicaid-certified nursing homes in New York State. Nursing home administrators, with input from other nursing home staff. Respondents rated the importance as a barrier to hospital-nursing home communication of (1) hospital providers' attitude, time, effort, training, payment, and familiarity with nursing home patients; (2) unplanned and off-hours transfers; (3) HIPAA privacy regulations; and (4) lost or failed information transmission. Associations were determined between barriers and the following organizational characteristics: (1) hospital-nursing home affiliations, pharmacy or laboratory agreements, cross-site staff visits, and cross-site physician care; (2) hospital size, teaching status, and frequency of geriatrics specialty care; (3) nursing home size, location, type, staffing, and Medicare quality indicators; and (4) hospital-to-nursing home communication, consistency of hospital care with health care goals, and communication quality improvement efforts. Of 647 questionnaires sent, 229 were returned (35.4%). The most frequently reported perceived barriers to communication were sudden or unplanned transfers (44.4%), transfers that occur at night or on the weekend (41.4%), and hospital providers' lack of effort (51.0%), lack of familiarity with patients (45.0%), and lack of time (43.5%). Increased hospital size, teaching hospitals, and urban nursing home location were associated with greater perceived importance of these barriers, and cross-site staff visits and hospital provision of laboratory and pharmacy services to the nursing home were associated with lower perceived importance of these barriers. Hospital and nursing home characteristics and interorganizational relationships were associated with nursing home

  15. Attractiveness of working in home care: An online focus group study among nurses.

    Science.gov (United States)

    De Groot, Kim; Maurits, Erica E M; Francke, Anneke L

    2018-01-01

    Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and retention of home-care nursing staff. The aims of this explorative, qualitative study were to gain in-depth knowledge about which aspects home-care nurses find attractive about their work and to explore whether these aspects vary for home-care nurses with different levels of education. Discussions were conducted with six online focus groups in 2016 with a total of 38 Dutch home-care nurses. The transcripts were analysed using the principles of thematic analysis. The findings showed that home-care nurses find it attractive that they are a "linchpin", in the sense of being the leading professional and with the patient as the centre of care. Home-care nurses also find having autonomy attractive: autonomy over decision-making about care, freedom in work scheduling and working in a self-directed team. Variety in patient situations and activities also makes their work attractive. Home-care nurses with a bachelor's degree did not differ much in what they found attractive aspects from those with an associate degree (a nursing qualification after completing senior secondary vocational education). It is concluded that autonomy, variety and being a "linchpin" are the attractive aspects of working in home care. To help recruit and retain home-care nursing staff, these attractive aspects should be emphasised in nursing education and practice, in recruitment programmes and in publicity material. © 2017 John Wiley & Sons Ltd.

  16. Facility and market factors affecting transitions from nursing home to community.

    Science.gov (United States)

    Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa

    2011-09-01

    Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.

  17. Is There a Trade-off Between Quality and Profitability in United States Nursing Homes?

    Science.gov (United States)

    Godby, Tyler; Saldanha, Sarah; Valle, Jazmine; Paul, David P; Coustasse, Alberto

    Nursing home residents across the United States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals who could not perform these tasks for themselves. Not-for-profit (NFP) versus for-profit (FP) nursing homes have been examined for utilization and efficacy; however, it has been shown that NFP nursing homes generally offer higher quality care and generate greater profit margins compared with FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared with FP nursing homes. Benefits and barriers in regard to financial stability and quality of care exist for both FP and NFP homes. Based on the findings of this review, it is suggested that NFP nursing homes have achieved higher quality of care because of a more effective balance of business aspects, as well as prioritizing resident well-being, and care quality over profit maximization in NFP homes.

  18. Mapping the literature of home health nursing.

    Science.gov (United States)

    Friedman, Yelena

    2006-04-01

    The purpose of this study was to identify core journals in home health nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section. A citation analysis of two core journals was done to determine distribution of references by format types and age of citations and dispersion of the literature, according to Bradford's Law of Scattering. The analysis of indexing coverage for Zone 1 and 2 was also provided. The study showed that 64.2% of citations came from journals, versus 22.9% from books and 12.9% from other publications. PubMed/ MEDLINE rated highest in average indexing coverage of Zone 1 and 2 journals, followed by CINAHL. PsycINFO, SocioAbstracts, and EBSCO Health Business FullTEXT showed practically no coverage for the home health nursing literature. As expected, journal articles were found to be the primary source for referencing and books, the secondary source. In regard to bibliographic control, no databases provided full coverage of the journals in the field of home health nursing. PubMed/MEDLINE and CINAHL gave better results in combination, because CINAHL tended to cover more nursing journals, while PubMed/MEDLINE did better with medical titles.

  19. Representation in the Care Planning Process for Nursing Home Residents With Dementia.

    Science.gov (United States)

    McCreedy, Ellen; Loomer, Lacey; Palmer, Jennifer A; Mitchell, Susan L; Volandes, Angelo; Mor, Vincent

    2018-05-01

    Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process-a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment. Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial. A total of 292 NHs from 1 large for-profit NH system. Long-stay NH residents in 2016. We identified all care planning assessments conducted in 2016 for long-stay NH residents. Cognitive functioning was defined using the Cognitive Function Scale. The Minimum Data Set was used to determine whether a resident, family member, and/or legal guardian participated in the assessment process. Certification and Survey Provider Enhance Reporting system data was used to identify facility-level correlates of family participation. Bivariate and multivariable hierarchical regression results are presented. The analytic sample included 18,552 long-stay NH residents. Family member/representative participation varied by degree of resident cognitive impairment; 8% of residents with no cognitive impairment had family or representative participation in care planning during 2016, compared with 26% of residents with severe impairment. NHs with more social workers had greater family participation in care planning. Available NH characteristics do not explain most of the variation in family participation between NHs (residual intraclass correlation = .57). Only a minority of family members and surrogates participate in NH care planning, even for residents with severe cognitive impairment. The association between social work staffing and participation suggests family involvement may be a measure of quality improvement

  20. Exploratory and Confirmatory Factor Analyses of Delirium Symptoms in a Sample of Nursing Home Residents.

    Science.gov (United States)

    Moyo, Patience; Huang, Ting-Ying; Simoni-Wastila, Linda; Harrington, Donna

    2018-02-01

    This study examined the latent constructs of delirium symptoms among nursing home (NH) residents in the United States. Cross-sectional NH assessment data (Minimum Data Set 2.0) from the 2009 Medicare Current Beneficiary Survey were used. Data from two independent, randomly selected subsamples of residents ≥65 years were analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). There were 367 and 366 individuals in the EFA and CFA, respectively. Assessment of multiple model fit statistics in CFA indicated that the two-factor structure provided better fit for the data than a one-factor solution. The two factors represented cognitive and behavioral latent constructs as suggested by the related literature. A correlation of .72 between these constructs suggested moderate discriminant validity. This finding emphasizes the importance of health care providers to be attentive to both cognitive and behavioral symptoms when diagnosing, treating, and managing delirium.

  1. Nickel-hydrogen battery design for the Transporter Energy Storage Subsystem (TESS)

    Science.gov (United States)

    Lapinski, John R.; Bourland, Deborah S.

    1992-01-01

    Information is given in viewgraph form on nickel hydrogen battery design for the transporter energy storage subsystem (TESS). Information is given on use in the Space Station Freedom, the launch configuration, use in the Mobile Servicing Center, battery design requirements, TESS subassembley design, proof of principle testing of a 6-cell battery, possible downsizing of TESS to support the Mobile Rocket Servicer Base System (MBS) redesign, TESS output capacity, and cell testing.

  2. Registered Nurse Staffing in Pennsylvania Nursing Homes: Comparison before and after Implementation of Medicare's Prospective Payment System.

    Science.gov (United States)

    Kanda, Katsuya; Mezey, Mathy

    1991-01-01

    Examined changes in resident acuity and registered nurse staffing in all nursing homes in Pennsylvania before and after introduction of Medicare Prospective Payment System (PPS) in 1983. Found that acuity of nursing home residents increased significantly since introduction of PPS, full-time registered nurse staffing remained unchanged, and…

  3. [Hospital emergencies arising from nursing homes in a region: evolution, characteristics and appropriateness].

    Science.gov (United States)

    Sánchez-Pérez, Inma; Comes Garcia, Nuri; Romero Piniella, Lola; Prats Martos, Gemma; Arnau Bataller, Gemma; Coderch, Jordi

    Hospital emergencies (HE) arising from nursing homes (NH) are on the rise. We analyse the evolution, characteristics and appropriateness of HE of NH residents in a region, as well as resulting hospital admissions. Retrospective descriptive study between 2010 and 2013 of institutionalised residents of 11 NH located in Baix Empordà (704 beds) and Palamós Hospital. Gender, age, morbidity and relative weight according to clinical risk groups (CRG), NH, length of stay, diagnosis of the emergency, appropriateness of HE according to Bermejo's criteria and the HE appropriateness protocol (HEAP), and appropriateness of hospitalisations according to the Appropriateness Evaluation Protocol (AEP). Sample to evaluate appropriateness: 159 HE and 91 hospitalisations. frequency, mean, standard deviation, percentiles, Fisher's exact test and ANOVA, with a confidence interval of 95% and using IBM SPSS Statistics 23. 1,474 people were enrolled, of which 73% were women. Group ≥85 years increased to 60.3% and the mean weight of morbidity was 3.2 to 4.0 (p <0.001). 1,805 HE were generated. The annual rate per 1,000 stays arising from NH increased from 1.64 to 2.05, of which 90.6% were appropriate according to Bermejo's criteria and 93.7% according to the HEAP. Of these, 502 involved hospitalisation. The annual rate per 10 emergencies fell from 2.96 to 2.64 and 98.9% were appropriate according to the AEP. Hospital emergencies and hospitalisations of NH residents are increasing and are appropriate. Increasing age and disease burden could explain this phenomenon. NH and hospitals should react appropriately, considering the specific needs of this population sector. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Home health nursing care services in Greece during an economic crisis.

    Science.gov (United States)

    Adamakidou, T; Kalokerinou-Anagnostopoulou, A

    2017-03-01

    The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided. © 2016 International Council of Nurses.

  5. Use of mental health services by nursing home residents after hurricanes.

    Science.gov (United States)

    Brown, Lisa M; Hyer, Kathryn; Schinka, John A; Mando, Ahed; Frazier, Darvis; Polivka-West, Lumarie

    2010-01-01

    A growing body of research supports the value of mental health intervention to treat people affected by disasters. This study used a mixed-methods approach to evaluate pre- and posthurricane mental health service use in Florida nursing homes. A questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes, representing two-thirds of Florida's counties, to identify residents' mental health needs and service use. In four subsequent focus group meetings with 22 nursing home administrators, underlying factors influencing residents' use of services were evaluated. Although most nursing homes provided some type of mental health care during normal operations, disaster-related mental health services were not routinely provided to residents. Receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents. Nursing home staff should be trained to deliver disaster-related mental health intervention and in procedures for making referrals for follow-up evaluation and formal intervention.

  6. Prevalence of Malnutrition in Orally and Tube-Fed Elderly Nursing Home Residents in Germany and Its Relation to Health Complaints and Dietary Intake

    Directory of Open Access Journals (Sweden)

    Dorothee Volkert

    2011-01-01

    Full Text Available Objective. To investigate the prevalence of malnutrition in orally and tube-fed nursing home (NH residents in Germany and its relation to common health complaints and dietary intake. Methods. In 350 NH residents, subjects' characteristics, Mini Nutritional Assessment (MNA, and several health problems were inquired with the nursing staff using standardised interviews. In a subset of 122 residents, dietary intake was assessed by 3-day weighing records. Results. 7.7% of the participants were tube fed. 24.1% of orally nourished and 57.7% of tube-fed residents were malnourished (MNA < 17 p.. Malnutrition was significantly related to nausea/vomiting, constipation, pressure ulcers, dehydration, infections, antibiotic use, and hospitalisation. Mean daily energy intake was 1535 ± 413 kcal and mean protein intake was 54.2 ± 0.9 g/d irrespective of the nutritional state. Conclusion. In Germany, malnutrition is widespread among NH residents and is related to common health problems. The MNA rather reflects health condition than currently reduced dietary intake.

  7. Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy.

    Science.gov (United States)

    Chen, Chia-Ching; Yamada, Tetsuji; Nakashima, Taeko; Chiu, I-Ming

    2017-01-01

    The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

  8. Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy

    Directory of Open Access Journals (Sweden)

    Chia-Ching Chen

    2017-11-01

    Full Text Available ObjectivesThe purposes of this study are: (1 to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC service use; (2 to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3 to investigate health outcome disparity based on substitutability.Methodology and dataThe methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR, which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly.ResultsThere exists a complement relationship between the informal home care (IHC and community-based FHC services, and the elasticity’s ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services.ConclusionPolicy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

  9. Nurse Staffing and Quality of Care of Nursing Home Residents in Korea.

    Science.gov (United States)

    Shin, Juh Hyun; Hyun, Ta Kyung

    2015-11-01

    To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea. We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately

  10. [Job stress of nursing aides in Swiss nursing homes : Nonlinear canonical analysis].

    Science.gov (United States)

    Ziegler, A; Bernet, M; Metzenthin, P; Conca, A; Hahn, S

    2016-08-01

    Due to demographic changes, the demand for care in nursing homes for the elderly and infirmed is growing. At the same time nursing staff shortages are also increasing. Nursing aides are the primary care providers and comprise the largest staff group in Swiss nursing homes. They are exposed to various forms of job stress, which threaten job retention. The aim of this study was to discover which features of the work situation and which personal characteristics of the nursing aides were related to the workload. Data from nursing aides in Swiss nursing homes were investigated through a secondary analysis of a national quantitative cross-sectional study, using descriptive statistics and a nonlinear canonical correlation analysis. A total of 1054 nursing aides were included in the secondary analysis, 94.6 % of whom were women between the ages of 42 and 61 years. The job stress most frequently mentioned in the descriptive analysis, almost 60 % of the participants referred to it, was staff shortage. The nonlinear canonical correlation analysis revealed that many job strains are caused by social and organizational issues. In particular, a lack of support from supervisors was associated with staff not feeling appreciated. These job strains correlated with a high level of responsibility, the feeling of being unable to work independently and a feeling of being exploited. These strains were predominant in the nursing aides between 32 and 51 years old who had part time jobs but workloads of 80-90 %. Middle-aged nursing aides who worked to 80-90 % are particularly at risk to resign from the position prematurely. Measures need to be mainly implemented in the social and organizational areas. It can be assumed that a targeted individual support, recognition and promotion of nursing aides may decrease the level of job strain.

  11. Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?

    Science.gov (United States)

    Teno, Joan M; Feng, Zhanlian; Mitchell, Susan L; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

    2008-05-01

    To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. NHs in the United States. NH residents at the time of NH inspection between 1993 and 2004. Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use.

  12. Does information matter? Competition, quality, and the impact of nursing home report cards.

    Science.gov (United States)

    Grabowski, David C; Town, Robert J

    2011-12-01

    We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.

  13. Predictive Factors associated with Death of Elderly in Nursing Homes

    Directory of Open Access Journals (Sweden)

    Kiwol Sung, PhD, RN

    2014-06-01

    Conclusion: Dyspnea, problematic behaviors, and ADL data were identified as the key factors associated with death among nursing home residents. Future plans for the prediction of death among nursing home residents can be made by nursing staff, factoring in these identified variables, to ensure more comfortable conditions and more responsive care.

  14. Body weight changes in elderly psychogeriatric nursing home residents

    NARCIS (Netherlands)

    Knoops, K.T.B.; Slump, E.; Groot, de C.P.G.M.; Wouters-Wesseling, W.; Brouwer, M.L.; Staveren, van W.A.

    2005-01-01

    Objective. This study was undertaken to identify predictors of body weight change in nursing home patients with possible to severe dementia. Methods. For 24 weeks, 108 elderly residents of a nursing home were followed. Body weight was measured every 2 weeks. Other anthropometric characteristics,

  15. Mapping the literature of home health nursing

    OpenAIRE

    Friedman, Yelena

    2006-01-01

    Objectives: The purpose of this study was to identify core journals in home health nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section.

  16. RURAL-URBAN DIFFERENCES IN NURSING HOME ACCESS, QUALITY AND COST

    OpenAIRE

    Yu, Wei; Bradford, Garnett L.

    1995-01-01

    Rural-urban differences in the supply of nursing home services as hypothesized to be jointly affected by competitive and regulatory forces, government policies, and the cost structure. Study findings indicate that rural services are slightly less accessible and lower in quality. A translog cost share function reveals no difference in the operating cost structure of rural and urban homes. Cost shares for nursing care are directly related to the degree of skilled nursing provided by homes. Sign...

  17. Barriers to nursing home staff accessing CPD must be broken down.

    Science.gov (United States)

    2016-09-29

    A study on priorities for the professional development of registered nurses (RNs) in nursing homes published in Age and Ageing ( page 6 ) has identified that staff shortages, lack of access to NHS courses and lack of paid study time are the main reasons why RNs do not access continuing professional development (CPD) activities. Specialist gerontological education for care home nurses was, however, seen as a means to ensure that care home nursing attracts the best people.

  18. Communication of the death of a patient in hospices and nursing homes: a qualitative study.

    Science.gov (United States)

    Rivolta, Maria Marcella; Rivolta, Licia; Garrino, Lorenza; Di Giulio, Paola

    2014-02-01

    Announcing the death of a patient to another in hospices and nursing homes (NH) requires special skills, especially when the recipient is another resident. The aim of this study is to describe how hospice and NH staff deal with the communication regarding a patient's death, if this communication is perceived as a problem, and strategies implemented. The 55 health care workers (HCWs, 26 nurses and 29 auxiliary nurses) of two NHs and two hospices in Turin (Italy) were interviewed with a semi-structured interview exploring the residents' perception of need to receiving information on another patient's death, the experiences of having given this information in the last 6 months, and the strategies implemented. The interviews were analyzed using Colaizzi's method and researchers looked for the main themes and related subthemes. Six themes were identified and grouped into 2 main themes: a. the choice to tell the truth or not, which may be influenced by: the patients' request for confirmation of the fate of the other resident, by patients' fear of death ("I will be next"), the relationships among the guests, and personal and group experiences; b. the need to share own feelings and the burden of deciding whether or not to inform the other residents and how to go about this. If a structured discussion of experiences and reflection on cases is not implemented, HCWs may limit communication to bare information, lies, and adopt behaviors of avoidance and concealment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Tetanus immunity in nursing home residents of Bolu, Turkey

    Directory of Open Access Journals (Sweden)

    Tamer Ali

    2005-01-01

    Full Text Available Abstract Background Tetanus is a serious but vaccine-preventable disease and fatality rate of the disease is high in the neonates and the elderly. The aim of this study was to detect the tetanus antibody prevalence in the over sixty-year age residents of the nursing homes in Bolu. Methods A voluntary-based study was done in the residents of two nursing homes in Bolu, Turkey. Blood samples were taken from 71 volunteers residing in there nursing homes. Tetanus IgG antibodies were measured by a commercial ELISA kit. Results Among overall subjects, only 11 (15.7 % had the protective tetanus antibody titers at the time of the study. Totally, 10 subjects were examined in emergency rooms due to trauma or accidents within the last ten years and, four (40% of them had protective antibody levels. Of the remaining 61 subjects only 7 (11% had protective antibody levels (p Conclusions Tetanus antibody level is below the protective level in the majority of the over-sixty-year-age subjects residing in the nursing homes. Each over sixty-year age person in our country should be vaccinated. Until this is accomplished, at least, nursing home residents should be vaccinated during registration.

  20. Family Members’ Experience with Hospice in Nursing Homes

    Science.gov (United States)

    Gage, L. Ashley; Washington, Karla T.; Oliver, Debra Parker; Lewis, Alexandra; Kruse, Robin L.; Demiris, George

    2014-01-01

    Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents’ family members has been limited. The purpose of this qualitative investigation was to explore family members’ experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members’ experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516

  1. Media Portrayal of the Nursing Homes Sector: A Longitudinal Analysis of 51 U.S. Newspapers.

    Science.gov (United States)

    Miller, Edward Alan; Livingstone, Ian; Ronneberg, Corina R

    2017-06-01

    Most Americans' low opinion of the nursing home (NH) sector could derive, in part, from the way in which it is portrayed in the media. This study furthers understanding of media portrayal of the NH sector by identifying how NHs were depicted in 51U.S. newspapers from 1999 to 2008. Keyword searches of the LexisNexis database were performed to identify 16,280 NH-related articles. Article content was analyzed, and tone, themes, prominence, and central actor were assessed. Basic frequencies and descriptive statistics were used to examine article content across regions, market type, and over time. Findings reveal considerably less NH coverage in the Western United States and a steady decline in NH coverage nationally over time. Most articles were news stories; more than one third were located on the front page of the newspaper or section. Most articles focused on NH industry and government interests, very few on residents/family and community concerns. Most articles were neutral or negative in tone; very few were positive or mixed. Common themes included quality, financing, and legal concerns. Tone, themes, and other article attributes varied across region, market type, and over time. Overall, findings reveal changes in how newspapers framed NH coverage, not only with respect to tone but also with respect to what dimensions of this complex issue have been emphasized during the time period analyzed. Variation in media coverage may contribute to differences in government and public views toward the NH sector across regions and over time. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Faith and End of Life in Nursing Homes

    Directory of Open Access Journals (Sweden)

    Robert L. Rubinstein

    2011-01-01

    Full Text Available This paper explores the role of religious belief in the experiences of dying and death in a Catholic nursing home. The home appeals to residents and their families due to the active religious presence. Thus, religion is a salient element of the “local culture” which exists in this long-term care setting. The preeminence of faith within the organization and the personal religious convictions of staff, residents, and families may drive how death and dying are discussed and experienced in this setting, as well as the meanings that are attached to them. This paper examines the relationship between faith and the experience and meaning of death in this nursing home. We present themes that emerged from open-ended interviews with residents, family members, and staff, gathered between 1996 and 2004. The data indicate that people select the home due to their Catholic faith and the home's religious tone. Themes also show that belief in God and an afterlife helps shape the experience of dying and death for our informants. Our paper does not compare ease of dying with other nursing homes or within other belief systems.

  3. The role of the hospice social worker in the nursing home setting.

    Science.gov (United States)

    Amar, D F

    1994-01-01

    Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to "talk therapies". The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as groupwork, negotiation, education, and advocacy.

  4. Improving Nursing Home Staff Knowledge and Attitudes about Pain

    Science.gov (United States)

    Jones, Katherine R.; Fink, Regina; Pepper, Ginny; Hutt, Eveyln; Vojir, Carol P.; Scott, Jill; Clark, Lauren; Mellis, Karen

    2004-01-01

    Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. Design and Methods: Twelve nursing homes participated in this intervention study: six…

  5. Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes.

    Science.gov (United States)

    Dumyati, Ghinwa; Stone, Nimalie D; Nace, David A; Crnich, Christopher J; Jump, Robin L P

    2017-04-01

    Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. A small number of studies provide evidence that specifically address these challenges. Their outcomes support a paradigm shift that moves infection prevention and control practices away from a pathogen-specific approach and toward one that focuses on resident risk factors.

  6. Organizational factors associated with the use of information systems in nursing homes.

    Science.gov (United States)

    Davis, Jullet A; Brannon, Diane; Whitman, Marilyn V

    2009-01-01

    The use of information systems (ISs) in nursing homes is gradually increasing, yet little is known about the factors that promote the use of these systems. Using resource dependency theory as the conceptual framework, this study examines how chain membership, ownership status, and innovativeness are associated with ISs use in nursing homes. We analyzed the results of the 2004 National Nursing Home Survey. The sampling process consisted of a stratified probability design. A total of 1,174 nursing homes participated in the survey. The results of the regression analysis revealed that facilities that were members of a chain were significantly more likely to use all types of ISs and ISs for administrative tasks than were nonchain facilities. In addition, nonprofit nursing homes were significantly more likely to use administrative systems. The demand for nursing home services is expected to increase substantially with the aging baby boomers. The use of ISs may assist nursing homes to improve service delivery by collecting and analyzing service, finance, and administrative data that are necessary to achieve operational efficiencies. Membership in a multifacility chain may both increase the need for network-wide communication and provide resources promoting use.

  7. Antidepressant treatment of depression in rural nursing home residents.

    Science.gov (United States)

    Kerber, Cindy Sullivan; Dyck, Mary J; Culp, Kennith R; Buckwalter, Kathleen

    2008-09-01

    Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.

