Nursing Aides Research Articles

“I Want to Tea”: An Entering Medical Student's Perspective on Geriatrics

Every Friday, I eat meals in the dining room of an assisted living facility, alongside fuzzy-haired seniors and caregivers spooning tinned peaches into their mouths. This has been my life for the past 3 years. Winnie isn't doing well, the lines of her face tightening every time she opens her mouth. Today, she's convinced the nursing aides have stolen her jewelry. Angrily clasping at her chest, each time exposing a small square of wrinkled skin, she shouts: “Where are my pearls?” I glance at the glistening beads threaded around her neck. I don't know what to say. A phrase flashes into my mind: Alzheimer's World. Coined by Bob Demarco from the Alzheimer's Reading Room, Alzheimer's World is the absurdist universe that people with dementia inhabit. It's a planet populated with alternative conventions, with figures coming back from the dead and words sliding into a perpetual jumble. Although to some extent, this universe resembles our own reality, it's a reality that's been picked up like a vase of flowers and repositioned slightly to the left. The important thing about Alzheimer's World is not that you bring its residents back to the real world (for such a thing is impossible); it's that you stay with them inside their convoluted universe. So I play along, helping Winnie open the drawers in search of the missing pearls. “I want to tea,” Winnie says, forlornly. I know what she means. I wheel her into the bathroom and let her go about her business. There's a lot I've learned from spending time with elderly people: Use “we” instead of “you.” Follow up on your promises. Enunciate. Use your eyebrows. I've also gotten to understand the language of dementia. Sometimes, when a person says “no,” it doesn't really mean “no.” Like a young child learning to talk, but sadly in a developmental reverse, it's just the only word she has left. Most believe a doctor's role is primarily to save lives. If an individual is sick, you prescribe a pill. If he has a tumor, you put him on the operating table. But what's the cure for old age? How do you rescue someone who's already pushed the brakes on life? Past a certain age, no one can stop the inevitable deterioration of the human body. Arteries harden, arthritic knots work their way into hands, feet, and backs. Synapses fizzle out. What I've realized is that caring for those afflicted with “old age” is not to cure them of their diseases but to allow them, as best we can, to live a life of dignity and grace until the end. To look out for the little, less-romantic things. Whether the individual is at risk for falling. Whether her clothes are going to chafe in her wheelchair seat. What I like about medicine, that imperfect art, is how nothing is ever straightforward. Truths are challenged every day, with one medication blasting through viruses one day, burning holes through the person's digestive system the next. It becomes imperative to adjust to changes quickly and judiciously, to draw from a large and kaleidoscopically changing body of knowledge beneath the surface level formula of diagnose, treat, cure. I've found myself gravitating toward geriatrics because such readjustments are integral to the practice. Because each body deteriorates in a different way, each regimen of care must also be individualized. Volunteering at the hospice, I'm seldom told what “disease” my patient has. We're taught to get to know the people underneath, rather than let an illness define them. “I want to go home,” Winnie says as she exits the bathroom. I step in and flush the toilet. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: Jennifer Xu is the sole contributor of this article. Sponsor's Role: None.

Perspectives of Unlicensed Assistive Personnel on Career Development

An equivalency program, Method 3, is a viable but underused option for unlicensed assistive personnel (UAP) who pursue licensure. This study describes the perceptions of UAP on opportunities for career development. Eighteen UAP participated in three focus groups. Thematic analysis was conducted with verbatim transcription. Three major themes represented the lively discussions that occurred: core driving forces, processes of career development, and anticipated and desirable outcomes. Various subthemes described these major themes. Method 3 provides a realistic approach to help UAP persevere with career development. Collaboration with management and peers, encouragement, and effective communication contributed to the success of participants, despite obstacles and challenges. Camaraderie and flexible scheduling were critical elements in participants' pursuit of first licensure. Taking small steps was described as an effective approach for UAP to persevere with career development. Support for informal career development is essential. Nursing leaders should consider an equivalency approach to accommodate individual preferences and learning needs for career development.

