Nursing Aides Research Articles

Continuing Education for Patient Care Technicians

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

Occupational hepatitis C seroconversions in a Brazilian hospital

There are six known cases of occupational human immunodeficiency virus (HIV) seroconversion in Brazil. However, there are neither published cases of occupational hepatitis C virus (HCV) seroconversion nor systematic studies of blood and body fluid exposures (BBFE) that could estimate the risk of HCV or HIV occupational seroconversion in Brazil. To describe the outcomes of BBFEs in a Brazilian hospital over 12 years and 2 months. Statistical analysis of a computerized database of exposure events recorded on printed forms. Incidence rates (IR) were calculated as the number of BBFE per 100 full-time equivalent worker-years. There were 1457 BBFE, 87% being percutaneous and 561 (38%) recurring in health care workers (HCWs) who reported having previous exposures. The highest IRs occurred in laboratory technicians (9.7), medical students (9.5), cleaning staff (9.5) and nursing aids (9.2). The IR in temporary employees was 13.0. Two HCWs, a nursing aid and a surgeon, seroconverted to hepatitis C after HCV exposures involving 13 G catheter needles. The risk of acquiring a HCV infection was 2 in 38 percutaneous HCV exposures, i.e. 5% (95% CI: 0.89-16.3). There were no seroconversions to HIV despite 80 percutaneous HIV exposures. HCV has a higher potential for occupational transmission than HIV. Measures to reduce the risks of BBFE and occupational transmission of blood-borne viral infections should be improved in Brazil.

A National Survey of Medication Aides: Education, Supervision, and Work Role by Work Setting

Medication aides are unlicensed assistive personnel who administer medications. A survey was developed to provide insights into medication aide education, supervision, and work role. Items were derived by reviewing the literature and regulations. Data were analyzed by calculating percentages over all respondents, followed by breaking out data by type of work setting. In some cases, state regulations were incorporated to determine the percentage of responders who were performing tasks that regulations stated they should not perform. Survey responses varied by type of work setting; for instance, 6% in assisted living, 3% in nursing homes, 21% in other long-term care, and 10% in other facilities reported having no supervision. Also, 31% indicated they were allowed to administer as-needed medications without an assessment of the patient by a licensed nurse, and 5% indicated they were allowed to administer injectables, yet state regulations indicated they were not allowed to perform these tasks. Study implications are discussed.

Use of a dementia training designed for nurse aides to train other staff.

Problematic resident behaviors may escalate in long-term care facilities (LTCs). If nurse aides (NAs) are not nearby, the nearest staff to intervene may be non-direct care workers (NDCWs), who have little or no dementia training. This pilot research tested Internet dementia-training program, designed for NAs, on NDCWs in a LTC setting. Sixty-eight NDCWs participated, filling out two baseline surveys at 1-month intervals and a posttest survey after training. The surveys included video-situation testing, items addressing psychosocial constructs associated with behavior change, and measures training-acceptance. Paired t tests showed significant positive effects on measures of knowledge, attitudes, self-efficacy, and behavioral intentions, with small-moderate effect sizes. Nursing staff as well as non-health care workers showed improved scores, and the web-site training program was well received by all participants. These results suggest that Internet training may allow staff development coordinators to conserve limited resources by cross-training of different job categories with the same program.

Webwise.

The Cavell Nurses' Trust website is part of a rebranding of the charity Nurse Aid, which is a source of financial support for students, registered and retired nurses, and healthcare assistants.

Original Research

Inadequate primary health care and screening have been identified as serious issues for people with disabilities, but little evidence exists on the nursing care of this population when hospitalized. This study sought to explore the experiences of people with disabilities in their interactions with nurses and unlicensed assistive personnel and their perceptions of the care they received during hospital stays. In this descriptive qualitative study, 35 people with disabilities were interviewed in focus groups, and audio recordings of the interviews were transcribed and validated for accuracy. Content analysis identified major themes. Four themes were identified: poor communication on the part of nursing staff, compromised care, negative attitudes among staff, and participants' fears related to quality of care. The findings suggest the need for further research into the nursing care of people with disabilities during hospitalization. Educational strategies to ensure that nurses and unlicensed assistive personnel have adequate knowledge about the needs of people with disabilities may help in augmenting the care provided to this population.