  8. Changing Patterns of Glucose-Lowering Medication Use in VA Nursing Home Residents With Diabetes, 2005 to 2011.

    Science.gov (United States)

    Lee, Sei J; Stijacic-Cenzer, Irena; Barnhart, Caroline; McClymont, Keelan; Steinman, Michael A

    2015-10-01

    Although nursing home (NH) residents make up a large and growing proportion of Americans with diabetes mellitus, little is known about how glucose-lowering medications are used in this population. We sought to examine glucose-lowering medication use in Veterans Affairs (VA) NH residents with diabetes between 2005 and 2011. Retrospective cohort study, using linked laboratory, pharmacy, administrative, and NH Minimum Dataset (MDS) 2.0 databases in 123 VA NHs. A total of 9431 long-stay (>90 days) VA NH residents older than 65 followed for 52,313 person-quarters. We identified receipt of glucose-lowering medications, including insulin, metformin, sulfonylureas, thiazolidinediones, and others (alpha-glucosidase inhibitors, meglitinides, glucagonlike peptide-1 analogs, dipeptidyl peptidase-4 inhibitors and amylin analogs) per quarter. The rates of sulfonylurea use in long-stay NH residents dropped dramatically from 24% in 2005 to 12% in 2011 (P use (10% to 2%, P use in 2007 (4% to Metformin use was stable, ranging between 7% and 9% (P = .24). Insulin use increased slightly from 30% to 32% (P Use of other classes of glucose-lowering medications was stable (P = .22) and low, remaining below 1.3%. Between 2005 and 2011, there were dramatic declines in use of sulfonylureas and thiazolidinediones in VA NH residents, suggesting that prescribing practices can be quickly changed in this setting. Published by Elsevier Inc.

  9. The effect of laughter therapy on the quality of life of nursing home residents.

    Science.gov (United States)

    Kuru, Nilgun; Kublay, Gulumser

    2017-11-01

    To evaluate the effect of Laughter therapy on the quality of life of nursing home residents. By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance. Quasi-experimental design. The study was conducted between 2 March - 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection. After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest. Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention. The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents. © 2016 John Wiley & Sons Ltd.

  10. Medicare home health utilization as a function of nursing home market factors.

    OpenAIRE

    Swan, J H; Benjamin, A E

    1990-01-01

    Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health u...

  11. Assessment of dementia in nursing home residents by nurses and assistants

    DEFF Research Database (Denmark)

    Sørensen, Lisbeth Uhrskov; Foldspang, Anders; Gulmann, Nils Christian

    2001-01-01

    Objectives To describe the criterion validity of nursing home staff's assessment of organic disorder compared with ICD-10 criteria, and to identify determinants of staff assessment of organic disorder. Method Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. Nursing staff...... members were interviewed about the residents' activities of Daily Living, behavioural problems, orientation in surroundings and communication skills, and asked if the resident had an organic disorder. Multiple logistic regression was used to select the items that most strongly determined staff assessment...... as under-labelling of residents, a tendency that will affect communication with medical personnel and may lead to inadequate or wrong medical treatment and to negative performance as well as negative role expectations in everyday life in nursing homes....

  12. Losing Items in the Psychogeriatric Nursing Home

    Directory of Open Access Journals (Sweden)

    J. van Hoof PhD

    2016-09-01

    Full Text Available Introduction: Losing items is a time-consuming occurrence in nursing homes that is ill described. An explorative study was conducted to investigate which items got lost by nursing home residents, and how this affects the residents and family caregivers. Method: Semi-structured interviews and card sorting tasks were conducted with 12 residents with early-stage dementia and 12 family caregivers. Thematic analysis was applied to the outcomes of the sessions. Results: The participants stated that numerous personal items and assistive devices get lost in the nursing home environment, which had various emotional, practical, and financial implications. Significant amounts of time are spent on trying to find items, varying from 1 hr up to a couple of weeks. Numerous potential solutions were identified by the interviewees. Discussion: Losing items often goes together with limitations to the participation of residents. Many family caregivers are reluctant to replace lost items, as these items may get lost again.

  13. The incidence of depression and its risk factors in Dutch nursing homes and residential care homes.

    Science.gov (United States)

    Boorsma, Marijke; Joling, Karlijn; Dussel, Martine; Ribbe, Miel; Frijters, Dinnus; van Marwijk, Harm W J; Nijpels, Giel; van Hout, Hein

    2012-11-01

    Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for depression in Dutch nursing homes and residential care homes. Data on depression were extracted from the Vrije Universiteit naturalistic cohort on routine care monitoring with the Minimum Data Set of the Resident Assessment Instrument. A total of 1,324 residents in six nursing homes and 1,723 residents in 23 residential care homes with an average follow-up of 1.2 years. Depression was defined as a clinical diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and the use of antidepressants. Residents with prevalent depression at baseline were excluded. The incidence rate was 13.6 per 100 person years in the nursing homes and 10.2 per 100 person years in the residential care homes. The independent risk factors for in-home depression for residents in nursing homes included dementia (OR: 1.7; 95% CI: 1.02-2.95) and a score of 3 or more on the Depression Rating Scale (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.23-3.70). A protective effect was seen on the use of a hearing aid (OR: 0.3; 95% CI: 0.12-0.80). In the residential care homes, being male (OR: 2.1; 95% CI: 1.27-3.30), having cancer (OR: 2.9; 95% CI: 1.64-4.95), and a score of 2 or higher on the Cognitive Performance Scale (OR: 1.5; 95% CI: 1.05-2.22) increased the risk to develop depression. Age greater than 85 years (OR: 0.5; 95% CI: 0.31-0.67) and hearing impairment (OR: 0.8; 95% CI: 0.60-1.00) appeared to be protective. The incidence rate for depression in residents of Dutch nursing homes and residential care homes was high and the associated risk factors found may have important implications for staff. 2012 American Association for Geriatric Psychiatry

  14. Depression in elderly women resident in a long-stay nursing home.

    Science.gov (United States)

    Lampert, Melissa Agostini; Rosso, Ana Luiza Pereira

    2015-01-01

    Depression is the most common psychiatric disorder among the elderly: it is present in 23-40% of community-dwelling elderly and in 25-80% of institutionalized elderly. Depressive symptoms are most prevalent in elderly women because they more readily seek healthcare services, are more vulnerable to stress and live longer than men. To investigate the prevalence of depression and its comorbidities in a long-stay nursing home (NH). This retrospective, descriptive, epidemiological study was performed at a NH in southern Brazil and comprised the first part of a larger project to determine depression and its relationship with psychosocial factors in NH residents. Sociodemographic and medical data were obtained through the examination of medical files from November 2012 to January 2013. Depression was defined as the diagnosis reported by physicians in medical files and scores on the Geriatric Depression Scale (15-item version) above 5. Other clinical and psychiatric diagnoses were obtained from medical files. Out of a total of 142 elderly women, 51.4% had at least one psychiatric disorder, the most common being depression, affective bipolar disorder and mental retardation. Almost one third (32.3%) of the elderly women were depressed. The ward containing the highest number of cognitively and physically independent women contained 41.3% of the total depressed elderly. A total of 52.1% of all depressed elderly had other associated clinical or psychiatric disorders, with mental retardation and hypothyroidism being the most frequent. The prevalence of dementia was high in this NH. Further studies evaluating the psychosocial factors involved in depressed elders should be conducted in an effort to prevent depression and promote mental health in institutionalized elders.

  15. Depression in elderly women resident in a long-stay nursing home

    Directory of Open Access Journals (Sweden)

    Melissa Agostini Lampert

    Full Text Available Depression is the most common psychiatric disorder among the elderly: it is present in 23-40% of community-dwelling elderly and in 25-80% of institutionalized elderly. Depressive symptoms are most prevalent in elderly women because they more readily seek healthcare services, are more vulnerable to stress and live longer than men. OBJECTIVE: To investigate the prevalence of depression and its comorbidities in a long-stay nursing home (NH. METHODS: This retrospective, descriptive, epidemiological study was performed at a NH in southern Brazil and comprised the first part of a larger project to determine depression and its relationship with psychosocial factors in NH residents. Sociodemographic and medical data were obtained through the examination of medical files from November 2012 to January 2013. Depression was defined as the diagnosis reported by physicians in medical files and scores on the Geriatric Depression Scale (15-item version above 5. Other clinical and psychiatric diagnoses were obtained from medical files. RESULTS: Out of a total of 142 elderly women, 51.4% had at least one psychiatric disorder, the most common being depression, affective bipolar disorder and mental retardation. Almost one third (32.3% of the elderly women were depressed. The ward containing the highest number of cognitively and physically independent women contained 41.3% of the total depressed elderly. A total of 52.1% of all depressed elderly had other associated clinical or psychiatric disorders, with mental retardation and hypothyroidism being the most frequent. CONCLUSION: The prevalence of dementia was high in this NH. Further studies evaluating the psychosocial factors involved in depressed elders should be conducted in an effort to prevent depression and promote mental health in institutionalized elders.

  16. Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi Method.

    NARCIS (Netherlands)

    Hollaar, V.; Maarel-Wierink, C. van der; Putten, G.J. van der; Sanden, W. van der; Swart, B.J. de; Baat, C. de

    2016-01-01

    BACKGROUND: In nursing home residents, it is not possible to distinguish pneumonia and aspiration pneumonia clinically. International literature reveals no consensus on which and how many characteristics and risk indicators must be present to diagnose (nursing home-acquired) pneumonia and aspiration

  17. Advance Directives among Nursing Home Residents with Mild, Moderate, and Advanced Dementia.

    Science.gov (United States)

    Tjia, Jennifer; Dharmawardene, Marisa; Givens, Jane L

    2018-01-01

    To describe prevalence and content of AD documentation among NH residents by dementia stage. The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear. Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2.0 (n = 180,621). Dementia severity was classified as follows: mild (CPS 1-2), moderate (CPS 3-4), and advanced (CPS 5-6). ADs were defined as the presence of a living will, do-not-resuscitate order, do-not-hospitalize order, medication restriction, or feeding restriction). Overall, 59% of residents had any AD and 17% had a living will. Prevalence of any AD increased by dementia severity: mild (51.2%), moderate (58.2%), and advanced (61.5%) (p will was associated with higher education (≥high school graduate vs. some high school or less) and being married. While dementia severity was associated with greater likelihood of having documented any AD, almost 4 in 10 residents with dementia lacked any AD. Effective outreach may focus efforts on subgroups with lower odds of any AD or living wills, including non-white, less educated, and unmarried NH residents. A greater understanding of how such factors impact care planning will help to address barriers to patient-centered care for this population.

  18. The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

    Science.gov (United States)

    Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.

    2016-01-01

    Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819

  19. Home nurses' turnover intentions: the impact of informal supervisory feedback and self-efficacy.

    Science.gov (United States)

    Van Waeyenberg, Thomas; Decramer, Adelien; Anseel, Frederik

    2015-12-01

    To examine how home nurses' turnover intentions are affected by the quality and frequency of supervisory feedback and by their own self-efficacy. Little is known about effective retention strategies for the growing home healthcare sector that struggles to retain an adequate workforce. While the work environment and supervisors have been found to play a key-role in nurses' turnover intentions, home nurses mostly work autonomously and apart from their supervisors. These circumstances require a customized approach and need to be understood to ensure high-quality home health care. We used a correlational, cross-sectional survey design. A convenience sample of 312 home nurses was selected from a division of a large home health care organization in Flanders, Belgium. Data were collected in 2013 using structured questionnaires and analysed using descriptive statistics, structural equation modelling and relative weight analysis. The quality of feedback was related to lower levels of turnover intentions. This relationship was fully mediated by home nurses' self-efficacy. Frequent favourable feedback was directly related to lower turnover intentions while the relationship between frequent unfavourable feedback and turnover intentions was conditional on home nurses' level of self-efficacy. This study contributes to our understanding of home nurses' turnover intentions and the role of informal supervisory feedback and home nurses' self-efficacy. © 2015 John Wiley & Sons Ltd.

  20. [Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study].

    Science.gov (United States)

    Bahrmann, A; Wörz, E; Specht-Leible, N; Oster, P; Bahrmann, P

    2015-04-01

    The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

  1. Observational Learning among Older Adults Living in Nursing Homes

    Science.gov (United States)

    Story, Colleen D.

    2010-01-01

    The purpose of this study was to evaluate learning by older adults living in nursing homes through observational learning based on Bandura's (1977) social learning theory. This quantitative study investigated if older adults could learn through observation. The nursing homes in the study were located in the midwestern United States. The…

  2. Pain management in the nursing home.

    Science.gov (United States)

    Dumas, Linda G; Ramadurai, Murali

    2009-06-01

    This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).

  3. Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses.

    Science.gov (United States)

    Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P; Francke, Anneke L

    2018-03-05

    The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce. © 2018 John Wiley & Sons Ltd.

  4. Quality of care in Norwegian nursing homes - typology of family perceptions.

    Science.gov (United States)

    Vinsnes, Anne G; Nakrem, Sigrid; Harkless, Gene E; Seim, Arnfinn

    2012-01-01

    This study aimed to elucidate the understandings and beliefs about quality held by family members of residents of Norwegian nursing homes. The objective reported in the study considers how family member judge factors that enhance or hamper high care quality. The percentage of those who will require care in a nursing home some time before the end of their lives will increase dramatically in the next 20 years. Therefore, anticipating this pressure to expand nursing home availability, it is urgent that these services are developed from a keen understanding of what creates the best value. Care quality from the family's perspective is just one piece of the nursing home experience that must be understood for optimal value in care to be realised. Qualitative methodology. Three focus group interviews; purposive sampling was used to recruit the 16 family members of residents in nursing homes. Three domains emerged that served as anchors for a typology of family perceptions of the quality care continuum: resident contentment, suitability of staff and environmental context. Each domain was developed with categories describing high- to low-quality markers, which were then clarified by enhancing and hindering factors. This typology provides a family perspective framework that may be useful to nursing leadership at all levels of the nursing home organisation to identify important quality of care strengths as well as markers of poor care. Overall, the typology is offered to expand nurses' understanding of quality, both practically and conceptually, to provide the best value in nursing care. © 2011 Blackwell Publishing Ltd.

  5. How Home Health Nurses Plan Their Work Schedules: A Qualitative Descriptive Study.

    Science.gov (United States)

    Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

    2018-06-12

    To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process. Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting. Qualitative descriptive design. Semi-structured interviews were conducted with 20 registered nurses who had greater than 2 years of experience in home health and were employed by one of the three participating home health agencies in the mid-Atlantic region of the United States. Data were analyzed using conventional content analysis. Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritize visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients. Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments. Home health nurses plan their work schedules to provide high quality care that is patient-centered and timely. The findings also highlight organizational priorities to facilitate continuity of care and support nurses while alleviating the burnout

  6. [Role of Visiting Nursing Care in Japanese Home Healthcare].

    Science.gov (United States)

    Yu, Sang-Ju

    2018-02-01

    Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.

  7. Exploring correlates of turnover among nursing assistants in the National Nursing Home Survey.

    Science.gov (United States)

    Temple, April; Dobbs, Debra; Andel, Ross

    2011-01-01

    High turnover of nursing assistants (NAs) has implications for the quality of nursing home care. Greater understanding of correlates of NA turnover is needed to provide insight into possible retention strategies. This study examined nursing home organizational characteristics and specific job characteristics of staff in relation to turnover of NAs. Cross-sectional data on 944 nationally representative nursing homes were derived from the 2004 National Nursing Home Survey. Using a 3-month turnover rate, 25% of the facilities with the lowest turnover rates were classified as low turnover, 25% of the facilities with the highest turnover were classified as high turnover, and the remaining 50% of the facilities were classified as moderate turnover. Multinomial logistic regression was used to examine organizational and job characteristics associated with low and high turnover compared with moderate turnover. One organizational characteristic, staffing levels at or greater than 4.0 hours per patient day, was associated with greater odds of low NA turnover and reduced odds of high NA turnover. Job characteristics including higher wages and union membership were associated with greater odds of low NA turnover, whereas wages, fully paid health insurance, employee assistance benefits, and involvement in resident care planning were associated with reduced odds of high NA turnover. The results of this study suggest that job characteristics of NA staff may be particularly important for turnover. Specifically, the provision of competitive wages and benefits (particularly health insurance) and involvement of NAs in resident care planning could potentially reduce NA turnover, as could maintaining high levels of nurse staffing.

  8. Systematic pain assessment in nursing homes: a cluster-randomized trial using mixed-methods approach.

    Science.gov (United States)

    Mamhidir, Anna-Greta; Sjölund, Britt-Marie; Fläckman, Birgitta; Wimo, Anders; Sköldunger, Anders; Engström, Maria

    2017-02-28

    the groups. Nursing pain related documentation was sparse. In general, nurses from the outset were positive regarding pain assessments. Persisting positive attitudes seemed strengthened by continued assessment experiences and perceptions of improved pain management. The implementation of a systematic work approach to pain issues in nursing homes indicates that an increased awareness, collaboration across and shared understanding among the team members of the pain assessment results can improve pain management and lead to decreased physical deterioration or the maintenance of physical and functional abilities among NH residents. However, pain (proxy-measured) and wellbeing level did not reveal any interaction effects between the groups over time. The study was registered in ISRCTN71142240 in September 2012, retrospectively registered.

  9. Estimating the costs associated with malnutrition in Dutch nursing homes.

    Science.gov (United States)

    Meijers, Judith M M; Halfens, Ruud J G; Wilson, Lisa; Schols, Jos M G A

    2012-02-01

    Malnutrition in western health care involves a tremendous burden of illness. In this study the economic implications of malnutrition in Dutch nursing homes are investigated as part of the Health and Economic Impact of Malnutrition in Europe Study from the European Nutrition for Health Alliance. A questionnaire was developed, focussing on the additional time and resources spent to execute all relevant nutritional activities in nursing home patients with at risk of malnutrition or malnourished. Results were extrapolated on national level, based on the prevalence rates gathered within the national Prevalence Measurement of Care Problems 2009. The normal nutritional costs are 319 million Euro per year. The total additional costs of managing the problem of malnutrition in Dutch nursing homes involve 279 million Euro per year and are related to extra efforts in nutritional screening, monitoring and treatment. The extra costs for managing nursing home residents at risk of malnutrition are 8000 euro per patient and 10000 euro for malnourished patients. The extra costs related to malnutrition are a considerable burden for the nursing home sector and urge for preventive measures. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  10. Father Attendance in Nurse Home Visitation

    Science.gov (United States)

    Holmberg, John R.; Olds, David L.

    2015-01-01

    Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707

  11. Analyzing Exertion of Hardy's Tragic Effect in "Tess"

    Science.gov (United States)

    Yang, Wei

    2009-01-01

    This paper begins with a brief introduction to [Thomas] Hardy's whole life and his works, especially this novel "Tess [of the D'Urbervilles]" and points out the tragic effect's importance and Hardy's tragic idea. Linked to this tragic effect, this paper analyzes the nice application in "Tess." At last, we can understand more…

  12. Coming and staying: a qualitative exploration of Registered Nurses' experiences working in nursing homes.

    Science.gov (United States)

    Prentice, Dawn; Black, Margaret

    2007-09-01

    Aim. This paper reports on a qualitative study that explored the reasons why Registered Nurses (RNs) chose to work in nursing homes in Southern Ontario, Canada and what factors attracted them to remain. Background.  There is a paucity of information about factors associated with the recruitment and retention of RNs within long-term care (LTC) in Canada. As the population of older people is growing in Canada and elsewhere, it is essential that we better understand what attracts RNs to work and remain in this setting. Design and method. A case study approach was used in this study of nine RNs working in three nursing homes. Data were collected through in-depth interviews. Findings. Six sub-themes were identified: 'Job of Choice', 'Job of Convenience', 'Caring for the Residents', 'A Supportive Environment', 'Heavy Workload' and 'Supervisory Role of the RN'. Conclusion. Nurses chose to work in the nursing home because it was a 'Job of Convenience'. However, characteristics of the organizational environment played a major role in their remaining. Also, the caring relationship with residents played a role in the nurses remaining in this setting. Relevance to clinical practice. Strategies are provided that nurse managers may consider when planning recruitment and retention activities for LTC settings.

  13. Being a nurse in nursing home for patients on the edge of life.

    Science.gov (United States)

    Hov, Reidun; Athlin, Elsy; Hedelin, Birgitta

    2009-12-01

    Nurses in nursing homes care for patients with complex health problems that need to be followed up by medical treatment. Most patients benefit from the treatment, but for some the treatment seems only to lengthen their death process. Sometimes questions are raised as to whether life-sustaining treatment should be withheld/withdrawn. Decisions related to such questions are difficult to make as some patients are 'on the edge of life', which is understood as a transition between living and dying with an unpredictable outcome, whether the illness will lead to recovery or dying. The aim of this study was to acquire a deeper understanding of what it is to be a nurse in a nursing home for patients on the edge of life. The research design was qualitative, based on hermeneutic phenomenology. Fourteen nurses at two nursing homes were interviewed twice. The result shows that when facing a patient on the edge of life, the nurses were challenged as professionals and as human beings. Two main themes were identified, which included two sub-themes each. The first main theme: 'striving to do right and good for everyone' included the sub-themes 'feeling certain, but accompanied by uncertainty' and 'being caught between too much responsibility and too little formal power'. The second main theme: 'being a vulnerable helper--the prize and the price', contained the sub-themes 'needing emotional protection in professional commitment' and 'feeling undervalued in spite of professional pride'. The essence was: 'being a lonely and enduring struggler between opposite poles'. The findings revealed paradoxes in nurses' work which might threaten nurses' professional identity and put heavy demands on their professional performance. There is a need for formal involvement in end-of-life decisions from nurses, further education and support to nurses related to patients on the edge of life.

  14. Articulation Matrix for Home Health Aide, Nursing Assistant, Patient Care Assistant, Practical Nursing.

    Science.gov (United States)

    Florida State Univ., Tallahassee. Center for Instructional Development and Services.

    This document demonstrates the relationships among four Florida nursing education programs (home health aide, nursing assistant, patient care assistant, and practical nursing) by listing student performance standards and indicating which ones are required in each program. The 268 student performance standards are arranged in 23 areas of…

  15. The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

    OpenAIRE

    Rabiner, D J; Stearns, S C; Mutran, E

    1994-01-01

    OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the Nat...

  16. Medication reconciliation in nursing homes: thematic differences between RN and LPN staff.

    Science.gov (United States)

    Vogelsmeier, Amy A; Scott-Cawiezell, Jill R; Pepper, Ginette A

    2011-12-01

    The purpose of this qualitative descriptive study was to describe medication reconciliation practices in nursing homes with a specific focus on nursing staff involvement in the process. The study was conducted in eight Midwestern nursing homes and included 46 onsite observations of resident transfers to the nursing home. Informal interviews of nursing staff performing medication reconciliation were conducted during each observation. Findings suggest nursing home nursing staff, including both RN and licensed practical nurse (LPN) staff, were primarily responsible for performing medication reconciliation; however, these staff often varied in how they processed resident transfer information to identify medication order discrepancies. Patterns of differences were found related to their perceptions about medication reconciliation, as well as their actions when performing the process. RN staff were more often focused on resident safety and putting the "big picture" together, whereas LPN staff were more often focused on the administrative assignment and "completing the task." Copyright 2011, SLACK Incorporated.

  17. Seasonal influenza vaccination coverage and its determinants among nursing homes personnel in western France.

    Science.gov (United States)

    Elias, Christelle; Fournier, Anna; Vasiliu, Anca; Beix, Nicolas; Demillac, Rémi; Tillaut, Hélène; Guillois, Yvonnick; Eyebe, Serge; Mollo, Bastien; Crépey, Pascal

    2017-07-07

    Influenza-associated deaths is an important risk for the elderly in nursing homes (NHs) worldwide. Vaccination coverage among residents is high but poorly effective due to immunosenescence. Hence, vaccination of personnel is an efficient way to protect residents. Our objective was to quantify the seasonal influenza vaccination (IV) coverage among NH for elderly workers and identify its determinants in France. We conducted a cross-sectional study in March 2016 in a randomized sample of NHs of the Ille-et-Vilaine department of Brittany, in western France. A standardized questionnaire was administered to a randomized sample of NH workers for face-to-face interviews. General data about the establishment was also collected. Among the 33 NHs surveyed, IV coverage for the 2015-2016 season among permanent workers was estimated at 20% (95% Confidence Interval (CI) 15.3%-26.4%) ranging from 0% to 69% depending on the establishments surveyed. Moreover, IV was associated with having previously experienced a "severe" influenza episode in the past (Prevalence Ratio 1.48, 95% CI 1.01-2.17), and varied by professional categories (p benefits had a significant influence on the IV coverage (p communication tools may be required to be adapted to the various NH professionals to improve influenza prevention.