Reducing the Risks of Delegation

School nurses are challenged by Federal Civil Rights Laws and the Standards of School Nursing Practice to care for a burgeoning population of students with special healthcare needs. Due to the realities of current school nurse-to-student ratios, school nurses are frequently responsible for directing unlicensed assistive personnel (UAPs) to support the health and safety needs of students, where State Nurse Practice Acts, state legislation, and local policy mandates allow. The delegation of health care tasks to UAPs poses many professional, ethical, and legal dilemmas for school nurses. One strategy to reduce the risks of delegation is through the use of procedure skills checklists, as highlighted by the experience of one large urban school district. Part 1 of this two-part article (Shannon & Kubelka, 2013) explored the scope of the problem and the principles of delegation, including legal and ethical considerations. Part 2 discusses the use of procedure skills checklists by school nurses as a strategy to reduce the risks of delegation of student special health care tasks to UAPs.

Reducing the Risks of Delegation

School nurses are challenged by federal civil rights laws and the standards of school nursing practice to care for a burgeoning population of students with special health care needs. Due to the realities of current school nurse-to-student ratios, school nurses are frequently responsible for directing unlicensed assistive personnel (UAPs) to support the health and safety needs of students, where State Nurse Practice Acts, state legislation, and local policy mandates allow. The delegation of health care tasks to UAPs poses many professional, ethical, and legal dilemmas for school nurses. One strategy to reduce the risks of delegation is through the use of procedure skills checklists, as highlighted by the experience of one large urban school district. Part 1 of this two-part article will explore the scope of the problem and the principles of delegation, including legal and ethical considerations.

Nursing home care: exploring the role of religiousness in the mental health, quality of life and stress of formal caregivers

Despite the high number of studies on family caregivers, there is little research on the impact of religiosity on formal caregiving (paid providers). We examine the role of religiousness in the mental health, quality of life and stress of nurse aides (NA) who provide care for patients in a nursing home. NA in a Brazilian nursing home were invited to participate. Because of its coping function, we hypothesized that religiousness was related to better mental health and quality of life. Linear regression was used to test this hypothesis and control for confounders. Compared with the Brazilian general population, NA scored higher on measures of religious involvement. Intrinsic religiosity was associated with better mental health and quality of life. Organizational religiosity was associated with better social functioning, better general mental health and fewer anxiety symptoms. Non-organizational religiosity (prayer), however, was associated with negative outcomes, such as higher stress, poorer general health perceptions and more anxiety symptoms. Most NA indicated that they had prayed for and with their patients. In conclusion, paid caregivers (NA) have a strong sense of religiousness, which plays an important role in many ways, including the type of care they provide, their mental health and their quality of life.

Nurse aide decision making in nursing homes: factors affecting empowerment

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.

Mental illness training on the Internet for nurse aides: a replication study.

Internet training courses for nurse aides (NAs) in long-term care facilities (LTCs) have been shown to be effective. Little is known, however, about Internet training effects on NAs in a non-research context, or about continued utilization of an available training programme. In this research, a replication study was conducted with the Internet training programme Caring Skills: Working with Mental Illness. Three LTCs provided the training to all NAs, each within a 1-month interval scheduled during consecutive months. Supervisors were interviewed subsequently about their experiences organizing and supervising the training. Participants in all three LTCs showed positive pre-post-tests effects with large effect sizes on situational knowledge and self-efficacy, and knowledge about mental illness. Users rated the programme highly, and they indicated that it would improve quality of their resident care. Supervisors praised the training, and they said NAs were using recommended training behaviours. Although available to all staff, nursing and other staff made little use of the training in subsequent months. Training for NAs on the Internet thus appears feasible, and it is perceived to be beneficial for resident care. Plans for continued utilization and dissemination of best practices to other staff, however, should be integrated when planning for staff training on the Internet.

A Controlled Trial of an Intervention to Increase Resident Choice in Long Term Care

The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. A controlled trial with a delayed intervention design. Four community, for-profit nursing homes. A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.