Compliance with hand hygiene and glove change in a general hospital, Mashhad, Iran: An observational study

Hand hygiene is the single most important element of strategies to prevent health care-associated infections. However, handwashing rates among health care workers have ranged from 9% to 50%. This observation took place as a structured, overt strategy to assess the hospital staff's hand hygiene compliance. The study was carried out in Imam Reza General Hospital, Mashhad, Iran. All hospital staff, including physicians, nurses, and unlicensed assistive personnel in 4 randomly selected wards, were observed by 2 infection control nurse specialists for 5 observation periods on each ward. The observation was overt, and observers compiled data by filling out 2 checklists. All staff knew that they were being observed, and the observers made no interventions. The overall compliance with hand hygiene activities was 47.9% (438 episodes out of 913 potential opportunities) and, with sole emphasis on handwashing, was only 8.5%. Inappropriate glove use might be a component of poor hand hygiene compliance. Training campaigns should be implanted for health care personnel and all hospital staff to re-emphasize the importance of adherence to hand hygiene protocols.

Pathway out of Poverty: A Values-Based College-Community Partnership to Improve Long-Term Outcomes of Underrepresented Students

Native Hawaiians, representing 25% of Hawai'i's population, suffer socioeconomic and health strains as evidenced by overrepresentation in low-wage jobs without health insurance and a higher prevalence of chronic disease compared with Hawai'i's other ethnic groups. Native Hawaiians are more likely to attend community colleges than 4-year colleges and have high dropout rates. To describe a culturally relevant, community-based action research approach to build a program to keep Hawaiians in college to advance career options and improve long-term health and socioeconomic outcomes. Culturally relevant approaches that depended on participation from a variety of community partners were used to evaluate needs and design interventions. The Pathway Out of Poverty Program uses Hawaiian values and traditions of healthy living to lead students through a nursing pathway from nurse aide (NA) to licensed practical nurse (LPN) to registered nurse (RN), with inherent increases in wage-earning potential. In the first 3.5 years, 150 students enrolled in NA training, and 135 students (90%) graduated and were certified. Of the 135, 77 (57%) transitioned to higher education and 79% transitioned to jobs that offered health insurance (20% were in both groups). Of the 77 entering higher education, 33 (43%) aimed for a degree in nursing. Students expressed growing interest in health promotion for themselves, family members, and others. Community partners were key to developing a successful community college-based Pathway Program to help marginalized and other underrepresented students move from low-wage to living-wage jobs and improve their long-term health outcomes.

The effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction: a systematic review.