  18. The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes.

    Science.gov (United States)

    de Souto Barreto, Philipe; Cadroy, Yves; Kelaiditi, Eirini; Vellas, Bruno; Rolland, Yves

    2017-04-01

    A protective effect of obesity on death has been reported in the context of various co-morbidities. We studied if the obesity paradox applied to nursing home (NH) older residents according to dementia status. Prospective data from 3741 NH residents from France. All-cause mortality was the dependent measure. Subjects were categorized according with body mass index (BMI) as underweight, normal-weight, overweight, and obese. Dementia status was obtained from medical charts. Cox regressions were performed. There were 344 (9.2%) residents who were underweight, 1367 (43.8%) normal weight, 1069 (28.6%) overweight and 691 (18.5%) obese. 1083 (28.9%) people died during follow-up. In residents with dementia, mortality risk was reduced by almost half in overweight and obese people (HRs of 0.60 [0.48-0.76] and 0.53 [0.38-0.75], respectively; p paradox in very old and functionally limited NH residents. Therefore, weight loss in NH residents, particularly in people with dementia, should be considered with extreme caution even for obese people. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  19. Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania

    Directory of Open Access Journals (Sweden)

    Degenholtz Howard

    2006-05-01

    Full Text Available Abstract Background Job satisfaction is important for nursing home staff and nursing home management, as it is associated with absenteeism, turnover, and quality of care. However, we know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. Methods In this investigation, we use data from 251 caregivers (i.e., Registered Nurses, Licensed Practical Nurses, and Nurse Aides to examine: job satisfaction scores of these caregivers and what characteristics of these caregivers are associated with job satisfaction. The data were collected from two nursing homes over a two and a half year period with five waves of data collection at six-month intervals. The Job Description Index was used to collect job satisfaction data. Results We find that, overall nursing home caregivers are satisfied with the work and coworkers, but are less satisfied with promotional opportunities, superiors, and compensation. From exploratory factor analysis three domains represented the data, pay, management, and work. Nurse aides appear particularly sensitive to the work domain. Of significance, we also find that caregivers who perceived the quality of care to be high have higher job satisfaction on all three domains than those who do not. Conclusion These results may be important in guiding caregiver retention initiatives in nursing homes. The finding for quality may be especially important, and indicates that nursing homes that improve their quality may have a positive impact on job satisfaction of staff, and thereby reduce their turnover rates.

  20. Effect of Nursing Home Staff Training on Quality of Patient Survival.

    Science.gov (United States)

    Linn, Margaret W.; And Others

    1989-01-01

    Assessed effects of nursing home staff training in care for the dying on quality of life of 306 terminally ill patients in 5 pairs of matched nursing homes assigned randomly to trained and not trained staff groups. Patients in trained homes had less depression and greater satisfaction with care than patients in control homes at 1 and 3 months.…

  1. Compliance to Universal Design Criteria in Nursing Homes of Tehran

    Directory of Open Access Journals (Sweden)

    Morteza Nasiri

    2016-07-01

    Conclusion: The findings of this study showed that the majority of nursing homes evaluated did not follow the universal design criteria. Therefore, providing the proper guidelines and policies to promote the universal design observance in nursing homes is considered as a major necessity.

  2. Screening for depression and assessing change in severity of depression. Is the Geriatric Depression Scale (30-.15- and 8- item versions) useful for both purposes in nursing home patients?

    NARCIS (Netherlands)

    Smalbrugge, M.; Jongenelis, L.; Pot, A.M.; Eefsting, J.A.; Beekman, A.T.F.

    2008-01-01

    The objectives of this study were to determine the ability of the 30-, 15- and 8-item versions of the GDS for screening and assessing change in severity of depression in nursing home patients. The GDS and the MADRS were administered to 350 elderly NH-patients by trained interviewers. The presence of

  3. Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design.

    Science.gov (United States)

    Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane

    2016-07-08

    For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. To identify parental needs when wanting to provide neonatal home care supported by telemedicine. The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.

  4. Preventing Rehospitalization through effective home health nursing care.

    Science.gov (United States)

    Vasquez, Monica S

    2009-01-01

    To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare. PRIMARY PRACTICE SETTINGS(S): Primarily for home healthcare but can also be a tool for all other fields in nursing. Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system. The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.

  5. Drivers of change: Learning from the lived experiences of nursing home social workers.

    Science.gov (United States)

    Lee, Ahyoung Anna; Lee, Sharon Narae; Armour, Marilyn

    2016-01-01

    In response to the growing attention to integrated health care and the cultural change movement in nursing homes, this study examines the lived experiences of nursing home social workers to better understand their role perceptions, job satisfaction, and relationship with other staff members. Hermeneutic phenomenology was used in order to understand the lived experience of being a nursing home social worker. Ten nursing home social workers were recruited from a southern state and individual interviews were conducted. From the interviews, four themes emerged: challenge, coping, mattering, and rewarding. Guided by identity negotiation theory and social identity theory, these findings are discussed. Also, implications for social work education, nursing home administration, and policy is discussed.

  6. [Cases of MRSA in nursing homes in Oslo 2005-11].

    Science.gov (United States)

    Steen, Tore Wælgaard; Jørgensen, Silje Bakken; Garder, Kirsten Marie; Kollerud, Ruby del Risco; Kvalvaag, Gunnar; Blomfeldt, Anita

    2013-09-17

    The number of infections caused by MRSA has increased substantially in Norway in the past decade. It is an objective to prevent MRSA from becoming established in nursing homes and hospitals. The purpose of the article is to describe the features of the development of MRSA cases found in nursing homes in Oslo. We carried out a retrospective study of registered cases of MRSA (both sufferers and carriers) in Oslo in 2005-11. Data were obtained from the City of Oslo municipal health services' MRSA database and from genotyping carried out at Akershus University Hospital. The annual number of cases of MRSA found in Oslo increased during the period 2005-11 from 92 in 2005 to 268 in 2011, a total of 1198 cases. Of these, 224 cases (19%) were registered in nursing homes, distributed among 22 institutions, 158 residents and 66 staff, with an average of 32 cases annually (14-58 spread). Twenty-eight of 50 nursing homes had no cases of MRSA, while 159 of the cases were related to outbreaks of MRSA. Three of 20 outbreaks affected residents only. The nursing home isolates consisted of 40 different spa types, of which 160 (71%) of the isolates were clustered in three clonal complexes. The most common spa type t304 was found in 116 (52%) of the cases. Cases of MRSA in Oslo in total increased sharply from 2005 to 2011, while the number of cases in nursing homes was stable. It is, however, uncertain whether this reflects the actual incidence.

  7. Hospital in the Home nurses' recognition and response to clinical deterioration.

    Science.gov (United States)

    Gray, Erika; Currey, Judy; Considine, Julie

    2018-05-01

    To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses' assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a

  8. Ethics and quality care in nursing homes: Relatives' experiences.

    Science.gov (United States)

    Jakobsen, Rita; Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Sørlie, Venke

    2017-01-01

    A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives

  9. Development and testing of a scale for assessing the quality of home nursing.

    Science.gov (United States)

    Chiou, Chii-Jun; Wang, Hsiu-Hung; Chang, Hsing-Yi

    2016-03-01

    To develop a home nursing quality scale and to evaluate its psychometric properties. This was a 3-year study. In the first year, 19 focus group interviews with caregivers of people using home nursing services were carried out in northern, central and southern Taiwan. Content analysis was carried out and a pool of questionnaire items compiled. In the second year (2007), study was carried out on a stratified random sample selected from home nursing organizations covered by the national health insurance scheme in southern Taiwan. The study population was the co-resident primary caregivers of home care nursing service users. Item analysis and exploratory factor analysis were carried out on data from 365 self-administered questionnaires collected from 13 selected home care organizations. In the third year (2008), a random sample of participants was selected from 206 hospital-based home care nursing organizations throughout Taiwan, resulting in completion of 294 questionnaires from 27 organizations. Confirmatory factor analysis was then carried out on the scale, and the validity and reliability of the scale assessed. The present study developed a reliable and valid home nursing quality scale from the perspective of users of home nursing services. The scale comprised three factors: dependability, communication skills and service usefulness. This scale is of practical value for the promotion of long-term community care aging in local policies. The scale is ready to be used to assess the quality of services provided by home care nursing organizations. © 2015 Japan Geriatrics Society.

  10. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

    Science.gov (United States)

    Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

    2014-01-01

    A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.

  11. US and Dutch nurse experiences with fall prevention technology within nursing home environment and workflow: a qualitative study

    NARCIS (Netherlands)

    Vandenberg, Ann E.; van Beijnum, Bernhard J.F.; Overdevest, Vera G.P.; Capezuti, Elizabeth; Johnson II, Theodore M.

    2017-01-01

    Falls remain a major geriatric problem, and the search for new solutions continues. We investigated how existing fall prevention technology was experienced within nursing home nurses' environment and workflow. Our NIH-funded study in an American nursing home was followed by a cultural learning

  12. US and Dutch nurse experiences with fall prevention technology within nursing home environment and workflow : a qualitative study

    NARCIS (Netherlands)

    Vandenberg, Ann E.; van Beijnum, Bernhard J.F.; Overdevest, Vera G.P.; Capezuti, Elizabeth; Johnson II, Theodore M.

    2017-01-01

    Falls remain a major geriatric problem, and the search for new solutions continues. We investigated how existing fall prevention technology was experienced within nursing home nurses' environment and workflow. Our NIH-funded study in an American nursing home was followed by a cultural learning

  13. Making difficult decisions: the role of quality of care in choosing a nursing home.

    Science.gov (United States)

    Pesis-Katz, Irena; Phelps, Charles E; Temkin-Greener, Helena; Spector, William D; Veazie, Peter; Mukamel, Dana B

    2013-05-01

    We investigated how quality of care affects choosing a nursing home. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. In all states, consumers were more likely to choose nursing homes of high hotel services quality but not clinical care quality. Nursing home choice was also significantly associated with shorter distance from prior residence, not-for-profit status, and larger facility size. In the absence of quality report cards, consumers choose a nursing home on the basis of the quality dimensions that are easy for them to observe, evaluate, and apply to their situation. Future research should focus on identifying the quality information that offers the most value added to consumers.

  14. Nursing homes: Development of elderly care management in the Buddhist way

    Directory of Open Access Journals (Sweden)

    Warakorn Poolswat

    2015-11-01

    Full Text Available This research aims to study the historical background and current situation of care management in nursing homes for the elderly in Western Thailand and develop care management according to Buddhist principles. This qualitative research analyzes three nursing homes using interview, observation, focus group discussion and workshop as data collection tools. The researchers used a snowball sampling method to identify 109 respondents, made up of 35 key informants, 34 casual informants and 40 general informants. The researchers verified data with a triangulation method and analyzed information descriptively. Results found that the most eminent problems in care management of elderly nursing homes are the image of experts, environment and activity management. Nursing homes do not respond to spiritual requests because of a lack of social and spiritual development. It is necessary to find a new way to emphasize responsibility and respond to spiritual requests by Buddhist means. In this paper, the researchers propose a set of guidelines for the care management of nursing homes in Western Thailand.

  15. Variations in levels of care between nursing home patients in a public health care system.

    Science.gov (United States)

    Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

    2014-03-05

    Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

  16. Second-career CNAs in nursing homes: tapping an underused resource.

    Science.gov (United States)

    Pennington, Karen; Congdon, Joann G; Magilvy, Joan K

    2007-06-01

    The purpose of this study was to describe the characteristics, work perceptions, and factors influencing employment of second-career certified nursing assistants (CNAs) in nursing homes. The qualitative descriptive design included a purposeful sample of 17 participants from 5 nursing homes. Data generation consisted of demographic surveys and audiotaped interviews that were transcribed, coded, and analyzed for emerging themes. Four themes were identified: negative first impressions of the work did not deter second-career CNAs, second-career CNAs lived out personal ideals and values through their work, positive relationships and job benefits retained second-career CNAs, and second-career CNAs expressed hopes for transforming nursing homes. Results revealed a group of committed, mature workers to fill labor shortages in an essential health care setting.

  17. Nursing Home Self-assessment of Implementation of Emergency Preparedness Standards.

    Science.gov (United States)

    Lane, Sandi J; McGrady, Elizabeth

    2016-08-01

    Introduction Disasters often overwhelm a community's capacity to respond and recover, creating a gap between the needs of the community and the resources available to provide services. In the wake of multiple disasters affecting nursing homes in the last decade, increased focus has shifted to this vital component of the health care system. However, the long-term care sector has often fallen through the cracks in both planning and response. Problem Two recent reports (2006 and 2012) published by the US Department of Health and Human Services (DHHS), Office of Inspector General (OIG), elucidate the need for improvements in nursing homes' comprehensive emergency preparedness and response. The Center for Medicare and Medicaid Services (CMS) has developed an emergency preparedness checklist as a guidance tool and proposed emergency preparedness regulations. The purpose of this study was to evaluate the progress made in nursing home preparedness by determining the level of completion of the 70 tasks noted on the checklist. The study objectives were to: (1) determine the preparedness levels of nursing homes in North and South Carolina (USA), and (2) compare these findings with the 2012 OIG's report on nursing home preparedness to identify current gaps. A survey developed from the checklist of items was emailed to 418 North Carolina and 193 South Carolina nursing home administrators during 2014. One hundred seventeen were returned/"bounced back" as not received. Follow-up emails and phone calls were made to encourage participation. Sixty-three completed surveys and 32 partial surveys were received. Responses were compared to data obtained in a 2010 study to determine progress. Progress had been made in many of the overall planning and sheltering-in-place tasks, such as having contact information of local emergency managers as well as specifications for availability of potable water. Yet, gaps still persisted, especially in evacuation standards, interfacing with emergency

  18. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    Science.gov (United States)

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

    2014-01-01

    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  19. Depression in nursing homes: ensuring adequate treatment.

    Science.gov (United States)

    Llewellyn-Jones, Robert H; Snowdon, John

    2007-01-01

    Studies have shown a high prevalence of depressive disorders among nursing home residents around the world. Various losses in old age may precipitate depression, and physical illness and disability are major factors that contribute to the development and persistence of depressive disorders. Demoralization (existential distress) is common. Recognition of what a nursing home resident has lost is often a key to developing plans for management. The prognosis for recovery from depression is worse for patients who face an ongoing distressing situation or physical condition. For ongoing loss-related distress, including sadness about loss of health, it is important for patients to ventilate feelings, and to either re-acquire what is lost or to grieve and then adapt to the new situation. For major depression with melancholia, psychotic depression and bipolar disorders, biological treatments are of prime importance. Non-melancholic major depression is best treated with a combination of antidepressants and psychosocial therapies, the latter being particularly indicated when the depression has been precipitated by stressful and depressing events or situations. Psychosocial and environmental interventions are important in all types of depression and may prove more effective than the use of antidepressants for milder disorders. There has been a welcome increase in the recognition of depression in nursing homes and in the prescription of newer antidepressants, but the published evidence to date does not allow definitive recommendations regarding which antidepressants to use in this setting. Outcome research is needed to assess antidepressant efficacy and to better plan multifaceted treatment strategies for depressions of varying types and aetiologies among nursing home residents.

  20. A comparison of home care clients and nursing home residents: can community based care keep the elderly and disabled at home?

    Science.gov (United States)

    Shugarman, L R; Fries, B E; James, M

    1999-01-01

    Admission cohorts from the Michigan Medicaid Home and Community-Based Waiver program and Ohio nursing homes were compared on measures of resource utilization including a modified Resource Utilization Groups (RUG-III) system, Activities of Daily Living (ADLs), and overall case mix. We found that, contrary to previous research, the two samples were remarkably similar across RUG-III categories. However, the nursing home sample was more functionally impaired on measures of ADL functioning and overall case mix. Results of this study may inform policymakers and providers of the potential for maintaining the appropriate population in the home with government-funded home care.

  1. Factors associated with end-of-life by home-visit nursing-care providers in Japan.

    Science.gov (United States)

    Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi

    2017-06-01

    Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.

  2. Violence exposure and burn-out among Turkish nursing home staff.

    Science.gov (United States)

    Mandiracioglu, Aliye; Cam, Olcay

    2006-10-01

    The aim of this study was to describe the frequency of violence against personnel from residents and to identify the prevalence of burn-out among staff working in nursing homes. The study was performed in two cities in the west of Turkey. A semi-structured questionnaire on violence and Pines' Burnout scale were distributed among all the staff working in six nursing homes, and 214 of them responded. Of the total number of respondents, 56% stated that they had been exposed to violence during the preceding year. More than 20% stated that they had reported violence to their supervisor. Less than 10% had received medical or psychological support following the event. Violent incidents were reported significantly more frequently among staff who reported problems working with elderly residents. There was no relationship between violence towards staff and burn-out. Violence is commonly experienced by care workers in nursing homes for the elderly. Strategies to improve occupational conditions in nursing homes are required.

  3. 38 CFR 17.60 - Extensions of community nursing home care beyond six months.

    Science.gov (United States)

    2010-07-01

    ... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

  4. Pioneering a Nursing Home Quality Improvement Learning Collaborative: A Case Study of Method and Lessons Learned.

    Science.gov (United States)

    Gillespie, Suzanne M; Olsan, Tobie; Liebel, Dianne; Cai, Xueya; Stewart, Reginald; Katz, Paul R; Karuza, Jurgis

    2016-02-01

    To describe the development of a nursing home (NH) quality improvement learning collaborative (QILC) that provides Lean Six Sigma (LSS) training and infrastructure support for quality assurance performance improvement change efforts. Case report. Twenty-seven NHs located in the Greater Rochester, NY area. The learning collaborative approach in which interprofessional teams from different NHs work together to improve common clinical and organizational processes by sharing experiences and evidence-based practices to achieve measurable changes in resident outcomes and system efficiencies. NH participation, curriculum design, LSS projects. Over 6 years, 27 NHs from urban and rural settings joined the QILC as organizational members and sponsored 47 interprofessional teams to learn LSS techniques and tools, and to implement quality improvement projects. NHs, in both urban and rural settings, can benefit from participation in QILCs and are able to learn and apply LSS tools in their team-based quality improvement efforts. Published by Elsevier Inc.

  5. Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Simmons, Sandra F; Hollingsworth, Emily K; Long, Emily A; Liu, Xulei; Shotwell, Matthew S; Keeler, Emmett; An, Ruopeng; Silver, Heidi J

    2017-02-01

    To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents. Randomized, controlled trial. Five community NHs. Long-stay NH residents with an order for caloric supplementation (N = 122). Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P staff time to provide assistance. It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents' between-meal intake. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  6. Optimizing the TESS Planet Finding Pipeline

    Science.gov (United States)

    Chitamitara, Aerbwong; Smith, Jeffrey C.; Tenenbaum, Peter; TESS Science Processing Operations Center

    2017-10-01

    The Transiting Exoplanet Survey Satellite (TESS) is a new NASA planet finding all-sky survey that will observe stars within 200 light years and 10-100 times brighter than that of the highly successful Kepler mission. TESS is expected to detect ~1000 planets smaller than Neptune and dozens of Earth size planets. As in the Kepler mission, the Science Processing Operations Center (SPOC) processing pipeline at NASA Ames Research center is tasked with calibrating the raw pixel data, generating systematic error corrected light curves and then detecting and validating transit signals. The Transiting Planet Search (TPS) component of the pipeline must be modified and tuned for the new data characteristics in TESS. For example, due to each sector being viewed for as little as 28 days, the pipeline will be identifying transiting planets based on a minimum of two transit signals rather than three, as in the Kepler mission. This may result in a significantly higher false positive rate. The study presented here is to measure the detection efficiency of the TESS pipeline using simulated data. Transiting planets identified by TPS are compared to transiting planets from the simulated transit model using the measured epochs, periods, transit durations and the expected detection statistic of injected transit signals (expected MES). From the comparisons, the recovery and false positive rates of TPS is measured. Measurements of recovery in TPS are then used to adjust TPS configuration parameters to maximize the planet recovery rate and minimize false detections. The improvements in recovery rate between initial TPS conditions and after various adjustments will be presented and discussed.

  7. The introduction of a nursing guideline on depression at psychogeriatric nursing home wards: effects on Certified Nurse Assistants

    NARCIS (Netherlands)

    Verkaik, R.; Francke, A.L.; van Meijel, B.; Spreeuwenberg, P.M.; Ribbe, M.W.; Bensing, J.M.

    2011-01-01

    Background: To improve care for residents with depression in dementia, an evidence based nursing guideline was developed. Using the guideline has already shown positive effects on depression in psychogeriatric nursing home residents. Objective: To study the effects of the introduction of the nursing

  8. The introduction of a nursing guideline on depression at psychogeriatric nursing home wards: effects on Certified Nurse Assistants.

    NARCIS (Netherlands)

    Verkaik, R.; Francke, A.L.; Meijel, B. van; Spreeuwenberg, P.M.M.; Ribbe, M.W.; Bensing, J.M.

    2011-01-01

    Background: To improve care for residents with depression in dementia, an evidence based nursing guideline was developed. Using the guideline has already shown positive effects on depression in psychogeriatric nursing home residents. Objective: To study the effects of the introduction of the nursing

  9. Severity of Neuropsychiatric Symptoms in Nursing Home Residents

    Directory of Open Access Journals (Sweden)

    Anne-Sofie Helvik

    2016-01-01

    Full Text Available We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163 and 2010/2011 (n = 1,858. Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia.

  10. Stressors and Well-Being among Caregivers to Older Adults with Dementia: The In-Home versus Nursing Home Experience.

    Science.gov (United States)

    Stephens, Mary Ann Parris; And Others

    1991-01-01

    Examined differences in stressors and well-being for caregivers who care for relative with dementia at home and those with relative in nursing home (n=120). Found no differences in depression or somatic complaints, but nursing home caregivers reported fewer social disruptions and more stressors resulting from activities of daily living assistance,…

  11. The availability of allied health care in Dutch nursing homes.

    NARCIS (Netherlands)

    Boer, M.E. de; Leemrijse, C.J.; Ende, C.H.M. van den; Ribbe, M.W.; Dekker, J.

    2007-01-01

    Purpose. To determine the availability of allied health care in nursing homes in the Netherlands, and its dependency on characteristics of the nursing home. Methods. Structured surveys by telephone were carried out in a sample of 100 from a country total of 286 somatic (for somatic patients only)

  12. Diabetes knowledge in nursing homes and home-based care services: a validation study of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel.

    Science.gov (United States)

    Haugstvedt, Anne; Aarflot, Morten; Igland, Jannicke; Landbakk, Tilla; Graue, Marit

    2016-01-01

    Providing high-quality diabetes care in nursing homes and home-based care facilities requires suitable instruments to evaluate the level of diabetes knowledge among the health-care providers. Thus, the aim of this study was to examine the psychometric properties of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel. The study included 127 nursing personnel (32 registered nurses, 69 nursing aides and 26 nursing assistants) at three nursing homes and one home-based care facility in Norway. We examined the reliability and content and construct validity of the Michigan Diabetes Knowledge Test. The items in both the general diabetes subscale and the insulin-use subscale were considered relevant and appropriate. The instrument showed satisfactory properties for distinguishing between groups. Item response theory-based measurements and item information curves indicate maximum information at average or lower knowledge scores. Internal consistency and the item-total correlations were quite weak, indicating that the Michigan Diabetes Knowledge Test measures a set of items related to various relevant knowledge topics but not necessarily related to each other. The Michigan Diabetes Knowledge Test measures a broad range of topics relevant to diabetes care. It is an appropriate instrument for identifying individual and distinct needs for diabetes education among nursing personnel. The knowledge gaps identified by the Michigan Diabetes Knowledge Test could also provide useful input for the content of educational activities. However, some revision of the test should be considered.

  13. Obesity and intensive staffing needs of nursing home residents.

    Science.gov (United States)

    Harris, John Alexander; Engberg, John; Castle, Nicholas George

    2018-06-05

    The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m 2 ) to obesity Class IIIB (≥50 kg/m 2 ). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m 2 , the need for extensive staffing assistance with ADLs also increases substantially. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. When care situations evoke difficult emotions in nursing staff members: an ethnographic study in two Norwegian nursing homes.