2823 – Stress-related psychological symptoms among health care professionals in a greek hospital

Introduction Healthcare professionals (HCP) suffer from work-related or occupational stress often resulting from high expectations, coupled with insufficient time, skills and/or social support at work, but stress also resolves from everyday life. Aims The aim of the present study was to measure the stress-related psychological symptoms in HCP and to assess significant differences among different specialties. Methods Stress as a syndrome that is factorially distinct from depression and anxiety, characterized by nervous tension, difficulty relaxing and irritability, was measured with the stress scale of the Depression Anxiety Stress Scale (DASS). Statistical analysis was performed with SPSS-19. Results 196 HCP from a public hospital in Greece participated in the study. Of them, 33 (16.6%) were males and 166(83.4%) females. 49(24.6%) were nursing staff, 59(29.6%) medical staff (MS) and 91(45.7%) administrative personnel (AP). In stress, Nursing Aid (NA) (M = 14.8 ± 8.4), Paramedics (P) (M = 17.8 ± 10.5) and MS (M = 13.7 ± 10.7) had higher scores from the general population (M = 12.4 ± 9.8). Statistical significant differences were found with Mann Whitney U, in stress between Register Nurses (RN) (M = 8.1 ± 6.4) and MS (M = 13.7 ± 10.7) (z = −2.458 p Conclusions Health care staff experiences stress with significant differences among different specialties that are correlated with the profession and the demands of the job description.

Consistent Assignment of Nurse Aides: Association With Turnover and Absenteeism

Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The measures were from 2007 and came from 3,941 nursing homes. Multivariate logistic regression models were used to examine turnover and absenteeism. An average of 68% of nursing homes reported using consistent assignment, with 28% of nursing homes using nurse aides consistent assignment at the often recommended level of 85% (or more). Nursing homes using recommended levels of consistent assignment had significantly lower rates of turnover and of absenteeism. In the multivariate analyses, consistent assignment was significantly associated with both lower turnover and lower absenteeism (p < .01). Consistent assignment is a practice recommended by many policy makers, government agencies, and industry advocates. The findings presented here provide some evidence that the use of this staffing practice can be beneficial.

Settlement Ends Medicare's ‘Improvement’ Standard

Settlement Ends Medicare's ‘Improvement’ Standard

Continuing Education for Patient Care Technicians

Continuing Education for Patient Care Technicians

Communicating With Patients Who Have Advanced Dementia: Training Nurse Aide Students

The increase of dementia in older adults is changing how medical care is delivered. Recognizing symptoms of pain, managing behaviors, and providing quality of life for people who have advanced dementia requires a new skill set for caregivers. Researchers in this study targeted nurse aide students to test an educational module's effect on students' perceptions of dementia and their ability to care for patients with dementia. The results indicated the training was effective regarding nurse aides' understanding of residual cognitive abilities and need for meaningful contact among patients with advanced dementia; however, the training was not successful in terms of nurse aides' comfort level or perceived skills in working with this population of patients. The findings suggest a need to transform how caregivers are trained in communication techniques. Incorporating this training into nurse aide education has the potential to increase quality of life for people with dementia.

Resident-to-Resident Abuse in Nursing Homes as Reported by Nurse Aides

Information on the scale and scope of resident-to-resident abuse, including verbal, physical, material, psychological, and sexual abuse, is presented. Nursing homes (n = 249) from ten states were used, with a total of 4,451 nurse aides in these facilities returning the questionnaire. Most nursing homes experienced verbal, physical, material, and psychological abuse, but sexual abuse was less common. Our findings clearly show that both the scale and scope of resident-to-resident abuse is high in nursing homes. Resident-to-resident abuse is common enough to be considered an issue of concern impacting the quality of life and safety of many residents.