Delegation by the registered nurse is a decision making process that includes assessment, planning, implementation, and evaluation. Due to an ever-expanding global shortage of nurses, registered nurses are increasingly dependent on unlicensed assistive personnel to assist in the provision of safe patient care. Delegation is recognised as a fundamental nursing skill that can be utilised effectively to improve quality care. To examine and synthesize the best available evidence regarding the impact of delegation interventions used by the registered nurse with the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and registered nurse staff satisfaction. Registered nurses and unlicensed assistive personnel in patient care settings where delegation occurs.This review considered studies that evaluated the effectiveness of delegation interventions by registered nurses to unlicensed assistive personnel.The outcomes examined were quality of care, patient satisfaction, and/or registered nurse staff satisfaction as measured by validated and reliable tools.The review first considered randomised controlled trials; in their absence other research designs, such as non-randomised controlled trials, or other quasi-experimental studies, observational studies and descriptive studies were considered for inclusion in the systematic review. The search strategy aimed to find both published and unpublished studies in the English language from the inception of the included databases through December 2011. The databases searched included the Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, CINAHL, Healthsource Nursing/Academic edition, and PsycINFO. A search of the grey literature and electronic hand searching of relevant journals was also performed. The studies selected for retrieval were critically evaluated by two independent reviewers for methodological quality using standardised critical appraisal instruments from the Joanna Briggs Institute. Data were extracted using standardised data extraction instruments from the Joanna Briggs Institute. Studies were found to have significant heterogeneity between the populations and interventions of the included studies; therefore, pooled statistical meta-analysis could not be completed. The findings are presented in narrative form. Two quasi-experimental studies were identified. In one study, the women counselled by the lay nurse aides received 80% of recommended messages compared to 75% received by the women counselled by the nurse-midwives (β= 4.7, 95%CI: -1.7, 11.0; Non-inferiority). Non-inferiority was demonstrated between the lay nurse aides and the nurse-midwives with respect to communication techniques. The mean performance was high, 95% and 98% among nurse-midwives and lay nurse aides respectively (β =2.4, 95%CI: -0.2, 5.0; Non-inferiority). No difference was found between the nurse-midwives and the lay nurse aides in providing antenatal counselling, education, and maternal-newborn care when proper training and supervision was given. The other study examined six hypotheses that looked at quality of care outcomes in a care model where the registered nurse delegated tasks to unlicensed assistive personal. Five of these outcomes showed no significant improvement as a result of the intervention. Patient knowledge about intravenous therapy was the only quality of care outcome that showed improvement post-intervention with scores increasing from 27% at baseline to 78% at 12 months. There was no improvement in the one hypotheses evaluating registered nurses job satisfaction. There is a paucity of evidence on the effectiveness of delegation interventions and strategies by registered nurses to unlicensed assistive personnel. Delegation interventions require characteristics such as teamwork, training, support, supervision, communication, and evaluation to positively impact quality of care, patient satisfaction, and registered nurse staff satisfaction outcomes. Task shifting could have a positive impact on quality of care and staff satisfaction while providing the registered nurse with an opportunity to increase efficiency. The areas of feedback and evaluation in the registered nurse / unlicensed assistive personnel relationship needs further study.

An Internet Training to Reduce Assaults in Long-Term Care

Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach nurse aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved 2 weekly visits to the online training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. Hierarchical linear models showed significant group differences at T2 in knowledge, and these levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were nonsignificant at T2 but decreased significantly from T1 to T3 with a large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.

Alcohol Misuse and Abuse Reported by Nurse Aides in Assisted Living

Alcohol misuse and abuse in Assisted Living (AL) as reported by nurse aides is examined. Data came from a secondary analysis of nurse aides included in the Pennsylvania nurse aide registry. A total of 832 nurse aides had a prior place of employment in AL. Information reported from these nurse aides include the percent of residents identified as drinking alcohol, opinions of alcohol misuse and abuse, and the prevalence of alcohol misuse and abuse. Nurse aides believe a majority (69%) of AL residents drink alcohol. Of these residents, 34% are thought to drink alcohol daily. Estimated prevalence rates show that in 19% of cases nurse aides believe alcohol consumption has influenced residents’ health and 28% are suspected to make poor choices for alcohol consumption. The findings present preliminary evidence that alcohol misuse and abuse may be a problem of importance in AL. Given the potential impact of this on the health, safety, and quality of life for elders, more attention should be focused on alcohol misuse and abuse by residents living in AL.