    Science.gov (United States)

    Sandvoll, Anne Marie; Grov, Ellen Karine; Kristoffersen, Kjell; Hauge, Solveig

    2015-01-01

    Caring practice in nursing homes is a complex topic, especially the challenges of meeting the basic needs of residents when their behaviour evokes difficult emotions. Cognitive and physical changes related to aging and disability can contribute to behaviours considered to be unacceptable. For example, resident behaviours such as spitting, making a mess with food or grinding teeth are behaviours that most people do not want to see, hear or experience. The aim of this study was to gain a deeper understanding of how nursing home staff members deal with such behaviours in care situations. This article draws on ethnographic data to describe how nursing home staff members manage unpleasant resident behaviours. The study was based on two long-term units in two Norwegian public nursing homes. The Region's Medical Ethics Committee and the Norwegian Social Science Data Services granted approval. In total, 45 participants (37 nursing aides and eight nurses) agreed to participate in this study. Ten of the participants were interviewed at the end of the field study. This study indicates that nursing home staff members experience difficult emotions related to some residents' behaviours. However, they found these feelings difficult to express and rarely verbalized them openly. In addition, they were characterized by a strong obligation to help all residents, despite their own feelings. Therefore, it appears that an inner struggle occurs as a part of everyday practice. Despite these difficult emotions, nursing staff members believed that they needed to manage their responses and continued to offer good care to all residents. These findings extend our understanding of this unarticulated part of nursing home practice.

  15. Self-transcendence, nurse-patient interaction and the outcome of multidimensional well-being in cognitively intact nursing home patients.

    Science.gov (United States)

    Haugan, Gørill; Hanssen, Brith; Moksnes, Unni K

    2013-12-01

    The aim of this study was to investigate the associations between age, gender, self-transcendence, nurse-patient interaction and multidimensional well-being as the outcome among cognitively intact nursing home patients. Self-transcendence is considered to be a vital resource of well-being in vulnerable populations and at the end of life. Moreover, the quality of care and the nurse-patient interaction is found to influence self-transcendence and well-being in nursing home patients. A cross-sectional design employing the Self-Transcendence Scale, the Nurse-Patient Interaction Scale, the FACT-G Quality of Life and the FACIT-Sp Spiritual Well-Being questionnaires was adopted. A sample of 202 cognitively intact nursing home patients from 44 nursing homes in central Norway was selected. A previous documented two-factor construct of self-transcendence was applied. The statistical analyses were carried out by means of independent sample t-test, correlation and regression analyses. Multiple linear regression analyses revealed significant relationships between interpersonal self-transcendence and social, functional and spiritual well-being, whereas intrapersonal self-transcendence significantly related to emotional, social, functional and spiritual well-being. Nurse-patient interaction related to physical, emotional and functional well-being. Age and gender were not significant predictors for well-being, except for functional and spiritual well-being where women scored higher than men. Nurse-patient interaction and self-transcendence are vital resources for promoting well-being physically, emotionally, functionally, socially and spiritually among cognitively intact nursing home patients. Nurse-patient interaction signifies vital and ultimate nursing qualities promoting self-transcendence and multidimensional well-being. These findings are important for clinical nursing intending to increase patients' well-being. © 2012 The Authors Scandinavian Journal of Caring Sciences

  16. Prescription drugs in nursing homes: managing costs and quality in a complex environment.

    Science.gov (United States)

    Mendelson, Dan; Ramchand, Rajeev; Abramson, Richard; Tumlinson, Anne

    2002-11-12

    This brief provides a description of prescription drug use in nursing homes and a summary of current policy issues in this area. The brief first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The brief then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

  17. "Dignity": A central construct in nursing home staff understandings of quality continence care.

    Science.gov (United States)

    Ostaszkiewicz, Joan; Tomlinson, Emily; Hutchinson, Alison M

    2018-02-03

    To explore nursing home staff members' beliefs and expectations about what constitutes "quality continence care" for people living in nursing homes. Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of individuals who provide continence care may help bridge the gap between evidence and practice. A qualitative exploratory descriptive design. Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014-2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes. Participants' understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was "protecting residents' dignity" which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to "manage" incontinence, (iv) providing timely continence care, (v) considering residents' continence care preferences and (vi) communicating sensitively. The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a multidimensional framework that is informed by social, psychological

  18. Early discharge and home care after unplanned cesarean birth: nursing care time.

    Science.gov (United States)

    Brooten, D; Knapp, H; Borucki, L; Jacobsen, B; Finkler, S; Arnold, L; Mennuti, M

    1996-09-01

    This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. An urban tertiary-care hospital. The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborn was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group.

  19. Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

    Science.gov (United States)

    Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

    2014-07-01

    Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

  20. (ReViewing Maggie and Tess through the Lens of Standpoint Theory

    Directory of Open Access Journals (Sweden)

    Sardar M Anwaruddin

    2013-03-01

    Full Text Available Literary critics admire George Eliot's touching portrayal of Maggie Tulliver in The Mill on the Floss. Many readers prefer to read Maggie's character as a reworking of Eliot's own life. In this article, I compare Maggie with another famous literary heroine, Tess Durbeyfield of Thomas Hardy's Tess of the D'Urbervilles. Tess is a "low-born" country girl whose suffering begins as soon as her family discovers that they have noble connections. Both Maggie and Tess go through hardship and humiliation due to their sense of responsibility and commitment to do the best for their families. Looking at these two characters through the lens of feminist standpoint theory, I argue that Maggie and Tess' social locations, imposed gender-roles, and families' expectations are among the primary causes of their tragedy. As members of the oppressed (gender group, their epistemologies to understand the reality and to make sense of their social relationships contradict with those of the dominant group-masculine.

  1. Staff assignment practices in nursing homes: review of the literature.

    Science.gov (United States)

    Rahman, Anna; Straker, Jane K; Manning, Lydia

    2009-01-01

    Consistent assignment, whereby nursing home staff members, particularly certified nurse aides, are assigned to the same residents on most shifts, is increasingly viewed as a cornerstone of culture change in nursing homes. It has been advocated as a best-care model that increases residents' quality of life while contributing to a more stable frontline staff. Given these potential benefits, consistent assignment is now widely viewed as superior to rotating assignment, an alternative staffing model that aims to distribute care burden more fairly among staff and ensure that workers are familiar with most residents. Despite favorable anecdotal reports about the benefits of consistent assignment, the research literature reports mixed and sometimes contradictory findings for this staffing practice. This article reviews the research pertaining to staff assignment practices in nursing homes. Reviewed here are 13 reports on experimental trials (6 reports), evaluation research (4 reports), and nursing home surveys (3 reports). The review reveals broad diversity in staffing practices and raises questions that challenge popular assumptions about consistent assignment. The article closes with a discussion of the research, policy, and practice implications of the research findings.

  2. Operating environment and USA nursing homes' participation in the subacute care market: a longitudinal analysis.

    Science.gov (United States)

    Weech-Maldonado, Robert; Qaseem, Amir; Mkanta, William

    2009-02-01

    We examined the impact of environmental factors on USA nursing homes' participation in the subacute care market. Findings suggest that the Balanced Budget Act of 1997 did not have a significant impact in the participation of nursing homes in the subacute care market from 1998 to 2000. However, there was a declining trend in the participation of nursing homes in the subacute care market after the implementation of Medicare prospective payment system (PPS). Furthermore, nursing homes with a higher proportion of Medicare residents were more likely to exit the subacute care market after PPS. Results also suggest that nursing homes have responded strategically to the environmental demand for subacute care services. Nursing homes located in markets with higher Medicare managed care penetration were more likely to offer subacute care services. Environmental munificence was also an important predictor of nursing home innovation into subacute care. Nursing homes in states with higher Medicaid reimbursement and those in less competitive markets were more likely to participate in the subacute care market.

  3. Local Medicaid home- and community-based services spending and nursing home admissions of younger adults.

    Science.gov (United States)

    Thomas, Kali S; Keohane, Laura; Mor, Vincent

    2014-11-01

    We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.

  4. Exploring the concurrent validity of the nationwide assessment of permanent nursing home residence in Denmark

    DEFF Research Database (Denmark)

    Bebe, Anna; Nielsen, Anni Brit Sternhagen; Willadsen, Tora Grauers

    2017-01-01

    Background: Many register studies make use of information about permanent nursing home residents. Statistics Denmark (StatD) identifies nursing home residents by two different indirect methods, one based on reports from the municipalities regarding home care in taken place in a nursing home...... Danish Region, we randomly selected one municipality reporting to Stat D (Method 1) and one not reporting where instead an algorithm created by StatD was used to discover nursing home residents (Method 2). Method 1 means that municipalities reported to Stat D whether home care has taken place......, and the other based on an algorithm created by StatD.The aim of the present study was to validate StatD’s nursing home register using dedicated administrative municipality records on individual nursing home residents as gold standard. Methods: In total, ten Danish municipalities were selected. Within each...

  5. Risk Factors for Pressure Ulcers Including Suspected Deep Tissue Injury in Nursing Home Facility Residents: Analysis of National Minimum Data Set 3.0.

    Science.gov (United States)

    Ahn, Hyochol; Cowan, Linda; Garvan, Cynthia; Lyon, Debra; Stechmiller, Joyce

    2016-04-01

    To provide information on risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home residents in the United States. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Examine the literature related to risk factors for the development of PrUs.2. Compare risk factors associated with the prevalence of PrUs and sDTI from the revised Minimum Data Set 3.0 2012 using a modified Defloor's conceptual model of PrUs as a theoretical framework. This study aims to characterize and compare risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home (NH) residents in the United States. Secondary analysis of the 2012 Minimum Data Set (MDS 3.0). Medicare- or Medicaid-certified NHs in the United States. Nursing home residents (n = 2,936,146) 18 years or older with complete PrU data, who received comprehensive assessments from January to December 2012. Pressure ulcer by stage was the outcome variable. Explanatory variables (age, gender, race and ethnicity, body mass index, skin integrity, system failure, disease, infection, mobility, and cognition) from the MDS 3.0 were aligned with the 4 elements of Defloor's conceptual model: compressive forces, shearing forces, tissue tolerance for pressure, and tissue tolerance for oxygen. Of 2,936,146 NH residents who had complete data for PrU, 89.9% had no PrU; 8.4% had a Stage 2, 3, or 4 or unstagable PrU; and 1.7% had an sDTI. The MDS variables corresponding to the 4 elements of Defloor's model were significantly predictive of both PrU and sDTI. Black residents had the highest risk of any-stage PrU, and Hispanic residents had the highest risk of sDTI. Skin integrity, system failure, infection, and disease risk factors had larger effect sizes for sDTI than for other PrU stages

  6. Work-home interference among nurses: reciprocal relationships with job demands and health.

    Science.gov (United States)

    van der Heijden, Beatrice I J M; Demerouti, Evangelia; Bakker, Arnold B

    2008-06-01

    This paper is a report of a study with three aims: (i) to investigate whether emotional, quantitative and physical demands have a causal, negative impact on nurses' health; (ii) to examine whether work-home interference can explain this effect, by playing a mediating role; and (iii) to test the so-called loss spiral hypothesis claiming that nurses' health problems lead to even higher job demands and more work-home interference over time. While many scholars have thought in terms of the stressor-->work-home interference-->strain model, the validity of a model that includes opposite pathways needs to be tested. A questionnaire was completed twice, with a 1-year time interval by 753 (63.4%) Registered Nurses working in hospitals, 183 (15.4%) working in nursing homes, and 251 (21.1%) working in home care institutions. The first measurement took place between October 2002 and June 2003. Our findings strongly support the idea of cross-lagged, reciprocal relationships between job demands and general health over time. The reciprocal model with work-home interference as an intervening variable (including reciprocal relationships between job demands, work-home interference and general health) showed a good fit to the data, and proved to be superior to both the causality and reversed causation models. The higher nurses' job demands, the higher is their level of work-home interference and the more likely is a general health deterioration over time, in turn giving rise to higher job demands and work-home interference, which may even aggravate the nurses' general health, and so on.

  7. The nursing home elder microbiome stability and associations with age, frailty, nutrition and physical location.

    Science.gov (United States)

    Haran, John P; Bucci, Vanni; Dutta, Protiva; Ward, Doyle; McCormick, Beth

    2018-01-01

    The microbiome from nursing home (NH) residents is marked by a loss in diversity that is associated with increased frailty. Our objective was to explore the associations of NH environment, frailty, nutritional status and residents' age to microbiome composition and potential metabolic function. We conducted a prospective longitudinal cohort study of 23 residents, 65 years or older, from one NH that had four floors: two separate medical intensive floors and two floors with active elders. Residents were assessed using the mini nutritional assessment tool and clinical frailty scale. Bacterial composition and metabolic potential of residents' stool samples was determined by metagenomic sequencing. We performed traditional unsupervised correspondence analysis and linear mixed effect modelling regression to assess the bacteria and functional pathways significantly affected by these covariates.Results/Key findings. NH resident microbiomes demonstrated temporal stability (PERMANOVA P=0.001) and differing dysbiotic associations with increasing age, frailty and malnutrition scores. As residents aged, the abundance of microbiota-encoded genes and pathways related to essential amino acid, nitrogenous base and vitamin B production declined. With increasing frailty, residents had lower abundances of butyrate-producing organisms, which are associated with increased health and higher abundances of known dysbiotic species. As residents became malnourished, butyrate-producing organisms declined and dysbiotic bacterial species increased. Finally, the microbiome of residents living in proximity shared similar species and, as demonstrated for Escherichia coli, similar strains. These findings support the conclusion that a signature 'NH' microbiota may exist that is affected by the residents' age, frailty, nutritional status and physical location.

  8. Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams

    Science.gov (United States)

    Yeatts, Dale E.; Cready, Cynthia; Ray, Beth; DeWitt, Amy; Queen, Courtney

    2004-01-01

    Purpose: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and Methods: A quasi-experimental design is underway where certified nurse aide…

  9. Maximizing federal Medicaid dollars: nursing home provider tax adoption, 2000-2004.

    Science.gov (United States)

    Miller, Edward Alan; Wang, Lili

    2009-12-01

    Since Medicaid is jointly financed by the federal and state governments, state officials have sought to offset state expenditures by maximizing federal contributions. One such strategy is to adopt a provider tax, which enables states to collect revenues from providers; those revenues are then used to pay for services rendered to Medicaid recipients, thereby leveraging federal matching dollars without concomitant increases in state expenditures. The number of states adopting a nursing home tax increased from thirteen to thirty-one between 2000 and 2004. This study seeks to identify the factors that spurred the rapid increase in nursing home provider taxes following implementation of the Balanced Budget Act of 1997. Results indicate that states with more powerful nursing home lobbies, lower proportions of private pay nursing home residents, worse fiscal health, weaker fiscal capacity, broader Medicaid eligibility, and nursing home supply restrictions were more likely to adopt. This implies that state officials react rationally to prevailing fiscal and programmatic circumstances when formulating policy under Medicaid and that providers seek relief, in part, from the adverse fiscal consequences of federal policy changes by promoting policy change at the state level.

  10. Restorative Virtual Environment Design for Augmenting Nursing Home Rehabilitation

    DEFF Research Database (Denmark)

    Bruun-Pedersen, Jon Ram; Serafin, Stefania; Kofoed, Lise

    2016-01-01

    do, but more studies on content and design of proper custom designs for RVEs is necessary. This paper reviews the background for RVE design, describes four custom RVE designs for recreational VE exploration and presents user preferences among nursing home users concerning content and other pivotal......With increasing age, muscle strength decreases excessively rapidly if physical activity is not maintained. However, physical activity is increasingly difficult with age, due to balance, strength or coordination difficulties, arthritis, etc. Moreover, many nursing home residents become unable...... to experience natural surroundings. Augmenting a conventional biking exercise with a recreational virtual environment (RVE) has shown to serve as an intrinsic motivation contributor to exercise for nursing home residents. RVEs might be able to provide some of the health benefits that regular nature experiences...

  11. The Relationship between Religiosity and Attitudes of Nurses Aides toward Sexual Expression by Older Adults in Nursing Homes.

    Science.gov (United States)

    Stevenson, Robert T.; Courtenay, Bradley C.

    Systematic research on attitudes of nursing home staff toward the sexual expression of older residents is sparse and of recent origin. In order to determine the relationship between the degree of religiosity (religious commitment) of nursing home aides and their degree of tolerance concerning sexuality and aging, female nursing assistants (N=101)…

  12. Factors associated with resident aggression toward caregivers in nursing homes.

    Science.gov (United States)

    Zeller, Adelheid; Dassen, Theo; Kok, Gerjo; Needham, Ian; Halfens, Ruud J G

    2012-09-01

    Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes. A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study. Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied. The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age ( 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age ( 45 years: OR = 2.04). Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed. The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and

  13. Modifiable factors related to abusive behaviors in nursing home residents with dementia

    NARCIS (Netherlands)

    Volicer, L.; Kampen, van J.T.; Frijters, D.H.M.

    2009-01-01

    OBJECTIVES: To determine modifiable factors related to abusive behaviors in nursing home residents with dementia. DESIGN: Analysis of Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI) information. SETTING: We used MDS-RAI data from 8 Dutch nursing homes and 10 residential homes that

  14. Pressure ulcer prevention in nursing homes: nurse descriptions of individual and organization level factors.

    Science.gov (United States)

    Dellefield, Mary Ellen; Magnabosco, Jennifer L

    2014-01-01

    Sustaining pressure ulcer prevention (PUP) in nursing homes has been difficult to achieve. Implementation science researchers suggest that identification of individual staff and organizational factors influencing current practices is essential to the development of an effective and customized plan to implement practice changes in a specific setting. A mixed methods approach was used to describe nurses' perceptions of individual and organization-level factors influencing performance of PUP in two Veterans Health Administration (VHA) nursing homes prior to implementation of a national VHA initiative on Hospital Acquired Pressure Ulcers (HAPUs). Individual interviews of 16 nursing staff were conducted. Individual factors influencing practice were a personal sense of responsibility to Veterans and belief in the effectiveness and importance of preventive measures. Organizational factors were existence of cooperative practices between nursing assistants and licensed nurses in assessing risk; teamwork, communication, and a commitment to Veterans' well-being. Integration and reinforcement of such factors in the development and maintenance of customized plans of PUP initiatives is recommended. Published by Mosby, Inc.

  15. Pain management for older persons living in nursing homes: a pilot study.

    Science.gov (United States)

    Tse, Mimi M Y; Ho, Suki S K

    2013-06-01

    Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p pain scores and used more nondrug strategies for pain relief compared with the control group (p nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Impact of long term care and mortality risk in community care and nursing homes populations.

    Science.gov (United States)

    Lopes, Hugo; Mateus, Céu; Rosati, Nicoletta

    To identify the survival time, the mortality risk factors and the individuals' characteristics associated with cognitive and physical status at discharge, among the Portuguese long-term care (LTC) populations. Home-and-Community-Based Services (HCBS) and three types of Nursing Homes (NH). 20,984 individuals admitted and discharged in 2015. The Kaplan-Meier survival analysis and the Cox Proportional Hazards Models were used to study the mortality risk; the Wilcoxon signed-rank test to identify the number of individuals with cognitive and physical changes between admission and discharge; two cumulative odds ordinal logistic regressions to predict the cognitive and physical dependence levels at discharge RESULTS: The mortality rate at HCBS was 30%, and 17% at the NH, with a median survival time of 173 and 200 days, respectively. The main factors associated with higher mortality were older age, male gender, family/neighbour support, neoplasms and cognitive/physical dependence at admission. In NH/HCBS, 26%/18% of individuals improve their cognitive status, while in physical status the proportion was 38%/27%, respectively. Finally, older age, being illiterate and being classified at the lowest cognitive and physical status at admission decrease the likelihood of achieving a higher level of cognitive and physical independence at discharge. The adoption of a robust and complete assessment tool, the definition of guidelines to enable a periodical assessment of individuals' autonomy and the adoption of benchmark metrics allowing the comparison of results between similar units are some of the main goals to be taken into account for future developments of this care in Portugal. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Comparing Catheter-associated Urinary Tract Infection Prevention Programs Between VA and Non-VA Nursing Homes

    Science.gov (United States)

    Mody, Lona; Greene, M. Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W.; Wald, Heidi L.; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E.; King, Beth J.; Hogikyan, Robert; Edson, Barbara; Krein, Sarah L.

    2018-01-01

    OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that U.S. Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the “AHRQ Safety Program for Long-term Care” collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention. RESULTS A total of 353 (71%; 47 VA, 306 non-VA) of 494 nursing homes from 41 states responded. VA nursing homes reported more hours/week devoted to infection prevention-related activities (31 vs. 12 hours, P<.001), and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs. 66%, P<.001), sharing CAUTI data with leadership (94% vs. 70%, P=.014) and nursing personnel (85% vs. 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs. 81%, P=.004) and catheter insertion (83% vs. 94%, P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. PMID:27917728

  18. The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes.

    Science.gov (United States)

    Vainieri, Milena; Smaldone, Pierluigi; Rosa, Antonella; Carroll, Kathleen

    2017-08-23

    The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself. This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides' job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts. We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH. Findings show that the factors influencing nursing aides' satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers' satisfaction. Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts. Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.This is an open-access article distributed under the terms of the Creative Commons

  19. Investigation on nursing service satisfaction of the elderly living in nursing home and influencing factors--Taking Zhengzhou City as an example

    Directory of Open Access Journals (Sweden)

    Xing Wenhui

    2016-01-01

    Full Text Available Objective: Investigate the status quo of the elderly living in the nursing home and their satisfaction and needs of nursing services, and analyze the service needs of the elderly living in the nursing home of Zhengzhou City. Methods: Randomly select 312 elderly people from 84 nursing homes for questionnaire survey and in-depth interview. Results: More than 60% of the respondents show their satisfaction on the current life in the nursing home. Sex, occupation, physical condition, dietary level, accommodation level, service level and health care conditions of the nursing home have a significant impact on the satisfaction of the elderly. Conclusion: With the growth of the aging of population, improving the level of service for the elderly and improve the service facilities is an essential way to improve the satisfaction and urgent needs of the elderly.

  20. Changes in the personal dignity of nursing home residents: a longitudinal qualitative interview study.

    Directory of Open Access Journals (Sweden)

    Mariska G Oosterveld-Vlug

    Full Text Available BACKGROUND: Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. AIM: To investigate if and how nursing home residents' personal dignity changes over the course of time, and what contributes to this. DESIGN: A longitudinal qualitative study. METHODS: Multiple in-depth interviews, with an interval of six months, were carried out with 22 purposively sampled nursing home residents of the general medical wards of four nursing homes in The Netherlands. Transcripts were analyzed following the principles of thematic analysis. RESULTS: From admission onwards, some residents experienced an improved sense of dignity, while others experienced a downward trend, a fluctuating one or no change at all. Two mechanisms were especially important for a nursing home resident to maintain or regain personal dignity: the feeling that one is in control of his life and the feeling that one is regarded as a worthwhile person. The acquirement of both feelings could be supported by 1 finding a way to cope with one's situation; 2 getting acquainted with the new living structures in the nursing home and therefore feeling more at ease; 3 physical improvement (with or without an electric wheelchair; 4 being socially involved with nursing home staff, other residents and relatives; and 5 being amongst disabled others and therefore less prone to exposures of disrespect from the outer world. CONCLUSION: Although the direction in which a resident's personal dignity develops is also dependent on one's character and coping capacities, nursing home staff can contribute to dignity by creating optimal conditions to help a nursing home resident recover feelings of control and of being regarded as a worthwhile person.

  1. Changes in the personal dignity of nursing home residents: a longitudinal qualitative interview study.

    Science.gov (United States)

    Oosterveld-Vlug, Mariska G; Pasman, H Roeline W; van Gennip, Isis E; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

    2013-01-01

    Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. To investigate if and how nursing home residents' personal dignity changes over the course of time, and what contributes to this. A longitudinal qualitative study. Multiple in-depth interviews, with an interval of six months, were carried out with 22 purposively sampled nursing home residents of the general medical wards of four nursing homes in The Netherlands. Transcripts were analyzed following the principles of thematic analysis. From admission onwards, some residents experienced an improved sense of dignity, while others experienced a downward trend, a fluctuating one or no change at all. Two mechanisms were especially important for a nursing home resident to maintain or regain personal dignity: the feeling that one is in control of his life and the feeling that one is regarded as a worthwhile person. The acquirement of both feelings could be supported by 1) finding a way to cope with one's situation; 2) getting acquainted with the new living structures in the nursing home and therefore feeling more at ease; 3) physical improvement (with or without an electric wheelchair); 4) being socially involved with nursing home staff, other residents and relatives; and 5) being amongst disabled others and therefore less prone to exposures of disrespect from the outer world. Although the direction in which a resident's personal dignity develops is also dependent on one's character and coping capacities, nursing home staff can contribute to dignity by creating optimal conditions to help a nursing home resident recover feelings of control and of being regarded as a worthwhile person.