Training of Home Health Aides and Nurse Aides: Findings From National Data

Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the commonalities and differences in the perceptions of CNAs and HHAs regarding the initial and continuing education they received to prepare them for their job. More than 80% of HHAs and all CNAs received some initial training. Of these, significantly more HHAs compared to CNAs felt that training had prepared them “very well” for their jobs. The two groups also differed in their assessments of the content of the initial training; for example, more CNAs believed that their training was “excellent” in helping them address patients' limitations in activities of daily living compared to HHAs. The vast majority of HHAs and CNAs received continuing education, and about three fourths in each group assessed this training as being “very useful.” In light of the increasing demands for HHAs and CNAs with the aging of America, findings from these national studies could be used to inform educational and training initiatives for this critical workforce.

The concept of missed care: a literature review

To describe the concept and consequences of missed nursing care. A literature review was conducted searching on Medline, Trip Database, Cinahl, Cochrane, with the following key words: missed care, missed nursing care. Any needed nursing intervention omitted (totally or in part) or postponed is considered missed care. The causes of missed care are the scarcity of human resources, of equipment or communication, but also the criteria for setting priorities and the relationships with nurses aids may also have an impact. The missed care may be measured with the Misscare tool: those more frequently missed are deambulation, passive mobilization, hygiene and oral care. CONCLUSIONS. A description of the interventions omitted or only postponed at international level, a measurement of the variability of missed care according to the number of nurses, and their impact on patients'outcomed could improve a better understanding of this problem.

Criteria for delegating the safe hospital administration of drug therapy via natural route to nurses aids in hospital

To assess if and how many patients admitted to hospital could receive the drug therapy via natural route by specialized nurses aids (OSSc). Focus group to identify the items of an assessment instrument to select patients eligible to receive drug therapy from OSSc, validation (face validity, test retest, interrater reliability and factorial analysis) and implementation on 227 patients admitted to medical and surgical wards. During admission 106/227 patients (46.5%) could receive the therapy from OSSc for at least one day: 21 (9.2%) at admission, 73 (32.1%) after 4 days and 12 (11.3%) in the following days, but 29/106 (27.3%) formerly eligible patients change their condition and therapy should be administered by nurses. On average in medical wards 7.7 patients/day would be eligible while only 2.6 in surgery. The delegation of drug therapy in acute hospitals to OSSc seems unlikely for patients complexity and the need of daily assessments and adjustments. Nurses should each time select eligible patients guaranteeing the necessary supervision. This extra workload is not affordable.

Observation of the effect of behavioral change theory in the improvement of self- protection awareness and first aid techniques for the emergency department nurses

Objective To investigate and analyze the effect of behavioral change theory on the improvement of self-protection awareness and first aid techniques for the emergency department nurses. Methods 80 nurses in the hospital emergency department from August 2010 to October 2011 were chosen.They were given with behavioral change theory of intervention for the purpose.The levels of protection awareness,prevention of hospital infection behavior standardization and first aid techniques before and after intervention were recorded.And the results were analyzed. Results After intervention,the excellent results of the nurses' self-protection awareness survey were in 70 cases,the qualified results were in seven cases,the total pass rate was 96.25％.The self-protection awareness was significantly stronger than before the intervention.After the intervention,the prevention of hospital infection behavior standardization was in 65 cases with outstanding results,with a pass result was in 10 cases,the total pass rate was 93.75％.Standardization of behavior to prevent hospital infection after the intervention was significantly higher than before the intervention.After the intervention,the nurses’ first aid techniques was outstanding in 63 cases,with a pass result in 13 cases,the total pass rate was 95.00％.After the intervention,the nursing staff's first aid level was significantly better than before the intervention. Conclusions The theory of behavioral change can be effective in strengthening self-protection awareness of the nursing staff,and improve the level of first aid techniques. Key words: Behavioral change theory; Self-protection awareness; First aid techniques

One Sick Child Away from Being Fired: When 'Opting Out' is Not an Option

Professional women are not the only Americans whose jobs are in jeopardy because of work/family conflict. This report discusses a study of 99 union arbitrations that provide a unique window into how work and family responsibilities clash in the lives of bus drivers, telephone workers, construction linemen, nurses aides, carpenters, welders, janitors, and others — men as well as women — in working-class jobs.

Continuing Education for Patient Care Technicians

Unlicensed assistive personnel get an upgrade--and everyone benefits.