  2. Vigilant at the end of life: family advocacy in the nursing home.

    Science.gov (United States)

    Shield, Renee R; Wetle, Terrie; Teno, Joan; Miller, Susan C; Welch, Lisa C

    2010-05-01

    Increasing numbers of Americans die in nursing homes. Little is known about the roles and experiences of family members of persons who die in nursing homes. The authors conducted 54 qualitative telephone interviews of close family or friends of individuals who had spent at least 48 hours in the last month of life in a nursing home. Respondents had earlier participated in a national survey that found 587 of 1578 decedents (37.2%) received end-of-life nursing home care. In qualitative interviews respondents described the last year of life, focusing on the nursing home experience. Interviews were analyzed by a multidisciplinary team to identify key themes of areas of concern. An important interview theme revealed families often felt the need to advocate for their dying relative because of low expectations or experiences with poor quality nursing home care. They noted staff members who did not fully inform them about what to expect in the dying process. Respondents reported burden and gratification in care they themselves provided, which sometimes entailed collaboration with staff. Interviews also identified ways hospice care impacted families, including helping to relieve family burden. End-of-life advocacy takes on increased urgency when those close to the dying resident have concerns about basic care and do not understand the dying course. Enhancing communication, preparing families at the end of life, and better understanding of hospice are likely to increase family trust in nursing home care, improve the care of dying residents, and help reduce family burden.

  3. Efficacy and acceptance of professional dental cleaning among nursing home residents.

    Science.gov (United States)

    Barbe, Anna Greta; Kottmann, Hannah Elisa; Hamacher, Stefanie; Derman, Sonja Henny Maria; Noack, Michael Johannes

    2018-05-13

    To determine the impact of general and oral health status of nursing home residents in Germany on efficacy and acceptance of professional dental cleaning performed by a dental nurse. Participants (N = 41; mean age 83 ± 8 years) living in a nursing home were included. Personal and general health, oral health, oral hygiene habits, and needs were investigated. Individual acceptance regarding professional dental cleaning via different devices (scaler, interdental brushes, ultrasonic cleaning) was assessed, as was the efficacy of this method using after-cleaning indices. Oral health among nursing home residents was impaired and independent from dementia status. Most residents (33/41) performed oral hygiene procedures independently and showed better index values than those in need of external help. Residents requiring help with oral hygiene showed increased risk profiles (higher age, more often immobile, demented, more xerostomia). The dental cleaning procedure required a mean time of 37 ± 11 min, was widely accepted (36/41), and achieved clean results (plaque index 0.1 ± 0.5, oral hygiene index 0.2 ± 1.6, Volpe-Manhold index 0.4 ± 1.6); food residues were reduced to 0 independent from cognitive status. Regarding the cleaning methods, scalers were accepted best without difference between demented and non-demented residents. Professional dental cleaning in nursing homes is an accepted and efficacious oral hygiene procedure among nursing home residents. Professional dental cleaning is an efficacious and accepted method as a first step in line with strategies to improve oral health and should be considered in nursing home residents.

  4. Organizational Climate Determinants of Resident Safety Culture in Nursing Homes

    Science.gov (United States)

    Arnetz, Judith E.; Zhdanova, Ludmila S.; Elsouhag, Dalia; Lichtenberg, Peter; Luborsky, Mark R.; Arnetz, Bengt B.

    2011-01-01

    Purpose of the Study: In recent years, there has been an increasing focus on the role of safety culture in preventing costly adverse events, such as medication errors and falls, among nursing home residents. However, little is known regarding critical organizational determinants of a positive safety culture in nursing homes. The aim of this study…

  5. Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study.

    Science.gov (United States)

    Fain, Kevin M; Rosenberg, Paul B; Pirard, Sandrine; Bogunovic, Olivera; Spira, Adam P

    2015-07-01

    Many nursing home residents have cognitive impairment that affects their decision making. In order to identify potential markers of impaired decision making, we investigated the association between a range of nursing home resident characteristics and impaired decision making in a population-based sample. Participants were 13,013 residents in the 2004 National Nursing Home Survey. We used logistic regression to determine the association between resident characteristics (ie, gender, age, race, mood, recent pain, falls, fractures, or hospitalizations, length of stay, number of activities of daily living (ADL) requiring help, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making. After controlling for depression and anxiety diagnoses, as well as gender, age, race, and recent hospitalization or pain, characteristics associated with impaired decision making included depressed, sad, or anxious mood ["mild" odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.23-1.58; "severe" OR = 2.69, 95% CI = 2.27-3.20); diagnosed dementia or living on a dementia hall (OR = 5.07, 95% CI = 4.52-5.67); number of ADL requiring assistance (with 5 ADL, OR = 10.69, 95% CI = 6.82-16.75); length of nursing home stay [101-365 days (OR = 1.60, 95% CI = 1.36-1.89); 366 days-2 years (OR = 1.60, 95% CI = 1.34-1.90); >2 years (OR = 2.25, 95% CI = 1.92-2.63)]; and history of falls or fractures in the last 6 months (OR = 1.19, 95% CI = 1.07-1.32)]. Residents reporting pain in the last week were less likely to have impaired decision making (OR = 0.58, 95% CI = 0.52-0.66). We found several independent markers of impaired decision making in nursing home residents, including depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for ADL assistance. Some of these factors, in particular mood, are modifiable and addressing them may help improve decision making. These markers should be explored

  6. The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes--A cross-sectional study.

    Science.gov (United States)

    Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

    2015-09-01

    Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). Nursing homes from all three language regions of Switzerland. A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically

  7. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004.

    Science.gov (United States)

    Malloy, M H

    2010-09-01

    Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries. United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital 'other' midwife, home certified nurse midwife, home 'other' midwife, and free-standing birth center certified nurse midwife deliveries. For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital 'other' midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home 'other' midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths=614), 0.4 (deaths=7), 1.0 (deaths=14), 1.8 (deaths=75), and 0.6 (deaths=16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45). Deliveries at home attended by CNMs and 'other midwives' were associated with higher risks for mortality than deliveries in-hospital by CNMs.

  8. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristinn; Andreasen, Jan; Mortensen, Rikke N

    2016-01-01

    OBJECTIVES: Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort. METHODS: All patients who...... underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan.......1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (nursing home 1 year postoperatively were: age ≥80 years...

  9. Determinants for the use of psychotropics among nursing home residents

    DEFF Research Database (Denmark)

    Sørensen, Lisbeth Uhrskov; Foldspang, A; Gulmann, N C

    2001-01-01

    's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics. Results Fifty-six percent......Purpose To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use. Methods Prescribed daily medication was recorded from nurses' files. Based...

  10. Mental status testing in the elderly nursing home population.

    Science.gov (United States)

    Nadler, J D; Relkin, N R; Cohen, M S; Hodder, R A; Reingold, J; Plum, F

    1995-07-01

    The clinical utility of selected brief cognitive screening instruments in detecting dementia in an elderly nursing home population was examined. One hundred twenty nursing home residents (mean age 87.9) were administered the Mini-Mental State Exam (MMSE) and the Modified Mini-Mental State Exam (3MS). The majority of the subjects (75%) were also administered the Dementia Rating Scale (DRS). Both clinically diagnosed demented (n = 57) and non-demented (n = 63) subjects participated in the study. Dementia was diagnosed in accordance with DSM-III-R criteria by physicians specializing in geriatric medicine. Using standard cutoffs for impairment, the 3MS, MMSE, and DRS achieved high sensitivity (82% to 100%) but low specificity (33% to 52%) in the detection of dementia among nursing home residents. Positive predictive values ranged from 52% to 61%, and negative predictive values from 77% to 100%. Higher age, lower education, and history of depression were significantly associated with misclassification of non-demented elderly subjects. Receiver Operating Characteristic (ROC) curve analyses revealed optimal classification of dementia with cutoff values of 74 for the 3MS, 22 for the MMSE, and 110 for the DRS. The results suggest that the 3MS, MMSE, and DRS do not differ significantly with respect to classification accuracy of dementia in a nursing home population. Elderly individuals of advanced age (i.e., the oldest-old) with lower education and a history of depression appear at particular risk for dementia misclassification with these instruments. Revised cutoff values for impairment should be employed when these instruments are applied to elderly residents of nursing homes and the oldest-old.

  11. Gender Regimes in Ontario Nursing Homes: Organization, Daily Work, and Bodies.

    Science.gov (United States)

    Storm, Palle; Braedley, Susan; Chivers, Sally

    2017-06-01

    Today more men work in the long-term care sector, but men are still in the minority. Little is known about men's experiences in care work, and the dilemmas and opportunities they face because of their gender. This article focuses on men care workers' integration into the organization and flow of nursing home work as perceived by these workers and staff members. Using a rapid ethnography method in two Ontario nursing homes, we found work organization affected interpretations of gender and race, and that workers' scope for discretion affected the integration and acceptance of men as care workers. In a nursing home with a rigid work organization and little worker discretion, women workers perceived men workers as a problem, whereas at a nursing home with a more flexible work organization that stressed relational care, both women and men workers perceived men workers as a resource in the organization.

  12. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

    NARCIS (Netherlands)

    Lovink, M.H.; Persoon, A.; Vught, A.J. van; Schoonhoven, L.; Koopmans, R.T.C.M.; Laurant, M.G.H.

    2017-01-01

    INTRODUCTION: In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of

  13. Action research in nursing homes

    DEFF Research Database (Denmark)

    Andersen, John; Bilfeldt, Annette

    2016-01-01

    quality in a joint effort between care workers, residents at the nursing home, and researchers. It concludes that the project led to empowerment of the residents and staff and played an important role in the development of democratic knowledge building about better quality and ethics in elder care....

  14. Measures of emergency preparedness contributing to nursing home resilience.

    Science.gov (United States)

    Lane, Sandi J; McGrady, Elizabeth

    2017-12-13

    Resilience approaches have been successfully applied in crisis management, disaster response, and high reliability organizations and have the potential to enhance existing systems of nursing home disaster preparedness. This study's purpose was to determine how the Center for Medicare and Medicaid Services (CMS) "Emergency Preparedness Checklist Recommended Tool for Effective Health Care Facility Planning" contributes to organizational resilience by identifying the benchmark resilience items addressed by the CMS Emergency Preparedness Checklist and items not addressed by the CMS Emergency Preparedness Checklist, and to recommend tools and processes to improve resilience for nursing homes. The CMS Emergency Preparedness Checklist items were compared to the Resilience Benchmark Tool items; similar items were considered matches. Resilience Benchmark Tool items with no CMS Emergency Preparedness Checklist item matches were considered breaches in nursing home resilience. The findings suggest that the CMS Emergency Preparedness Checklist can be used to measure some aspects of resilience, however, there were many resilience factors not addressed. For nursing homes to prepare and respond to crisis situations, organizations need to embrace a culture that promotes individual resilience-related competencies that when aggregated enable the organization to improve its resiliency. Social workers have the skills and experience to facilitate this change.

  15. Activity Engagement: Perspectives from Nursing Home Residents with Dementia

    Science.gov (United States)

    Tak, Sunghee H.; Kedia, Satish; Tongumpun, Tera Marie; Hong, Song Hee

    2014-01-01

    Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending in church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed. PMID:25489122

  16. Risk factors for burnout among caregivers working in nursing homes.

    Science.gov (United States)

    Kandelman, Nadia; Mazars, Thierry; Levy, Antonin

    2018-01-01

    (i) To assess the level of burnout in nursing home caregivers within a unique healthcare network in France and (ii) to evaluate potential risk factors in this population. Burnout syndrome occurs frequently among nursing home caregivers and has strong detrimental effects on the quality of health care for residents. We used an observational survey to study burnout in nursing home caregivers. The survey was used to quantify burnout level (Maslach Burnout Inventory) and potential risk factors and was implemented from October 2013-April 2014. A logistic regression was used to explore the association between burnout and its risk factors. Three hundred and sixty questionnaires were delivered to caregivers in 14 nursing homes within a unique healthcare network. The response rate was 37% (132/360), and 124/132 (94%) surveys were analysed. Caregiver burnout rate was 40% (49/124). Median age was 41 years (range, 20-70) and most caregivers were female. The most common profession (n = 54; 44%) was nurse caregiver and 90% (n = 112) had an antecedent of bullying by a resident. Risk factors identified were as follows: the presence of institutional protocols (death announcement [OR: 3.7] and pain assessment [OR: 2.8]), working in a profit-making establishment (OR: 2.6) and the antecedent of bullying by a resident (OR: 6.2). Factors most negatively associated with burnout included: practising pastimes (OR: 0.4) and working as a nurse (OR: 0.3). The only significant risk factor in the multivariate analysis was the antecedent of bullying by a resident (OR: 5.3). Several specific risk factors for burnout in nursing home caregivers were identified. In high-risk populations of healthcare professionals, screening and management of risk factors is crucial for preventing burnout. © 2017 John Wiley & Sons Ltd.

  17. Belt restraint reduction in nursing homes: design of a quasi-experimental study

    Directory of Open Access Journals (Sweden)

    van Rossum Erik

    2010-02-01

    Full Text Available Abstract Background The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management, availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes. Methods and design Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT. Discussion A quasi

  18. Characteristics of highly rated leadership in nursing homes using item response theory.

    Science.gov (United States)

    Backman, Annica; Sjögren, Karin; Lindkvist, Marie; Lövheim, Hugo; Edvardsson, David

    2017-12-01

    To identify characteristics of highly rated leadership in nursing homes. An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviours and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care. Cross-sectional. From 290 municipalities, 60 were randomly selected and 35 agreed to participate, providing a sample of 3605 direct-care staff employed in 169 Swedish nursing homes. The staff assessed their managers' (n = 191) leadership behaviours using the Leadership Behaviour Questionnaire. Data were collected from November 2013 - September 2014, and the study was completed in November 2016. A two-parameter item response theory approach and regression analyses were used to identify specific characteristics of highly rated leadership. Five specific behaviours of highly rated nursing home leadership were identified; that the manager: experiments with new ideas; controls work closely; relies on subordinates; coaches and gives direct feedback; and handles conflicts constructively. The regression analyses revealed that managers with social work backgrounds and privately run homes were significantly associated with higher leadership ratings. This study highlights the five most important leadership behaviours that characterize those nursing home managers rated highest in terms of leadership. Managers in privately run nursing homes and managers with social work backgrounds were associated with higher leadership ratings. Further work is needed to explore these behaviours and factors predictive of higher leadership ratings. © 2017 John Wiley & Sons Ltd.

  19. Telemedicine in Neonatal Home Care

    DEFF Research Database (Denmark)

    Holm, Kristina Garne; Brødsgaard, Anne; Zachariassen, Gitte

    2016-01-01

    participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care......BACKGROUND: For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home...... visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. OBJECTIVE: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. METHODS: The study used...

  20. Ethics policies on euthanasia in nursing homes: a survey in Flanders, Belgium.

    Science.gov (United States)

    Lemiengre, Joke; Dierckx de Casterlé, Bernadette; Verbeke, Geert; Van Craen, Katleen; Schotsmans, Paul; Gastmans, Chris

    2008-01-01

    In many European countries there is a public debate about the acceptability and regulation of euthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing

  1. The experiences on dignity from the perspective of the elderly in nursing homes

    DEFF Research Database (Denmark)

    Høy, Bente

    2016-01-01

    The aim of the study was to explore nursing home residents’ practice experiences on dignity in caring situations and everyday life in order to illuminate the significance for a life in dignity. Elderly living in nursing homes are vulnerable which appeal to nursing care ethics and emphasise....... From the literature we have knowledge of how dignity is violated among persons who are sick, weak and helpless; however, the knowledge is limited on how dignity is maintained among vulnerable elderly in nursing homes. A hermeneutic approach was used to interpret the material, which was gathered during...... semi-structured interviews with elderly living in six nursing homes in Scandinavian. A total of 28 interviews were transcribed. The findings will be presented at the conference....

  2. Sexual Abuse of Older Nursing Home Residents: A Literature Review

    Directory of Open Access Journals (Sweden)

    Wenche Malmedal

    2015-01-01

    Full Text Available Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons.

  3. Status of the TESS Science Processing Operations Center

    Science.gov (United States)

    Jenkins, Jon M.; Twicken, Joseph D.; Campbell, Jennifer; Tenebaum, Peter; Sanderfer, Dwight; Davies, Misty D.; Smith, Jeffrey C.; Morris, Rob; Mansouri-Samani, Masoud; Girouardi, Forrest; hide

    2017-01-01

    The Transiting Exoplanet Survey Satellite (TESS) science pipeline is being developed by the Science Processing Operations Center (SPOC) at NASA Ames Research Center based on the highly successful Kepler Mission science pipeline. Like the Kepler pipeline, the TESS science pipeline will provide calibrated pixels, simple and systematic error-corrected aperture photometry, and centroid locations for all 200,000+ target stars, observed over the 2-year mission, along with associated uncertainties. The pixel and light curve products are modeled on the Kepler archive products and will be archived to the Mikulski Archive for Space Telescopes (MAST). In addition to the nominal science data, the 30-minute Full Frame Images (FFIs) simultaneously collected by TESS will also be calibrated by the SPOC and archived at MAST. The TESS pipeline will search through all light curves for evidence of transits that occur when a planet crosses the disk of its host star. The Data Validation pipeline will generate a suite of diagnostic metrics for each transit-like signature discovered, and extract planetary parameters by fitting a limb-darkened transit model to each potential planetary signature. The results of the transit search will be modeled on the Kepler transit search products (tabulated numerical results, time series products, and pdf reports) all of which will be archived to MAST.

  4. Nurse-patient interaction is a resource for hope, meaning in life and self-transcendence in nursing home patients.

    Science.gov (United States)

    Haugan, Gørill

    2014-03-01

    Spiritual dimensions such as hope, meaning in life and self-transcendence have been found to be predictors of successful ageing, life satisfaction and well-being in older individuals. Connectedness and communicating with others have been seen to facilitate hope, meaning in life and self-transcendence among nursing home patients. This study aimed to investigate the associations between hope, meaning in life, self-transcendence and nurse-patient interaction in a nursing home population. A cross-sectional design was employed, collecting data in 44 different Norwegian nursing homes (NHs) from 250 patients who met the inclusion criteria. Approval by all regulatory institutions dealing with research issues in Norway and the Management Unit at the 44 NHs was obtained. A sample of 202 cognitively intact nursing home patients responded to the Herth Hope Index, the Purpose in Life test, the Self-Transcendence Scale and the Nurse-Patient Interaction Scale. A structural equation model (SEM) of the hypothesized relationships between the constructs was tested. The SEM model fit well with the present data. Significant direct relationships of nurse-patient interaction on hope, meaning in life and self-transcendence were displayed. Meaning and the interconnectedness dimension of hope appeared to be particularly dynamic resources, revealing significant influences on all the constructs in the SEM model tested. Nurse-patient interaction influences hope, meaning in life and self-transcendence in cognitively intact nursing home patients and might be an important resource in relation to patients' health and global well-being. Thus, care providers are above all fundamental for nursing home patients. Advancing caregivers' interacting and communicating skills might facilitate patients' health and global well-being and inspire professional caregivers as they perform their daily care practices. More research of the effectiveness of such strategies is greatly needed. The SEM model tested

  5. Family members' expectations regarding nurses' competence in care homes: a qualitative interview study.

    Science.gov (United States)

    Kiljunen, Outi; Kankkunen, Päivi; Partanen, Pirjo; Välimäki, Tarja

    2017-11-22

    Structural and cultural changes in the care of older people have influenced nursing practice, creating a need to identify current competency requirements for nurses working in care homes. Family members have an important role in ensuring the well-being of older people living in care homes, and family members' can provide valuable information about competence requirements. To explore the expectations of the care home residents' family members regarding the competence of nurses in care homes for older people. A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 care home residents' family members between March and September 2016. Participants were recruited with help from regional associations and member associations of The Central Association of Carers in Finland and from regional associations of The Alzheimer's Society of Finland. The snowball technique was also used. The data were analysed using inductive content analysis. Ethics committee approval was obtained from the university committee on research ethics, and written informed consent was obtained from participants. The care home residents' family members expected that nurses would be able to interact with and treat people respectfully. Reflective collaboration between the nurse and a family member was also emphasised. Family members expected nurses to provide high-quality basic care and nursing and support residents' well-being individually and holistically. Family members' expectations reflect the need for ethical and interactional competence in the care home. In addition, evidence-based practice competencies are required to provide high-quality care. Nurses' ability to provide person-centred, individual and holistic care is vital to ensure care home residents' well-being. © 2017 Nordic College of Caring Science.

  6. Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study.

    Science.gov (United States)

    Dörks, Michael; Herget-Rosenthal, Stefan; Schmiemann, Guido; Hoffmann, Falk

    2016-01-01

    Polypharmacy has become an emerging public health issue in recent years, since use of multiple medications or polypharmacy is beneficial for many conditions, but may also have negative effects like adverse drug reactions. The risk further increases in patients with chronic renal failure, a comorbidity very frequent in nursing home residents. Since more than 50% of all drugs were renally excreted, dose adjustments in patients with renal failure are required. To assess polypharmacy in German nursing homes, in particular in residents with renal failure. Multi-center cross-sectional study in 21 nursing homes in Bremen and Lower Saxony/Germany. Baseline data were analysed using descriptive statistics. Multivariable logistic regression model and 95% confidence intervals were used to study the association of renal failure and polypharmacy. Of all 852 residents, the analysis comprised those 685 with at least one serum creatinine value so that the estimated creatinine clearance could be calculated. Of those, 436 (63.6%) had a severe or moderate renal failure, defined as estimated creatinine clearance renal failure (estimated creatinine clearance renal failure are common in German nursing home residents and an association of both could be found. Further studies are needed to assess the appropriateness of polypharmacy in these patients.

  7. Assessing Quality of Care and Elder Abuse in Nursing Homes via Google Reviews.

    Science.gov (United States)

    Mowery, Jared; Andrei, Amanda; Le, Elizabeth; Jian, Jing; Ward, Megan

    2016-01-01

    It is challenging to assess the quality of care and detect elder abuse in nursing homes, since patients may be incapable of reporting quality issues or abuse themselves, and resources for sending inspectors are limited. This study correlates Google reviews of nursing homes with Centers for Medicare and Medicaid Services (CMS) inspection results in the Nursing Home Compare (NHC) data set, to quantify the extent to which the reviews reflect the quality of care and the presence of elder abuse. A total of 16,160 reviews were collected, spanning 7,170 nursing homes. Two approaches were tested: using the average rating as an overall estimate of the quality of care at a nursing home, and using the average scores from a maximum entropy classifier trained to recognize indications of elder abuse. The classifier achieved an F-measure of 0.81, with precision 0.74 and recall 0.89. The correlation for the classifier is weak but statistically significant: = 0.13, P nursing homes can be used to detect indications of elder abuse with high precision and to assess the quality of care, but only when a sufficient number of reviews are available.

  8. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.

    Science.gov (United States)

    Mezuk, Briana; Lohman, Matthew; Leslie, Marc; Powell, Virginia

    2015-07-01

    We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. LTC may be an important point of engagement in suicide prevention.

  9. Case-mix reimbursement for nursing home services: Simulation approach

    Science.gov (United States)

    Adams, E. Kathleen; Schlenker, Robert E.

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

  10. Case-mix reimbursement for nursing home services: simulation approach.

    Science.gov (United States)

    Adams, E K; Schlenker, R E

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

  11. Certified Nursing Assistants’ Explanatory Models of Nursing Home Resident Depression

    OpenAIRE

    Piven, Mary Lynn; Anderson, Ruth A.; Colón-Emeric, Cathleen S.; Sandelowski, Margarete

    2008-01-01

    In this study, we explored how Certified Nursing Assistants (CNAs) understood resident depression. Interviews with 18 CNAs, working in two nursing homes were guided by Kleinman’s Explanatory Models of Illness framework. Interview data were content analyzed and CNAs’ descriptions of depression were compared to the MDS 2.0 Mood Screen and to DSM-IV-TR Depression Criteria. CNAs identified causes, signs, and symptoms of depression, but they were unsure about the duration and normalcy of depressio...

  12. Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.

    Science.gov (United States)

    Dingley, Catherine E; Clayton, Margaret; Lai, Djin; Doyon, Katherine; Reblin, Maija; Ellington, Lee

    Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.

  13. Variation in the place of death among nursing home residents in France.

    Science.gov (United States)

    Morin, Lucas; Johnell, Kristina; Aubry, Régis

    2015-05-01

    recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. a cross-sectional retrospective survey was conducted in 2013. coordinating physicians in 3,705 nursing homes in France. a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P nursing home facilities. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Restraint reduction in a nursing home and its impact on employee attitudes.

    Science.gov (United States)

    Sundel, M; Garrett, R M; Horn, R D

    1994-04-01

    To reduce physical restraint use in a nursing home and increase employee support for the restraint-reduction program. A one-group pretest-posttest design with repeated measures was used to determine changes in restraint use with participants over a 14-month interval. All individuals employed at the nursing home were surveyed at two time periods to determine their opinions on restraint use. A 265-bed private, non-profit nursing home in Dallas, Texas. A restrained cohort of 170 residents with a mean age of 84 years; 84% were female. A total of 182 employees participated in the first survey and 209 in the second. Formation of a project team that planned and supervised restraint removal. Inservice training on restraint use was conducted for all employees. Type and frequency of restraint use among the restrained cohort at four evaluation points within a 14-month interval. The frequency of restraint use in the nursing home population was also recorded. Survey measures included employee responses to a 16-item closed-end questionnaire before and after training. The mean number of restraints used with each resident in the restrained cohort decreased from 1.56 to 0.67. The number of residents on restraints in the nursing home was reduced during the course of the study (67.5% vs. 36.7%, P reduction program in a nursing home can produce positive results in terms of decreased restraint use and supportive employee attitudes. More practical alternatives to restraints need to be developed for application in the training of nursing home employees. Future studies on resident, employee, and family attitudes about restraint use are suggested.

  15. TESS: A RELATIVISTIC HYDRODYNAMICS CODE ON A MOVING VORONOI MESH

    International Nuclear Information System (INIS)

    Duffell, Paul C.; MacFadyen, Andrew I.

    2011-01-01

    We have generalized a method for the numerical solution of hyperbolic systems of equations using a dynamic Voronoi tessellation of the computational domain. The Voronoi tessellation is used to generate moving computational meshes for the solution of multidimensional systems of conservation laws in finite-volume form. The mesh-generating points are free to move with arbitrary velocity, with the choice of zero velocity resulting in an Eulerian formulation. Moving the points at the local fluid velocity makes the formulation effectively Lagrangian. We have written the TESS code to solve the equations of compressible hydrodynamics and magnetohydrodynamics for both relativistic and non-relativistic fluids on a dynamic Voronoi mesh. When run in Lagrangian mode, TESS is significantly less diffusive than fixed mesh codes and thus preserves contact discontinuities to high precision while also accurately capturing strong shock waves. TESS is written for Cartesian, spherical, and cylindrical coordinates and is modular so that auxiliary physics solvers are readily integrated into the TESS framework and so that this can be readily adapted to solve general systems of equations. We present results from a series of test problems to demonstrate the performance of TESS and to highlight some of the advantages of the dynamic tessellation method for solving challenging problems in astrophysical fluid dynamics.

  16. Pharmacologic management of non-cancer pain among nursing home residents.

    Science.gov (United States)

    Lapane, Kate L; Quilliam, Brian J; Chow, Wing; Kim, Myoung S

    2013-01-01

    Pain is common in nursing home settings. To describe scheduled analgesic use among nursing home (NH) residents experiencing non-cancer pain and evaluate factors associated with scheduled analgesic use. We identified 2508 residents living in one of 185 NHs predominantly from one for-profit chain, with pain recorded on two consecutive Minimum Data Set assessments. Pharmacy transaction files provided detailed medication information. Logistic regression models adjusted for clustering of residents in NHs identified factors related to scheduled prescription analgesics. Twenty-three percent had no scheduled analgesics prescribed. Those with scheduled analgesics were more likely to have excruciating pain (5.5% vs. 1.2%) and moderate pain documented (64.7% vs. 47.5%) than residents without scheduled analgesics. Hydrocodone (41.7%), short-acting oxycodone (16.6%), and long-acting fentanyl (9.4%) were common, and 13.8% reported any nonsteroidal anti-inflammatory agent use. Factors associated with decreased odds of scheduled analgesics included severe cognitive impairment (adjusted odds ratio [AOR] 0.56; 95% confidence interval [CI] 0.36 to 0.88), age more than 85 years (AOR 0.57; 95% CI 0.41 to 0.80), and Parkinson's disease (AOR 0.55; 95% CI 0.30 to 0.99). Factors associated with increased odds of scheduled analgesic use included history of fracture (AOR 1.79; 95% CI 1.16 to 2.76), diabetes (AOR 1.30; 95% CI 1.02 to 1.66), and higher Minimum Data Set mood scores (AOR 1.11; 95% CI 1.04 to 1.19). Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  17. The effects of a nursing guideline on depression in psychogeriatric nursing home residents with dementia.

    NARCIS (Netherlands)

    Verkaik, R.; Francke, A.L.; Meijel, B. van; Spreeuwenberg, P.M.M.; Ribbe, M.W.; Bensing, J.M.

    2011-01-01

    OBJECTIVE: To study the effects of introducing a nursing guideline on depression in residents with dementia of psychogeriatric nursing home wards. METHODS: A multi-center controlled clinical trial with randomization at ward level was used to study the effects of the guideline introduction. Nursing

  18. Motivators for physical activity among ambulatory nursing home older residents.

    Science.gov (United States)

    Chen, Yuh-Min; Li, Yueh-Ping

    2014-01-01

    The purpose of this study was to explore self-identified motivators for regular physical activity among ambulatory nursing home older residents. A qualitative exploratory design was adopted. Purposive sampling was performed to recruit 18 older residents from two nursing homes in Taiwan. The interview transcripts were analyzed by qualitative content analysis. Five motivators of physical activity emerged from the result of analysis: eagerness for returning home, fear of becoming totally dependent, improving mood state, filling empty time, and previously cultivated habit. Research on physical activity from the perspectives of nursing home older residents has been limited. An empirically grounded understanding from this study could provide clues for promoting and supporting lifelong engagement in physical activity among older residents. The motivators reported in this study should be considered when designing physical activity programs. These motivators can be used to encourage, guide, and provide feedback to support older residents in maintaining physical activity.

  19. Complexity Science and the Dynamics of Climate and Communication: Reducing Nursing Home Turnover

    Science.gov (United States)

    Anderson, Ruth A.; Corazzini, Kirsten N.; McDaniel, Reuben R.

    2008-01-01

    Purpose Turnover in nursing homes is a widespread problem adversely affecting care quality. Using complexity theory, we tested the effect of administrative climate, communication patterns, and the interaction between the two on turnover, controlling for facility context. Design and Methods Perceptions of administrative climate and communication were collected from 3,449 employees in 164 randomly sampled nursing homes, and they were linked to secondary data on facility characteristics, resource allocation, and turnover. We used hierarchical regression to test the hypotheses. Results Climate and communication both affected turnover, but lower turnover was dependent on the interaction between climate and communication. In nursing homes with reward-based administrative climates, higher levels of communication openness and accuracy explained lower turnover of licensed vocational nurses and certified nurse assistants, relative to nursing homes with an ambiguous climate. Adequate staffing and longer tenure of the nursing director were also important predictors of turnover. Implications Although context is important, managers can also influence turnover by addressing climate and communication patterns and by encouraging stable nursing leadership. PMID:15197292

  20. Leadership, staffing and quality of care in nursing homes

    Science.gov (United States)

    2011-01-01

    Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is

  1. Leadership, staffing and quality of care in nursing homes

    Directory of Open Access Journals (Sweden)

    Havig Anders

    2011-11-01

    Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses

  2. Urine Culture Testing in Community Nursing Homes: Gateway to Antibiotic Overprescribing.

    Science.gov (United States)

    Sloane, Philip D; Kistler, Christine E; Reed, David; Weber, David J; Ward, Kimberly; Zimmerman, Sheryl

    2017-05-01

    OBJECTIVE To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs) DESIGN Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period SETTING 31 NHs in North Carolina PARTICIPANTS 254 NH residents who had a urine culture ordered within the 1-month study period METHODS We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs. RESULTS Empirical treatment was started in 30% of cases. When cultures were reported, previously untreated cases received antibiotics 89% of the time for colony counts of ≥100,000 CFU/mL and in 35% of cases with colony counts of 10,000-99,000 CFU/mL. Due to the high rate of prescribing when culture results returned, 74% of these patients ultimately received a full course of antibiotics. Treated and untreated patients did not significantly differ in temperature, frequency of urinary signs and symptoms, or presence of Loeb criteria for antibiotic initiation. Factors most commonly associated with urine culture ordering were acute mental status changes (32%); change in the urine color, odor, or sediment (17%); and dysuria (15%). CONCLUSIONS Urine cultures play a significant role in antibiotic overprescribing. Antibiotic stewardship efforts in NHs should include reduction in culture ordering for factors not associated with infection-related morbidity as well as more scrutiny of patient condition when results become available. Infect Control Hosp Epidemiol 2017;38:524-531.

  3. Pain and pharmacologic pain management in long-stay nursing home residents.

    Science.gov (United States)

    Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer; Lapane, Kate L

    2017-06-01

    Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.

  4. Developing Mobile Clinical Decision Support for Nursing Home Staff Assessment of Urinary Tract Infection using Goal-Directed Design.

    Science.gov (United States)

    Jones, Wallace; Drake, Cynthia; Mack, David; Reeder, Blaine; Trautner, Barbara; Wald, Heidi

    2017-06-20

    Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff. Focus groups were conducted with providers and nurses in NHs in Denver, Colorado (n= 24). Qualitative descriptive analysis was applied to focus group transcripts to identify information needs and themes related to mobile clinical decision support for UTI identification and management. Personas representing typical end users were developed; typical clinical context scenarios were constructed using information needs as goals. Usability testing was performed using cognitive walk-throughs and a think-aloud protocol. Four information needs were identified including guidance regarding resident assessment; communication with providers; care planning; and urine culture interpretation. Design of a web-based application incorporating a published decision support algorithm for evidence-based UTI diagnoses proceeded with a focus on nursing information needs during resident assessment and communication with providers. Certified nursing assistant (CNA) and registered nurse (RN) personas were constructed in 4 context scenarios with associated key path scenarios. After field testing, a high fidelity prototype of UTI Decide was completed and evaluated by potential end users. Design recommendations and content recommendations were elicited. Goal-Directed Design informed the development of a mobile CDSS supporting participant-identified information needs for UTI assessment and communication

  5. TESS Follow-up Observing Programs at the University of Wyoming

    Science.gov (United States)

    Jang-Condell, Hannah; Kasper, David; Kar, Aman; Sorber, Rebecca; Hancock, Daniel A.; Leuquire, Jacob D.; Suhaimi, Afiq; Kobulnicky, Henry A.; Pierce, Michael; Pilachowski, Catherine A.

    2018-06-01

    The Transiting Exoplanet Survey Satellite (TESS), launched in Spring 2018, will detect thousands of new exoplanet candidates. These candidates will need to be vetted by ground-based observatories to rule out false positives. The Observatories at the University of Wyoming are well-positioned to take active roles in TESS Follow-Up Observing Program (TFOP) Working Groups. The 0.6-m Red Buttes Observatory has already demonstrated its capability to do precision photometric monitoring of transiting exoplanet targets as a participant in the Kilodegree Extremely Little Telescope Follow-Up Network (KELT-FUN). A new echelle spectrograph, Fiber High-Resolution Echelle (FHiRE), being built for the 2.3-m Wyoming InfraRed Observatory (WIRO), will enable precision radial velocity measurements of exoplanet candidates. Over 180 nights/year at both observatories will be available to our team to undertake follow-up observations of TESS Objects of Interest (TOIs). We anticipate making significant contributions to new exoplanet discoveries in the era of TESS.

  6. Justifying continuous sedation until death: a focus group study in nursing homes in Flanders, Belgium.

    Science.gov (United States)

    Rys, Sam; Deschepper, Reginald; Deliens, Luc; Mortier, Freddy; Bilsen, Johan

    2013-01-01

    Continuous Sedation until Death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, has become a common practice in nursing homes in Flanders (Belgium). Quantitative research has suggested that CSD is not always properly applied. This qualitative study aims to explore and describe the circumstances under which nursing home clinicians consider CSD to be justified. Six focus groups were conducted including 10 physicians, 24 nurses, and 14 care assistants working in either Catholic or non-Catholic nursing homes of varying size. Refractory suffering, limited life expectancy and respecting patient autonomy are considered essential elements in deciding for CSD. However, multiple factors complicate the care of nursing home residents at the end of life, and often hinder clinicians from putting these elements into practice. Nursing home clinicians may benefit from more information and instruction about managing CSD in the complex care situations which typically occur in nursing homes. Copyright © 2013 Mosby, Inc. All rights reserved.

  7. Emotional learning of undergraduate medical students in an early nursing attachment in a hospital or nursing home.

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Prins, Judith; Laan, Roland; Koopmans, Raymond

    2011-01-01

    Entering medicine for the first time is highly impressive for students, but we know little about the actual emotional learning processes taking place. We aimed to get more insight into expectations, experiences and emotions of students during their first clinical experiences in a hospital compared to a nursing home. We carried out a qualitative and a quantitative survey by administering questionnaires about expectations, impressive experiences and learning activities within two cohorts of first-year medical students before and after a 4-week nursing attachment. Despite different expectations, students reported similar experiences and learning activities for the nursing home and the hospital. Most impressive events were related to patient care, being a trainee, or professional identities being challenged. Students in nursing homes most often referred to their own relationships with patients. Students expressed different emotions, and frequently experienced positive and negative emotions at the same time. Rewarding experiences (not only difficult or stressful events) do matter for medical professional development. Students need to learn how to deal with and feel strengthened by the emotions evoked during clinical experiences, which should be supported by educators. The nursing home and the hospital seem to be equally suited as learning environments.

  8. Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

    Directory of Open Access Journals (Sweden)

    Asangaedem Akpan

    2007-04-01

    Full Text Available Asangaedem Akpan1,2,3, Margot A Gosney2, James Barrett3,4, 1Directorate of Medicine and Elderly Care, Warrington Hospital, Warrington, Cheshire, UK; 2School of Food Biosciences, The University of Reading, Whiteknights, Reading, UK; 3Liverpool John Moores University, Liverpool, UK; 4Directorate of Elderly Medicine and Rehabilitation, Clatterbridge Hospital, Merseyside, UKObjective: Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management. Methods: One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained.Results: Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%] and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%] were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01. Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%] (P < 0.01. Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation

  9. Nursing home facilities in Malaysia (premise, shared facilities & individual accommodation: Space requirement): A literature review

    Science.gov (United States)

    Nordin, Nik Muhammad Faris Bin Nik; Hasbollah, Hasif Rafidee bin; Ibrahim, Mohd Asrul Hery Bin; Marican, Nor Dalila bin; Halim, Muhd Hafzal bin Abdul; Rashid, Ahmad Faezi Bin Ab.; Yasin, Nurul Hafizah Binti Mohd

    2017-10-01

    The numbers of elderly in Malaysia are increased every year. The request towards elderly care services necessitated by the Nursing Home are in demand. However, Nursing Home in Malaysia is lack of standard of facilities in order to cater the care services for the elderly. This paper intends review the minimum standard facilities for the Nursing Homes in globally. The paper also offered insights in developing standard Nursing Home facilities in Malaysia.

  10. The costs of turnover in nursing homes.

    Science.gov (United States)

    Mukamel, Dana B; Spector, William D; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

    2009-10-01

    Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The instrumental variable estimate of turnover costs was negative and significant (P = 0.039). The marginal cost savings associated with a 10% point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs.

  11. Coping with the Obligation Dilemma: Prototypes of Social Workers in the Nursing Home.

    Science.gov (United States)

    Lev, Sagit; Ayalon, Liat

    2016-07-01

    We examined the ways in which the social worker is coping with obligation dilemma in an Israeli nursing home. The research was conducted using semi-structured, in-depth interviews carried out with fifteen social workers employed in nursing homes. The interviews were analysed thematically, using constant comparisons. The three themes were concerned with the social worker's place in the nursing home, her relationship with the management and staff, and her coping with the obligation dilemma. These themes highlighted the difference between the interviewees. On the background of this difference, four prototypes of nursing home's social workers were defined: the managerial, the contented, the fighter and the frustrated. From analysing the findings, the significant place of the personal and environmental factors that influence the ways in which the social worker deals with these four themes emerges. Our findings suggest that the strengthening, empowerment and support of social workers in institutions can directly enhance the health, security, emotional well-being and quality of life of nursing home residents.

  12. The significance of meaningful and enjoyable activities for nursing home resident's experiences of dignity

    DEFF Research Database (Denmark)

    Slettebø, Åshild; Saeteren, Berit; Caspari, Synnøve

    2017-01-01

    BACKGROUND: Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important. AIM: To examine how nursing home residents experience dignity through the provision of activities that foster...... meaning and joy in their daily life. METHOD: A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all...... participating countries granted their approval for the study. FINDINGS: The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity...

  13. The introduction of a nursing guideline on depression at psychogeriatric nursing home wards: effects on Certified Nurse Assistants.

    OpenAIRE

    Verkaik, R.; Francke, A.L.; Meijel, B. van; Spreeuwenberg, P.M.M.; Ribbe, M.W.; Bensing, J.M.

    2011-01-01

    Background: To improve care for residents with depression in dementia, an evidence based nursing guideline was developed. Using the guideline has already shown positive effects on depression in psychogeriatric nursing home residents. Objective: To study the effects of the introduction of the nursing guideline ‘depression in dementia’ on perceived professional autonomy, workload and feelings of powerlessness and confidence in Certified Nurse Assistants. Design: A multi-center controlled interv...

  14. Nursing home reimbursement and the allocation of rehabilitation therapy resources.

    Science.gov (United States)

    Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

    1988-10-01

    Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

  15. High-performance workplace practices in nursing homes: an economic perspective.

    Science.gov (United States)

    Bishop, Christine E

    2014-02-01

    To develop implications for research, practice and policy, selected economics and human resources management research literature was reviewed to compare and contrast nursing home culture change work practices with high-performance human resource management systems in other industries. The organization of nursing home work under culture change has much in common with high-performance work systems, which are characterized by increased autonomy for front-line workers, self-managed teams, flattened supervisory hierarchy, and the aspiration that workers use specific knowledge gained on the job to enhance quality and customization. However, successful high-performance work systems also entail intensive recruitment, screening, and on-going training of workers, and compensation that supports selective hiring and worker commitment; these features are not usual in the nursing home sector. Thus despite many parallels with high-performance work systems, culture change work systems are missing essential elements: those that require higher compensation. If purchasers, including public payers, were willing to pay for customized, resident-centered care, productivity gains could be shared with workers, and the nursing home sector could move from a low-road to a high-road employment system.

  16. The provision of diabetes care in nursing homes in Galway city and county: a survey of nursing homes

    LENUS (Irish Health Repository)

    Hurley, Lorna

    2014-03-01

    In addition to the increasing prevalence of diabetes, our population is growing older and living longer. This survey aimed to determine the care provided to residents with diabetes in Nursing Homes.\\r\

  17. The Effects of the Green House Nursing Home Model on ADL Function Trajectory: A Retrospective Longitudinal Study

    Science.gov (United States)

    YOON, Ju Young; BROWN, Roger L.; BOWERS, Barbara J.; SHARKEY, Siobhan S.; HORN, Susan D.

    2015-01-01

    Background Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House (GH) nursing home model, has shown positive psychological outcomes. However, little is known about whether the GH nursing home model has positive effects on physical function compared to traditional nursing homes. Objectives To examine the longitudinal effects of the GH nursing home model by comparing change patterns of ADL function over time between GH home residents and traditional nursing home residents. Design A retrospective longitudinal study. Settings Four GH organizations (nine GH units and four traditional units). Participants A total of 242 residents (93 GH residents and 149 traditional home residents) who had stayed in the nursing home at least six months from admission. Methods The outcome was ADL function, and the main independent variable was the facility type in which the resident stayed: a GH or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. Results The mean ADL function showed deterioration over time, and the rates of deterioration between GH and traditional home residents were not different over time. Four different ADL function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. Conclusions Although GH nursing homes are considered to represent an innovative model changing the nursing home environment into more

  18. The Impact of Organizational Innovations in Nursing Homes on Staff Perceptions: A Secondary Data Analysis.

    Science.gov (United States)

    Adams, Joost; Verbeek, Hilde; Zwakhalen, Sandra M G

    2017-01-01

    The shift in nursing home care for patients with dementia from traditional task-driven environments towards patient-centered small-scale environments has implications for nursing practice. Information about its implications for nursing staff is lacking, and only a few studies have addressed staff perceptions. We sought to explore staff perceptions of required skills and to determine differences in job satisfaction, motivation, and job characteristics of staff working in both care settings. A secondary data analysis was conducted. The data source used was drawn from a larger study testing the effects of small-scale living (Verbeek et al., 2009). Nursing staff working on a permanent basis and who were directly involved in care were eligible to participate in the study. Data on job satisfaction, motivation, and job characteristics of nursing staff working in typical small-scale and traditional care environments were derived using a questionnaire. Data were analyzed using descriptive statistics. Differences between nursing staff job satisfaction, motivation, and job characteristics were tested using multilinear regression analysis. In total, 138 staff members were included (81 staff members working in traditional nursing home wards and 57 staff members working in small-scale nursing home wards). The findings showed that in typical small-scale nursing homes, job satisfaction and job motivation were significantly higher compared to those in typical traditional nursing homes. Job autonomy and social support were also significantly higher, while job demands were significantly lower in these small-scale nursing homes. Social support was found to be the most significant predictor of job motivation and job satisfaction in both types of typical nursing homes. Nursing staff working in traditional care environments more often expressed the intention to switch to small-scale environments. Based on the findings of this study, it can be concluded that nursing homes environments

  19. Patient autonomy in home care: Nurses' relational practices of responsibility.

    Science.gov (United States)

    Jacobs, Gaby

    2018-01-01

    Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted in a professional development course ('learning circle') for home care nurses, including participant observations and focus groups. The theoretical notion of 'relational agency' and the moral concept of 'practices of responsibility' were used to conduct a narrative analysis on the nurses' stories about autonomy. Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients' strengths and collaboration with patients and informal caregivers. On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.

  20. Ethical issues in palliative care for nursing homes: Development and testing of a survey instrument.

    Science.gov (United States)

    Preshaw, Deborah Hl; McLaughlin, Dorry; Brazil, Kevin

    2018-02-01

    To develop and psychometrically assess a survey instrument identifying ethical issues during palliative care provision in nursing homes. Registered nurses and healthcare assistants have reported ethical issues in everyday palliative care provision. Identifying these issues provides evidence to inform practice development to support healthcare workers. Cross-sectional survey of Registered nurses and healthcare assistants in nursing homes in one region of the UK. A survey instrument, "Ethical issues in Palliative Care for Nursing homes", was developed through the findings of qualitative interviews with Registered nurses and healthcare assistants in nursing homes and a literature review. It was reviewed by an expert panel and piloted prior to implementation in a survey in 2015 with a convenience sample of 596 Registered nurses and healthcare assistants. Descriptive and exploratory factor analyses were used to assess the underlying structure of the Frequency and Distress Scales within the instrument. Analysis of 201 responses (response rate = 33.7%) revealed four factors for the Frequency Scale and five factors for the Distress Scale that comprise the Ethical issues in Palliative Care for Nursing homes. Factors common to both scales included "Processes of care," "Resident autonomy" and "Burdensome treatment." Additionally, the Frequency Scale included "Competency," and the Distress Scale included "Quality of care" and "Communication." The Ethical issues in Palliative Care for Nursing homes instrument has added to the palliative care knowledge base by considering the ethical issues experienced specifically by Registered nurses and healthcare assistants within the nursing home. This research offers preliminary evidence of the psychometric properties of the Ethical issues in Palliative Care for Nursing homes survey instrument. The two largest factors highlight the need to address the organisational aspects of caring and provide training in negotiating conflicting

  1. Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk.

    Science.gov (United States)

    Bowling, C Barrett; Zhang, Rebecca; Franch, Harold; Huang, Yijian; Mirk, Anna; McClellan, William M; Johnson, Theodore M; Kutner, Nancy G

    2015-03-21

    The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a "gold standard" metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 - 1.64) for MDS/2728, 1.48 (1.42 - 1.54) for MDS/No 2728, and 1.38 (1.25 - 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care.

  2. [Development of a web-based education program for nurses working in nursing homes on human rights of older adults].

    Science.gov (United States)

    Kim, Ki-Kyong

    2010-08-01

    This study was done to develop a web-based education program for nurses working in nursing homes. The focus was on the rights of older adults. The program was designed based on the Network-Based Instructional System Design (NBISD) model and was operated and evaluated between July 2007 and June 2008. Out of nursing records of 40 residents from a nursing home, the final 7 cases were deducted through classification using the Resource Utilization Group (RUG)-III. The data on needs for education was collected from 28 nurses working in 15 nursing homes located in Seoul and Gyeonggi Province, who agreed to complete a self-report questionnaire. A comprehensive review of the literature and two focus groups interviews were used to search for risk factors and guidelines for protection of human rights. The education program was developed based on Kolb's experiential learning model and composed of 5 units, which included content on types of human rights and rights to death with dignity, elder abuse, physical liberty, and self-determination. The program was positively evaluated showing a score of 3.35 (SD=0.37) out of 4. The educational program developed in this study should promote nurses' sensitivity to the rights of elders and improve nurses' behaviors in protecting the rights of elders residing in nursing homes.

  3. Individual and organizational factors related to work engagement among home-visiting nurses in Japan.

    Science.gov (United States)

    Naruse, Takashi; Sakai, Mahiro; Watai, Izumi; Taguchi, Atsuko; Kuwahara, Yuki; Nagata, Satoko; Murashima, Sachiyo

    2013-12-01

    The increasing number of elderly people has caused increased demand for home-visiting nurses. Nursing managers should develop healthy workplaces in order to grow their workforce. This study investigated the work engagement of home-visiting nurses as an index of workplace health. The aim of the present study was to reveal factors contributing to work engagement among Japanese home-visiting nurses. An anonymous, self-administered questionnaire was sent to 208 home-visiting nurses from 28 nursing agencies in three districts; 177 (85.1%) returned the questionnaires. The Job Demands-Resources model, which explains the relationship between work environment and employee well-being, was used as a conceptual guide. The authors employed three survey instruments: (i) questions on individual variables; (ii) questions on organizational variables; and (iii) the Utrecht Work Engagement Scale (Japanese version). Multiple regression analyses were performed in order to examine the relationships between individual variables, organizational variables, and work engagement. Nurse managers and nurses who felt that there was a positive relationship between work and family had significantly higher work engagement levels than others. The support of a supervisor was significantly associated with work engagement. Nurses in middle-sized but not large agencies had significantly higher work engagement than nurses in small agencies. Supervisor support and an appropriate number of people reporting to each supervisor are important factors in fostering work engagement among home-visiting nurses. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.

  4. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Science.gov (United States)

    2010-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

  5. Exploring the Synergic Effects of Nursing Home Work on Work-Related Musculoskeletal Disorders Among Nursing Assistants.

    Science.gov (United States)

    Ching, Shirley S Y; Szeto, Grace; Lai, Godfrey Kin Bun; Lai, Xiao Bin; Chan, Ying Tung; Cheung, Kin

    2018-03-01

    Little is known about how nursing assistants (NAs) perceive the nature of their work and how their work contributes to work-related musculoskeletal disorders (WMSDs). This qualitative study addressed these gaps. Twenty-four NAs with WMSDs working in four nursing homes participated in semistructured focus group interviews. Their WMSDs were not limited to the lower back but involved several body parts. The risk factors for WMSDs included physical, psychosocial, organizational, and personal factors as well as coworkers and clients. However, it is the synergistic effects of long work hours without sufficient rest, work even with musculoskeletal pain because of staff shortages, ineffective management with insufficient prework training and inadequate equipment maintenance, and an aging workforce with strong commitment to resident care that play a crucial role in WMSDs among NAs working in nursing homes. The study found that multidimensional intervention strategies using engineering, administrative, and personal controls should be developed to reduce WMSDs among NAs working in nursing homes.

  6. Where should Momma go? Current nursing home performance measurement strategies and a less ambitious approach

    Directory of Open Access Journals (Sweden)

    Lieberman Trudy

    2007-06-01

    Full Text Available Abstract Background Nursing home performance measurement systems are practically ubiquitous. The vast majority of these systems aspire to rank order all nursing homes based on quantitative measures of quality. However, the ability of such systems to identify homes differing in quality is hampered by the multidimensional nature of nursing homes and their residents. As a result, the authors doubt the ability of many nursing home performance systems to truly help consumers differentiate among homes providing different levels of quality. We also argue that, for consumers, performance measurement models are better at identifying problem facilities than potentially good homes. Discussion In response to these concerns we present a proposal for a less ambitious approach to nursing home performance measurement than previously used. We believe consumers can make better informed choice using a simpler system designed to pinpoint poor-quality nursing homes, rather than one designed to rank hundreds of facilities based on differences in quality-of-care indicators that are of questionable importance. The suggested performance model is based on five principles used in the development of the Consumers Union 2006 Nursing Home Quality Monitor. Summary We can best serve policy-makers and consumers by eschewing nursing home reporting systems that present information about all the facilities in a city, a state, or the nation on a website or in a report. We argue for greater modesty in our efforts and a focus on identifying only the potentially poorest or best homes. In the end, however, it is important to remember that information from any performance measurement website or report is no substitute for multiple visits to a home at different times of the day to personally assess quality.

  7. Nurse led home-based care for people with HIV/AIDS.

    Science.gov (United States)

    Wood, Elizabeth M; Zani, Babalwa; Esterhuizen, Tonya M; Young, Taryn

    2018-03-27

    Home-based care is used in many countries to increase quality of life and limit hospital stay, particularly where public health services are overburdened. Home-based care objectives for HIV/AIDS can include medical care, delivery of antiretroviral treatment and psychosocial support. This review assesses the effects of home-based nursing on morbidity in people infected with HIV/AIDS. The trials studied are in HIV positive adults and children, regardless of sex or setting and all randomised controlled. Home-based care provided by qualified nurses was compared with hospital or health-facility based treatment. The following electronic databases were searched from January 1980 to March 2015: AIDSearch, CINAHL, Cochrane Register of Controlled Trials, EMBASE, MEDLINE and PsycINFO/LIT, with an updated search in November 2016. Two authors independently screened titles and abstracts from the electronic search based on the study design, interventions and types of participant. For all selected abstracts, full text articles were obtained. The final study selection was determined with use of an eligibility form. Data extraction was performed independently from assessment of risk of bias. The results were analysed by narrative synthesis, in order to be able to obtain relevant effect measures plus 95% confidence intervals. Seven studies met the inclusion criteria. The trial size varied from 37 to 238 participants. Only one trial was conducted in children. Five studies were conducted in the USA and two in China. Four studies looked at home-based adherence support and the rest at providing home-based psychosocial support. Reported adherence to antiretroviral drugs improved with nurse-led home-based care but did not affect viral load. Psychiatric nurse support in those with existing mental health conditions improved mental health and depressive symptoms. Home-based psychological support impacted on HIV stigma, worry and physical functioning and in certain cases depressive symptoms

  8. An investigation of the effects of a nonprofit agency's investigations on quality of care in nursing homes.

    Science.gov (United States)

    Lorentz, Madeline; Finnegan, Brittany

    2013-01-01

    This study examined whether an agency's investigation of complaints in 40 nursing homes is positively correlated with the quality of nursing home care. A quantitative methodology design using quantitative and qualitative data was used to assess the relationship between Agency X's investigation of consumers' nursing home complaints and the quality of nursing home care. Results showed fewer violations after the agency's interventions, indicating improvement in the nursing care. Analysis showed on average 0.14 fewer violations. This decrease is statistically significant (p = .015), indicating that this agency's intervention improved nursing home care. Additional studies are needed to further explore the quality of care given in nursing homes. Nurses may propose to the Centers for Medicare & Medicaid Services to establish a new innovative system for ensuring high quality nursing home care by requiring the establishment of outside agencies, such as Agency X, to monitor care in addition to the annual surveys conducted by the Department of Health and Human Services. © 2013 Wiley Periodicals, Inc.

  9. Involvement in Activities and Wandering in Nursing Home Residents With Cognitive Impairment

    NARCIS (Netherlands)

    Volicer, L.; van der Steen, J.T.; Frijters, D.H.M.

    2013-01-01

    Objectives: Analysis of a relationship between wandering and involvement in meaningful activities in nursing home residents with cognitive impairment. DESIGN:: Cross-sectional analysis of the Minimum Data Set information. SETTING:: The analyses were conducted on 8 nursing homes in the Netherlands.

  10. Organization aesthetics in nursing homes.

    Science.gov (United States)

    Hujala, Anneli; Rissanen, Sari

    2011-05-01

    The aim of this study was to make visible the material dimensions of nursing management.   Management theories have mainly ignored the material dimensions, namely the physical spaces in which management actually takes place as well as the physical bodies of organization members. The perspective of organization aesthetics enhances our understanding of the role of materiality in nursing management. The data were collected in 2009 using observation and interviews in eight nursing homes. Qualitative content analysis with critical interpretations was used. Three main issues of organizational aesthetics related to nursing management were identified: (1) the functionality of working spaces and equipment; (2) the relevance of 'organizational' space; and (3) the emotional-aesthetic dimension of daily work. Materiality is closely related to management topics, such as decision-making, values and identity formation of organizational members. Aesthetic dimensions of care are constructed by management practices which, in their turn, influence the nature of management. Implications for nursing management  Nurse managers need to be aware of the unintended and unnoticed consequences of materiality and aesthetics. Space and body issues may have considerable effects, for example, on the identity of care workers and on the attractiveness of the care branch. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  11. Racial differences in dementia care among nursing home residents.

    Science.gov (United States)

    Sengupta, Manisha; Decker, Sandra L; Harris-Kojetin, Lauren; Jones, Adrienne

    2012-06-01

    This article aims to describe potential racial differences in dementia care among nursing home residents with dementia. Using data from the 2004 National Nursing Home Survey (NNHS) in regression models, the authors examine whether non-Whites are less likely than Whites to receive special dementia care--defined as receiving special dementia care services or being in a dementia special care unit (SCU)--and whether this difference derives from differences in resident or facility characteristics. The authors find that non-Whites are 4.3 percentage points less likely than Whites to receive special dementia care. The fact that non-Whites are more likely to rely on Medicaid and less likely to pay out of pocket for nursing home care explains part but not all of the difference. Most of the difference is due to the fact that non-Whites reside in facilities that are less likely to have special dementia care services or dementia care units, particularly for-profit facilities and those in the South.

  12. Self-transcendence in cognitively intact nursing-home patients: a resource for well-being.

    Science.gov (United States)

    Haugan, Gørill; Rannestad, Toril; Hammervold, Randi; Garåsen, Helge; Espnes, Geir Arild

    2013-05-01

    This article reports an empirical study of self-transcendence in cognitively intact nursing-home patients. The aim was to investigate the interrelationships between self-transcendence and nursing-home patients' physical, social, emotional and functional well-being. Finding new and alternative approaches to increase well-being among nursing-home patients is highly warranted. Self-transcendence is considered a developmental process of maturity in adulthood and a vital resource for well-being at the end of life, thus self-transcendence could be a useful approach. Cross-sectional The self-transcendence scale and the Functional Assessment of Cancer Therapy General (FACT-G) Quality of Life questionnaire were used. A sample of 202 cognitively intact nursing-home patients in Mid-Norway was selected to respond to the instruments in 2008 and 2009. Analysis was applied by means of LISREL 8·8 Structural Equation Modelling. A two-factor construct of self-transcendence showed that intrapersonal self-transcendence directly affected functional well-being and indirectly influenced physical, emotional and functional well-being. Interpersonal self-transcendence directly affected social and emotional well-being. Additionally important influences were disclosed from functional to emotional and from emotional to physical well-being. Finding nursing interventions to enhance both intrapersonal and interpersonal self-transcendence might benefit nursing-home patients' overall well-being. In a holistic perspective of body-mind-spirit, this research generates new-research questions about the pathways between the different dimensions of well-being in nursing-home patients, which is important to holistic nursing practice. © 2012 Blackwell Publishing Ltd.

  13. Nursing Home Cost Studies and Reimbursement Issues

    Science.gov (United States)

    Bishop, Christine E.

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care. PMID:10309223

  14. Nursing home cost studies and reimbursement issues.

    Science.gov (United States)

    Bishop, C E

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.

  15. Reanalyzing the Characteristics of Modern Feminism in Tess of the D’Urb-ervilles

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-yan

    2015-01-01

    This paper mainly focuses on the hero Tess, a beautiful, hardworking, sweet-natured and innocent girl. As the outstand⁃ing pioneer of the Feminists, Tess embodies the typical characteristics of the modern women:hardworking, brave, responsible and independent. Tess is not only a person who appears in the novel, but one representative of all the feminists in our modern society.

  16. Attractiveness of working in home care: an online focus group study among nurses.

    NARCIS (Netherlands)

    Groot, K. de; Maurits, E.E.M.; Francke, A.L.

    2018-01-01

    Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and

  17. The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents

    Directory of Open Access Journals (Sweden)

    M. D. Rijnaard

    2016-01-01

    Full Text Available Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1 original and peer-reviewed research, (2 qualitative, quantitative, or mixed methods research, (3 research about nursing home residents (or similar type of housing, and (4 research on the sense of home, meaning of home, at-homeness, or homelikeness. Results. Seventeen mainly qualitative articles were included. The sense of home of nursing home residents is influenced by 15 factors, divided into three themes: (1 psychological factors (sense of acknowledgement, preservation of one’s habits and values, autonomy and control, and coping; (2 social factors (interaction and relationship with staff, residents, family and friends, and pets and activities; and (3 the built environment (private space and (quasi-public space, personal belongings, technology, look and feel, and the outdoors and location. Conclusions. The sense of home is influenced by numerous factors related to the psychology of the residents and the social and built environmental contexts. Further research is needed to determine if and how the identified factors are interrelated, if perspectives of various stakeholders involved differ, and how the factors can be improved in practice.

  18. Depression in nursing homes: prevalence, recognition, and treatment.

    Science.gov (United States)

    Kramer, Dietmar; Allgaier, Antje-Kathrin; Fejtkova, Sabina; Mergl, Roland; Hegerl, Ulrich

    2009-01-01

    Depression is very common in people above 65 years living in long-term care. However, little is known about how well depression is recognized and how adequately it is treated. Therefore, the present study aimed at assessing accuracy of the unaided clinical diagnosis of the attending physicians, and the medical treatment situation in nursing home residents. A random sample of 97 residents of 10 nursing homes in Munich was examined with the Section A "Affective Syndrome" of the Structured Clinical Interview (SCID) for DSM-IV to detect depression. Information concerning clinical diagnosis and medication was obtained from the subjects' medical records. 14.4% suffered acutely from major depression, 14.4% suffered from minor depression, and 18.6% were diagnosed as depressive according to the physician and nursing records. In total, 27.8% received antidepressants. Merely 42.9% of the subjects with acute major depression were diagnosed by their attending physicians as depressive, and only half of them received an antidepressant; 17.5% received antidepressants without a diagnosis of depression in their physician and nursing records. In accordance with the guidelines, 73.3% of the antidepressants prescribed were SSRIs or newer antidepressants. Only 20.0% were tricyclic antidepressants. Findings show that depression is relatively frequent in residents of nursing homes. Moreover, it is insufficiently recognized by physicians and is even more seldom adequately treated. Also, a significant proportion of residents receive antidepressants without a documented associated indication. Therefore, the recognition and guideline-based treatment of depression should be improved in this high-risk group.

  19. Efficiency and quality of care in nursing homes: an Italian case study.

    Science.gov (United States)

    Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano

    2011-03-01

    This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency.

  20. The effect of pay-for-performance in nursing homes: evidence from state Medicaid programs.

    Science.gov (United States)

    Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

    2013-08-01

    Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting-the implementation of P4P for nursing homes by state Medicaid agencies. 2001-2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls. Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change. Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered. © Health Research and Educational Trust.

  1. Home health nurses: stress, self-esteem, social intimacy, and job satisfaction.

    Science.gov (United States)

    Moore, S; Lindquist, S; Katz, B

    1997-06-01

    A survey of 253 home health care nurses' perceptions of work-related stress, self-esteem, social intimacy, and job satisfaction found that stress has a negative correlation with self-esteem, social intimacy, and job satisfaction. A positive correlation, however, was found between self-esteem and social intimacy and job satisfaction. Health system administrators, owners, and directors had significantly higher levels of self-esteem, nurses with 5 years or more in their home health nursing position had significantly higher levels of self-esteem. The survey found that nurses with less than a baccalaureate degree possessed significantly lower levels of sociability than those with a graduate or baccalaureate degree. Administrators and managers scored significantly higher on sociability than head nurses.

  2. Inter-rater reliability of nursing home quality indicators in the U.S

    Directory of Open Access Journals (Sweden)

    Roy Jason

    2003-11-01

    Full Text Available Abstract Background In the US, Quality Indicators (QI's profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators. Methods We sampled nursing homes in 6 states, selecting up to 30 residents per facility who were observed and assessed by research nurses on 100 clinical assessment elements contained in the Minimum Data Set (MDS and compared these with the most recent assessment in the record done by facility nurses. Kappa statistics were generated for all data items and derived for 22 QI's over the entire sample and for each facility. Finally, facilities with many QI's with poor Kappa levels were compared to those with many QI's with excellent Kappa levels on selected characteristics. Results A total of 462 facilities in 6 states were approached and 219 agreed to participate, yielding a response rate of 47.4%. A total of 5758 residents were included in the inter-rater reliability analyses, around 27.5 per facility. Patients resembled the traditional nursing home resident, only 43.9% were continent of urine and only 25.2% were rated as likely to be discharged within the next 30 days. Results of resident level comparative analyses reveal high inter-rater reliability levels (most items >.75. Using the research nurses as the "gold standard", we compared composite quality indicators based on their ratings with those based on facility nurses. All but two QI's have adequate Kappa levels and 4 QI's have average Kappa values in excess of .80. We found that 16% of participating facilities performed poorly (Kappa .75 on 12 or more QI's. No facility characteristics were related to reliability of the data on which Qis are based. Conclusion While a few QI's being used for public reporting

  3. [Life project of residents and institutional approach in nursing homes].

    Science.gov (United States)

    Chanut, Corinne

    The life project in a nursing home involves all the players concerned: first of all, the resident, then the caregivers, the families and the institution. This unifying tool, organised around the elderly, helps to develop collective competencies, favours the integration of new residents and reassures families. This article presents a nursing home's experience of setting up a life project. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study.

    Science.gov (United States)

    Yoon, Ju Young; Brown, Roger L; Bowers, Barbara J; Sharkey, Siobhan S; Horn, Susan D

    2016-01-01

    Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House nursing home model, has shown positive psychological outcomes. However, little is known about whether the Green House nursing home model has positive effects on physical function compared to traditional nursing homes. To examine the longitudinal effects of the Green House nursing home model by comparing change patterns of activities of daily living function over time between Green House home residents and traditional nursing home residents. A retrospective longitudinal study. Four Green House organizations (nine Green House units and four traditional units). A total of 242 residents (93 Green House residents and 149 traditional home residents) who had stayed in the nursing home at least 6 months from admission. The outcome was activities of daily living function, and the main independent variable was the facility type in which the resident stayed: a Green House or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. The mean activities of daily living function showed deterioration over time, and the rates of deterioration between Green House and traditional home residents were not different over time. Four different activities of daily living function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. Although Green House nursing homes are

  5. Coping with the Obligation Dilemma: Prototypes of Social Workers in the Nursing Home

    OpenAIRE

    Lev, Sagit; Ayalon, Liat

    2015-01-01

    We examined the ways in which the social worker is coping with obligation dilemma in an Israeli nursing home. The research was conducted using semi-structured, in-depth interviews carried out with fifteen social workers employed in nursing homes. The interviews were analysed thematically, using constant comparisons. The three themes were concerned with the social worker's place in the nursing home, her relationship with the management and staff, and her coping with the obligation dilemma. The...

  6. Drug overprescription in nursing homes: an empirical evaluation of administrative data.

    Science.gov (United States)

    Stroka, Magdalena A

    2016-04-01

    A widely discussed shortcoming of long-term care in nursing homes for the elderly is the inappropriate or suboptimal drug utilization, particularly of psychotropic drugs. Using administrative data from the largest sickness fund in Germany, this study was designed to estimate the effect of institutionalization on the drug intake of the frail elderly. Difference-in-differences propensity score matching techniques were used to compare drug prescriptions for the frail elderly who entered a nursing home with those who remained in the outpatient care system; findings suggest that nursing home residents receive more doses of antipsychotics, antidepressants, and analgesics. The potential overprescription correlates with estimated drug costs of about €87 million per year.

  7. Addressing cancer patient and caregiver role transitions during home hospice nursing care.

    Science.gov (United States)

    Hudson, Janella; Reblin, Maija; Clayton, Margaret F; Ellington, Lee

    2018-05-15

    Many family caregivers and hospice patients experience role changes resulting from advancing illness and the need for increased caregiver responsibility. Successful navigation of conflicts that arise because of these role transitions has been linked to higher quality of patient care and improved caregiver bereavement adjustment. Nursing communication with patients and their caregivers plays an important role in facilitating these transitions. Our objective is to describe patient-caregiver-nurse communication during transitions at end of life. A secondary, qualitative analysis was conducted on transcripts. Using an iterative process of constant comparison, coders inductively categorized nurse, caregiver, and patient communication behavior into overarching themes. Participants were home hospice nurses and cancer patient/spouse caregiver dyads; participants were >45 years of age, English speaking, and cognitively able to participate. Research took place in the home during nurse visits.ResultNineteen unique home hospice visits were analyzed. Patient-caregiver conflict occurred in two major content themes (1) negotiating transitions in patient independence and (2) navigating caregiver/patient emotions (e.g., frustration, sadness). Nurse responses to transition conflict included problem-solving, mediating, or facilitating discussions about conflicts. Nurse responses to emotional conflict included validation and reassurance.Significance of resultsOur findings provide insight into the topics and processes involved in patient and caregiver transitions in home hospice and the role hospice nursing communication plays in mediating potential conflict. Nurses are often asked to take on the role of mediator, often with little conflict resolution communication education; results can be used for nursing education.

  8. Expressing sexuality in nursing homes. The experience of older women: A qualitative study.

    Science.gov (United States)

    Palacios-Ceña, Domingo; Martínez-Piedrola, Rosa María; Pérez-de-Heredia, Marta; Huertas-Hoyas, Elisabet; Carrasco-Garrido, Pilar; Fernández-de-Las-Peñas, Cesar

    In nursing homes, a number of barriers to the expression of sexuality exist, such as the lack of privacy, certain attitudes on behalf of the staff and the family, the lack of a sexual partner, and physical limitations. The aim of this study was to describe the lived experience of sexuality in elderly Spanish women residing in nursing homes. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2013 and 2015. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using thematic analysis. Twenty female residents participated. Three main themes emerged from the data: a) expressing sexuality, b) sexuality as a duty and c) respecting vows. Female residents reported key elements influencing how they manage their sexuality in Nursing Homes. These results serve to improve our understanding regarding the expression of sexuality in older female nursing home residents. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care.

    Science.gov (United States)

    Weaver, Meaghann S; Wichman, Brittany; Bace, Sue; Schroeder, Denice; Vail, Catherine; Wichman, Chris; Macfadyen, Andrew

    2018-06-01

    The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage ( P home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.

  10. Association Between the Nursing Home Minimum Data Set for Vision and Vision-Targeted Health-Related Quality of Life in Nursing Home Residents as Assessed by Certified Nursing Assistants

    Directory of Open Access Journals (Sweden)

    Mark W. Swanson

    2009-01-01

    Conclusions: Ratings by CNAs on the vision-targeted quality of life of nursing home residents under their care is in general agreement with the MDS category assigned by the nurse coordinator. However, CNA ratings are largely homogeneous in the adequate vision to moderately impaired categories.

  11. When Patients Customize Nursing Home Ratings, Choices And Rankings Differ From The Government's Version.

    Science.gov (United States)

    Mukamel, Dana B; Amin, Alpesh; Weimer, David L; Sharit, Joseph; Ladd, Heather; Sorkin, Dara H

    2016-04-01

    Report cards currently published by the Centers for Medicare and Medicaid Services (CMS) offer composite (summary) quality measures based on a five-star ratings system, such as the one featured on the Nursing Home Compare website. These ratings are "one size fits all patients" measures. Nursing Home Compare Plus is an alternative that allows patients and their families to create their own composite scores based on their own preferences and medical needs. We present data from 146 patients who were discharged from the hospital to nursing homes who used Nursing Home Compare Plus. We found that the individual patient-constructed composites differed from CMS's five-star ratings composite. Patients differed from each other and from CMS in the number of performance measures they chose to include in their composite and in their weighting of each performance measure. When comparing Nursing Home Compare Plus to Medicare's five-star ratings, we found only minimal agreement on ranking of nursing homes. We conclude that patients might benefit if current report cards are modified to include an option for personalized ranking. Project HOPE—The People-to-People Health Foundation, Inc.

  12. The TESS Science Processing Operations Center

    Science.gov (United States)

    Jenkins, Jon M.; Twicken, Joseph D.; McCauliff, Sean; Campbell, Jennifer; Sanderfer, Dwight; Lung, David; Mansouri-Samani, Masoud; Girouard, Forrest; Tenenbaum, Peter; Klaus, Todd; hide

    2016-01-01

    The Transiting Exoplanet Survey Satellite (TESS) will conduct a search for Earth's closest cousins starting in early 2018 and is expected to discover approximately 1,000 small planets with R(sub p) less than 4 (solar radius) and measure the masses of at least 50 of these small worlds. The Science Processing Operations Center (SPOC) is being developed at NASA Ames Research Center based on the Kepler science pipeline and will generate calibrated pixels and light curves on the NASA Advanced Supercomputing Division's Pleiades supercomputer. The SPOC will also search for periodic transit events and generate validation products for the transit-like features in the light curves. All TESS SPOC data products will be archived to the Mikulski Archive for Space Telescopes (MAST).

  13. Overcoming resistance to culture change: nursing home administrators' use of education, training, and communication.

    Science.gov (United States)

    Tyler, Denise A; Lepore, Michael; Shield, Renee R; Looze, Jessica; Miller, Susan C

    2014-01-01

    Nursing home culture change is becoming more prevalent, and research has demonstrated its benefits for nursing home residents and staff-but little is known about the role of nursing home administrators in culture change implementation. The purpose of this study was to determine what barriers nursing home administrators face in implementing culture change practices, and to identify the strategies used to overcome them. The authors conducted in-depth individual interviews with 64 administrators identified through a nationally representative survey. Results showed that a key barrier to culture change implementation reported by administrators was staff, resident, and family member resistance to change. Most nursing home administrators stressed the importance of using communication, education and training to overcome this resistance. Themes emerging around the concepts of communication and education indicate that these efforts should be ongoing, communication should be reciprocal, and that all stakeholders should be included.

  14. Use and Perceived Benefits of Mobile Devices by Physicians in Preventing Adverse Drug Events in the Nursing Home

    Science.gov (United States)

    Handler, Steven M.; Boyce, Richard D.; Ligons, Frank; Perera, Subashan; Nace, David A.; Hochheiser, Harry

    2015-01-01

    Objective Although mobile devices equipped with drug reference software may help prevent adverse drug events (ADEs) in the nursing home (NH) by providing medication information at the point-of-care, little is known about their use and perceived benefits. The goal of this study was to conduct a survey of a nationally representative sample of NH physicians to quantify the use and perceived benefits of mobile devices in preventing ADEs in the NH setting. Design/Setting/Participants We surveyed physicians who attended the 2010 the AMDA Annual Symposium about their use of mobile devices and beliefs about the effectiveness of drug reference software in preventing ADEs. Results The overall net valid response rate was 70% (558/800) with 42% (236/558) using mobile devices to assist with prescribing in the NH. Physicians with ≤15 years clinical experience were 67% more likely to be mobile device users, compared to those with >15 years of clinical experience (odds ratio=1.68; 95% confidence interval=1.17-2.41; p=0.005). For those who used a mobile device to assist with prescribing, almost all (98%) reported performing an average of one or more drug look-ups per day, performed an average of 1-2 lookups per day for potential drug-drug interactions (DDIs), and most (88%) believed that drug reference software had helped to prevent at least one potential ADE in the preceding four-week period. Conclusions The proportion of NH physicians who use mobile devices with drug reference software, while significant, is lower than in other clinical environments. Our results suggest that NH physicians who use mobile devices equipped with drug reference software believe they are helpful for reducing ADEs. Further research is needed to better characterize the facilitators and barriers to adoption of the technology in the NH and its precise impact on NH ADEs. PMID:24094901

  15. A university-sponsored home health nursing program in Karachi, Pakistan.

    Science.gov (United States)

    Smego, Raymond A; Khan, Mohammad Aslam; Khowaja, Khurshid; Rafique, Rozina; Datoo, Farida

    2005-11-01

    This article describes a university-sponsored home health nursing program in a large urban center in Pakistan and details the essential elements needed in implementing such a program in a developing country. Compared to in-hospital treatment, home healthcare reduced hospital stay from 12.8 days to 3.9 days, and resulted in a net savings of Pakistani rupees (PRs) 5,374,135 (USD 89,569). A cost-effective home treatment program in a resource-limited country can be successfully implemented by using the hospital pharmacy as the central point for the preparation and distribution of medications and specialty nursing services.

  16. Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

    Science.gov (United States)

    Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

    2011-01-01

    Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

  17. The costs of turnover in nursing homes

    Science.gov (United States)

    Mukamel, Dana B.; Spector, William D.; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

    2009-01-01

    Background Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. Objectives To estimate the net costs associated with turnover of direct care staff in nursing homes. Data and sample 902 nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set (MDS), Medicare enrollment files, Census and Area Resource File (ARF). Research Design We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable (IV) limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. Results The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The IV estimate of turnover costs was negative and significant (p=0.039). The marginal cost savings associated with a 10 percentage point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. Conclusion The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs. PMID:19648834

  18. Status of knowledge on student-learning environments in nursing homes: A mixed-method systematic review.

    Science.gov (United States)

    Husebø, Anne Marie Lunde; Storm, Marianne; Våga, Bodil Bø; Rosenberg, Adriana; Akerjordet, Kristin

    2018-04-01

    To give an overview of empirical studies investigating nursing homes as a learning environment during nursing students' clinical practice. A supportive clinical learning environment is crucial to students' learning and for their development into reflective and capable practitioners. Nursing students' experience with clinical practice can be decisive in future workplace choices. A competent workforce is needed for the future care of older people. Opportunities for maximum learning among nursing students during clinical practice studies in nursing homes should therefore be explored. Mixed-method systematic review using PRISMA guidelines, on learning environments in nursing homes, published in English between 2005-2015. Search of CINAHL with Full Text, Academic Search Premier, MEDLINE and SocINDEX with Full Text, in combination with journal hand searches. Three hundred and thirty-six titles were identified. Twenty studies met the review inclusion criteria. Assessment of methodological quality was based on the Mixed Methods Appraisal Tool. Data were extracted and synthesised using a data analysis method for integrative reviews. Twenty articles were included. The majority of the studies showed moderately high methodological quality. Four main themes emerged from data synthesis: "Student characteristic and earlier experience"; "Nursing home ward environment"; "Quality of mentoring relationship and learning methods"; and "Students' achieved nursing competencies." Nursing home learning environments may be optimised by a well-prepared academic-clinical partnership, supervision by encouraging mentors and high-quality nursing care of older people. Positive learning experiences may increase students' professional development through achievement of basic nursing skills and competencies and motivate them to choose the nursing home as their future workplace. An optimal learning environment can be ensured by thorough preplacement preparations in academia and in nursing home wards

  19. Long and short hospice stays among nursing home residents at the end of life.

    Science.gov (United States)

    Huskamp, Haiden A; Stevenson, David G; Grabowski, David C; Brennan, Eric; Keating, Nancy L

    2010-08-01

    To identify characteristics of nursing homes and residents associated with particularly long or short hospice stays. Observational study using administrative data on resident characteristics and hospice utilization from a large regional hospice linked with publicly available data on nursing home characteristics. A total of 13,479 residents who enrolled in hospice during 2001-2008. Logistic regression models of the probability of a long (>180 days) or very short (stay, adjusting for nursing home characteristics, a measure of nursing home quality developed using Minimum Data Set Quality Indicator/Quality Measures data, and resident characteristics. Nursing home characteristics were not statistically significant predictors of long stays. The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid. Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay, while those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays. Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria, and these residents had longer lengths of stay, on average. Few facility characteristics were associated with very long or very short hospice stays. However, high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.

  20. Economic impact analysis of an end-of-life programme for nursing home residents.

    Science.gov (United States)

    Teo, W-S Kelvin; Raj, Anusha Govinda; Tan, Woan Shin; Ng, Charis Wei Ling; Heng, Bee Hoon; Leong, Ian Yi-Onn

    2014-05-01

    Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs. Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life. The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3). This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.

  1. Top management leadership style and quality of care in nursing homes.

    Science.gov (United States)

    Castle, Nicholas G; Decker, Frederic H

    2011-10-01

    The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data). A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality. The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.

  2. Factors Associated With Care Workers' Intention to Leave Employment in Nursing Homes: A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project.

    Science.gov (United States)

    Gaudenz, Clergia; De Geest, Sabina; Schwendimann, René; Zúñiga, Franziska

    2017-07-01

    The emerging care personnel shortage in Swiss nursing homes is aggravated by high turnover rates. As intention to leave is a predictor of turnover, awareness of its associated factors is essential. This study applied a secondary data analysis to evaluate the prevalence and variability of 3,984 nursing home care workers' intention to leave. Work environment factors and care worker outcomes were tested via multiple regression analysis. Although 56% of care workers reported intention to leave, prevalences varied widely between facilities. Overall, intention to leave showed strong inverse relationships with supportive leadership and affective organizational commitment and weaker positive relationships with stress due to workload, emotional exhaustion, and care worker health problems. The strong direct relationship of nursing home care workers' intention to leave with affective organizational commitment and perceptions of leadership quality suggest that multilevel interventions to improve these factors might reduce intention to leave.

  3. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

    Science.gov (United States)

    Lohman, Matthew; Leslie, Marc; Powell, Virginia

    2015-01-01

    Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions. LTC may be an important point of engagement in suicide prevention. PMID:25973805

  4. Work stress among nursing home care attendants in Taiwan: a questionnaire survey.

    Science.gov (United States)

    Hsu, Hui-Chuan; Kung, Yuan-Wei; Huang, Hsiao-Chien; Ho, Pei-Yu; Lin, Ya-Ying; Chen, Wen-Shin

    2007-07-01

    Care attendants constitute the main workforce in nursing homes, but their heavy workload, low autonomy, and indefinite responsibility result in high levels of stress and may affect quality of care. However, few studies have focused of this problem. The aim of this study was to examine work-related stress and associated factors that affect care attendants in nursing homes and to offer suggestions for how management can alleviate these problems in care facilities. We recruited participants from nine nursing homes with 50 or more beds located in middle Taiwan; 110 care attendants completed the questionnaire. The work stress scale for the care attendants was validated and achieved good reliability (Cronbach's alpha=0.93). We also conducted exploratory factor analysis. Six factors were extracted from the work stress scale: insufficient ability, stressful reactions, heavy workload, trouble in care work, poor management, and working time problems. The explained variance achieved 64.96%. Factors related to higher work stress included working in a hospital-based nursing home, having a fixed schedule, night work, feeling burden, inconvenient facility, less enthusiasm, and self-rated higher stress. Work stress for care attendants in nursing homes is related to human resource management and quality of care. We suggest potential management strategies to alleviate work stress for these workers.

  5. Quality of care in one Italian nursing home measured by ACOVE process indicators.

    Directory of Open Access Journals (Sweden)

    Claudia Pileggi

    Full Text Available To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH, to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care.Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions.With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia. On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs.Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.

  6. Doll therapy: an intervention for nursing home residents with dementia.

    Science.gov (United States)

    Shin, Juh Hyun

    2015-01-01

    The use of dolls as a therapeutic intervention for nursing home residents with dementia is relatively new. The current article describes a research study implemented with nursing home residents in Korea to examine the effects of doll therapy on their mood, behavior, and social interactions. A one-group, pretest-posttest design was used to measure the impact of doll therapy on 51 residents with dementia. Linear regression demonstrated statistically significant differences in aggression, obsessive behaviors, wandering, negative verbalization, negative mood, and negative physical appearance after introduction of the doll therapy intervention. Interactions with other individuals also increased over time. Findings support the benefits of doll therapy for nursing home residents with dementia; however, further research is needed to provide more empirical evidence and explore ethical considerations in the use of doll therapy in this vulnerable population. Copyright 2015, SLACK Incorporated.

  7. Replicating the Family: The Biopolitics of Involvement Discourses Concerning Relatives in Nursing Home Institutions

    Directory of Open Access Journals (Sweden)

    Jessica Holmgren

    2014-10-01

    Full Text Available The aim of this study was to describe the biopolitics of involvement discourses articulated by nursing staff concerning relatives in nursing home institutions, using a Foucault-inspired discourse analytical approach. Previous research has described how relatives have not been involved in nursing homes on their own terms. This is partly due to a lack of communication and knowledge, but it is also a consequence of an unclear organizational structure. Results from a discourse analysis of six focus group interviews with nursing staff show that the “involvement discourse” in nursing homes can be described as a “new” vs “old” family rhetoric. This rhetoric can be said to uphold, legitimize and provide different subject positions for both nursing staff and relatives concerning the conditions for involvement in nursing homes. As part of a “project of possibility” in elderly care, it may be possible to adopt a critical pedagogical approach among nursing staff in order to educate, strengthen and support them in reflecting on their professional norming and how it conditions the involvement of relatives.

  8. [Aromatherapy in nursing homes].

    Science.gov (United States)

    Barré, Lucile

    2015-01-01

    Pierre Delaroche de Clisson hospital uses essential oils as part of its daily organisation for the treatment of pain and the development of palliative care. The setting up of this project, in nursing homes and long-term care units, is the fruit of a complex mission carried out by a multidisciplinary team, which had to take into account the risks involved and overcome a certain amount of reluctance. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. Learning to care for older patients: hospitals and nursing homes as learning environments.

    Science.gov (United States)

    Huls, Marije; de Rooij, Sophia E; Diepstraten, Annemie; Koopmans, Raymond; Helmich, Esther

    2015-03-01

    A significant challenge facing health care is the ageing of the population, which calls for a major response in medical education. Most clinical learning takes place within hospitals, but nursing homes may also represent suitable learning environments in which students can gain competencies in geriatric medicine. This study explores what students perceive as the main learning outcomes of a geriatric medicine clerkship in a hospital or a nursing home, and explicitly addresses factors that may stimulate or hamper the learning process. This qualitative study falls within a constructivist paradigm: it draws on socio-cultural learning theory and is guided by the principles of constructivist grounded theory. There were two phases of data collection. Firstly, a maximum variation sample of 68 students completed a worksheet, giving brief written answers on questions regarding their geriatric medicine clerkships. Secondly, focus group discussions were conducted with 19 purposively sampled students. We used template analysis, iteratively cycling between data collection and analysis, using a constant comparative process. Students described a broad range of learning outcomes and formative experiences that were largely distinct from their learning in previous clerkships with regard to specific geriatric knowledge, deliberate decision making, end-of-life care, interprofessional collaboration and communication. According to students, the nursing home differed from the hospital in three aspects: interprofessional collaboration was more prominent; the lower resources available in nursing homes stimulated students to be creative, and students reported having greater autonomy in nursing homes compared with the more extensive educational guidance provided in hospitals. In both hospitals and nursing homes, students not only learn to care for older patients, but also describe various broader learning outcomes necessary to become good doctors. The results of our study, in particular the

  10. Functional Status After Colon Cancer Surgery In Elder Nursing Home Residents

    Science.gov (United States)

    Finlayson, Emily; Zhao, Shoujun; Boscardin, W. John; Fries, Brant E.; Landefeld, C. Seth; Dudley, R. Adams

    2015-01-01

    Objectives To determine functional status and mortality rates after colon cancer surgery in older nursing home residents. Design Retrospective cohort study. Setting and Participants 6822 nursing home residents age 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005. Measurements Changes in functional status were assessed before and after surgery using the Minimum Data Set-Activities of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Methods Using the Medicare Inpatient File and the Minimum Data Set for Nursing Homes, we identified the 6822 nursing home residents age 65 and older who underwent surgery for colon cancer. We used regression techniques to identify patient characteristics associated with mortality and functional decline at 1 year after surgery. Results On average, residents who underwent colectomy experienced a 3.9 point worsening in MDS-ADL score at one year. One year after surgery, the rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (age 80+ v. age 65–69, adjusted relative risk (ARR 1.53), 95%CI 1.15–2.04, pppp<0.0001) were associated with functional decline at one year. Conclusion Mortality and sustained functional decline are very common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population. PMID:22428583

  11. Exploring nursing assistants' roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study.

    Science.gov (United States)

    Liu, Justina Y W

    2014-05-01

    To explore nursing assistants' roles during the actual process of pain management (assessment, reporting, implementation of pain-relieving interventions and re-assessment) for cognitively impaired home residents with pain. Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents' pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants' functions in pain management. This is a descriptive, exploratory qualitative study. Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis. Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions. This study highlights the importance of nursing assistants in successful pain assessment and identifies their possible supporting roles in other aspects of pain management. However, nursing assistants' scope of practice resulted in their functions in pain management being continually undervalued by other healthcare professionals. Continuous in-service training, the use of a standardized pain management protocol and strategies for building coherent work teams in nursing homes are suggested to improve this situation. © 2013 John Wiley & Sons Ltd.

  12. Changes in clinical and hotel expenditures following publication of the nursing home compare report card.

    Science.gov (United States)

    Mukamel, Dana B; Spector, William D; Zinn, Jacqueline; Weimer, David L; Ahn, Richard

    2010-10-01

    Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. To examine the hypothesis that nursing homes responding to these changes in demand shifted the balance of resources from hotel to clinical activities. The study included 10,022 free-standing nursing homes nationwide during 2001 to 2006. RESEARCH DESIGN AND DATA: A retrospective multivariate statistical analysis of trends in the ratio of clinical to hotel expenditures, using Medicare cost reports, Minimum Data Set and Online Survey, Certification and Reporting data, controlling for changes in residents' acuity and facility fixed effects. Inference is based on robust standard errors. The ratio of clinical to hotel expenditures averaged 1.78. It increased significantly (P hotel expenditures following publication of the report card suggests that nursing homes responded as expected to the changes in the elasticity of demand with respect to clinical quality brought about by the public reporting of clinical quality measures. The response was stronger among nursing homes facing stronger incentives.

  13. Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff.

    Science.gov (United States)

    Bowblis, John R; Hyer, Kathryn

    2013-08-01

    To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.

  14. TESS Data Processing and Quick-look Pipeline

    Science.gov (United States)

    Fausnaugh, Michael; Huang, Xu; Glidden, Ana; Guerrero, Natalia; TESS Science Office

    2018-01-01

    We describe the data analysis procedures and pipelines for the Transiting Exoplanet Survey Satellite (TESS). We briefly review the processing pipeline developed and implemented by the Science Processing Operations Center (SPOC) at NASA Ames, including pixel/full-frame image calibration, photometric analysis, pre-search data conditioning, transiting planet search, and data validation. We also describe data-quality diagnostic analyses and photometric performance assessment tests. Finally, we detail a "quick-look pipeline" (QLP) that has been developed by the MIT branch of the TESS Science Office (TSO) to provide a fast and adaptable routine to search for planet candidates in the 30 minute full-frame images.

  15. Improvements in the quality of co-ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes.

    NARCIS (Netherlands)

    Achterberg, W.P.; Holtkamp, C.C.M.; Kerkstra, A.; Pot, A.M.; Ooms, M.E.; Ribbe, M.W.

    2001-01-01

    Aim: To study the effect of implementation of the Resident Assessment Instrument (RAI) on the quality of co-ordination of nursing care in Dutch nursing homes. Background: The Resident Assessment Instrument (RAI) was designed to improve the quality of care and quality of life in nursing homes. Until

  16. TESS Lens-Bezel Assembly Modal Testing

    Science.gov (United States)

    Dilworth, Brandon J.; Karlicek, Alexandra

    2017-01-01

    The Transiting Exoplanet Survey Satellite (TESS) program, led by the Kavli Institute for Astrophysics and Space Research at the Massachusetts Institute of Technology (MIT) will be the first-ever spaceborne all-sky transit survey. MIT Lincoln Laboratory is responsible for the cameras, including the lens assemblies, detector assemblies, lens hoods, and camera mounts. TESS is scheduled to be launched in August of 2017 with the primary goal to detect small planets with bright host starts in the solar neighborhood, so that detailed characterizations of the planets and their atmospheres can be performed. The TESS payload consists of four identical cameras and a data handling unit. Each camera consists of a lens assembly with seven optical elements and a detector assembly with four charge-coupled devices (CCDs) including their associated electronics. The optical prescription requires that several of the lenses are in close proximity to a neighboring element. A finite element model (FEM) was developed to estimate the relative deflections between each lens-bezel assembly under launch loads to predict that there are adequate clearances preventing the lenses from making contact. Modal tests using non-contact response measurements were conducted to experimentally estimate the modal parameters of the lens-bezel assembly, and used to validate the initial FEM assumptions. Key Words Non-contact measurements, modal analysis, model validation

  17. Effects of electronic health information technology implementation on nursing home resident outcomes.

    Science.gov (United States)

    Pillemer, Karl; Meador, Rhoda H; Teresi, Jeanne A; Chen, Emily K; Henderson, Charles R; Lachs, Mark S; Boratgis, Gabriel; Silver, Stephanie; Eimicke, Joseph P

    2012-02-01

    To examine the effects of electronic health information technology (HIT) on nursing home residents. The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior. © The Author(s) 2012

  18. Ethical issues experienced by healthcare workers in nursing homes: Literature review.

    Science.gov (United States)

    Preshaw, Deborah Hl; Brazil, Kevin; McLaughlin, Dorry; Frolic, Andrea

    2016-08-01

    Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress. The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs' experiences of ethical issues. Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home. The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work. The review highlighted a need for improved ethics education for care-providers. © The Author(s) 2015.

  19. The physical environment influences neuropsychiatric symptoms and other outcomes in assisted living residents.

    Science.gov (United States)

    Bicket, Mark C; Samus, Quincy M; McNabney, Mathew; Onyike, Chiadi U; Mayer, Lawrence S; Brandt, Jason; Rabins, Peter; Lyketsos, Constantine; Rosenblatt, Adam

    2010-10-01

    Although the number of elderly residents living in assisted living (AL) facilities is rising, few studies have examined the AL physical environment and its impact on resident well-being. We sought to quantify the relationship of AL physical environment with resident outcomes including neuropsychiatric symptoms (NPS), quality of life (QOL), and fall risk, and to compare the effects for demented and non-demented residents. Prospective cohort study of a stratified random sample of 326 AL residents living in 21 AL facilities. Measures included the Therapeutic Environmental Screening Scale for Nursing Homes and Residential Care (TESS-NH/RC) to rate facilities and in-person assessment of residents for diagnosis (and assessment of treatment) of dementia, ratings on standardized clinical, cognitive, and QOL measures. Regression models compared environmental measures with outcomes. TESS-NH/RC is modified into a scale for rating the AL physical environment AL-EQS. The AL Environmental Quality Score (AL-EQS) was strongly negatively associated with Neuropsychiatric Inventory (NPI) total score (p environment of AL facilities likely affects NPS and QOL in AL residents, and the effect may be stronger for residents without dementia than for residents with dementia. Environmental manipulations that increase resident privacy, as well as implementing call buttons and telephones, may improve resident well-being. Copyright © 2010 John Wiley & Sons, Ltd.

  20. Absenteeism- a complex problem: A study on absenteeism in Trondheim’s nursing homes

    OpenAIRE

    Evans, Josiane

    2011-01-01

    Absenteeism is a community problem when one looks at the amount of money spent because of it, an amount that could have been used on other more important matters. For this thesis I set out to study absenteeism in nursing homes here in my town, Trondheim. I wanted to study the nursing homes with relatively low absenteeism rate and the nursing homes with relatively high absenteeism rate to see if I could find differences that could explain the differences in their absenteeism rates. Interviews ...