Importance of Respect in Patient Care

Importance of Respect in Patient Care Sue Gibson I have been a state-tested nurses aide (STNA) for 32 years. When I get up to go to work, I always start out with a positive attitude. After I clock in for my shift, I go to my assigned floor to start my day. I gather up all my paperwork that is necessary and I'm off and running. I feel the best way to make a resident feel comfortable in their surroundings is to have the resident help in making as many decisions in their day as possible. Decision-making helps a resident feel at home. As an STNA, I am there to help them if a resident needs any kind of assistance during the shift that I am working. One of the first priority questions of the day concerns their meals. The resident selects the lunch and dinner choice. If a resident is not sure what they would like to choose for their meals, I help them choose from what is available to them. I write their selection down for the dietary department and I always thank the resident and smile as I leave the area. Now that they know what their choices are for the day, they have something to look forward to. [End Page 139] Another decision a resident has for the day is their choice of what they would like to wear for the day. He or she may have a favorite article of clothing they like to wear. They may like it because it may be their favorite color or something they really feel comfortable in. I again thank the resident on their decision-making and helping me make their day. I compliment the resident on how nice and neat they look. Showering is the next big thing of the day. Some residents love to get in the shower, while on the other hand, some residents hate to hear the word shower, let alone get into it. Some residents need a lot of encouragement to take a shower. I give the resident a choice as to when they would like to shower. All the residents have a regular shower day. If the resident is scheduled for a shower and would like to take the shower before going to bed, I tell the nurse and the shower is rescheduled for the afternoon shift. The decision is made by the resident and the resident is more likely to follow through with their decision. Activities are scheduled on a daily basis. When the activity is announced over our intercom system, I ask the residents if they would like to attend the activity and sometimes I take them to the floor the activity is being held on. Every Thursday there is a scheduled outing for either breakfast or lunch. It is my job on these outings to go with the activity staff and tend to the residents' needs, if necessary. We go out to a public restaurant and the resident chooses what they would like to eat. If they need help, I am there to help them. I'll ask them, "What are you hungry for?" or, "What sounds good to you?" I read the menu for them and give the residents time to choose what they would like. I have residents who need the food cut up for them because they cannot see well. I tell them where what food is on their plate. I sit by the resident who may need assistance or help in eating and drinking. I feel this outing is important to every resident who goes. Whether it is going out to eat, on a ride, or even to the doctor, they need to feel they have the freedom to choose to do this. It is not unusual to be physically or verbally abused by a resident on a daily basis. A resident might be angry over some little thing and the STNAs are the people they take their anger out on. I take into consideration that the residents are here for a reason, so I never take their words or actions as a personal attack on me. Staying in bed an entire shift...

The Influence of Consistent Assignment on Nursing Home Deficiency Citations

The association of consistent assignment of nurse aides (NAs) with quality of care and quality of life of nursing home residents is examined (using 5 groups of deficiency citations). Data used came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The information including consistent assignment and staffing variables of registered nurses, licensed practical nurses, and NAs were measured in 2007 and came from 3,941 facilities. Negative binomial regression and multivariate logistic regression models were used. An average of 68% of nursing homes in this sample reported using consistent assignment. However, the actual level of NA consistent assignment used varied substantially. Only 28% of nursing homes using NA consistent assignment did so at the often recommended level of 85% (or more). In the multivariate analyses, consistent assignment was associated with the deficiency citations examined in 4 of the 5 models. That is, quality of life deficiency citations (resident), quality of life deficiency citations (staffing), quality of life deficiency citations (facility), and quality of care deficiency citations were significantly (p < .01) lower in facilities with the highest levels of consistent NA assignment. Few significant findings were found in nursing homes using lower levels of consistent assignment. Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence in the peer-reviewed literature. The findings presented here provide some justification for the use of this staffing practice for NAs.

Internet training to respond to aggressive resident behaviors.

This research evaluated an individualized Internet training designed to teach nurse aides (NAs) strategies to prevent or, if necessary, react to resident aggression in ways that are safe for the resident as well as the caregiver. A randomized treatment and control design was implemented, with baseline, 1-, and 2-month assessments for 158 NAs. The training involved 2 weekly visits. The Internet intervention was a behaviorally focused and video-based training that included content on skills for safely dealing with physical aggression. Measures included video situation testing and assessment of psychosocial constructs associated with behavior change. Analysis of covariance showed positive results for knowledge, attitudes, self-efficacy, and empathy, with medium-large effect sizes maintained after 2 months. The training was well received by participants. Internet training is a viable approach to shape appropriate NA reactions to aggressive resident behaviors. This format has future potential because it offers fidelity of presentation and automated documentation, with minimal supervision.

Medication Administration in Nursing Homes: RN Delegation to Unlicensed Assistive Personnel

Medication administration in nursing homes is a complex process that requires careful oversight by registered nurses (RNs) to minimize risks of errors and adverse effects. However, the declining number of RNs in nursing homes requires RNs to delegate some aspects of medication administration to other nursing staff members, including unlicensed assistive personnel (UAP). Delegating medication administration allows RNs to focus on all aspects of the medication use process, including communicating with physicians about residents' conditions and medication therapy needs as well as assessing and evaluating residents' responses to medication therapy. With a carefully supervised delegation process, UAP should be able to administer medications safely, and RNs can oversee the complex needs of frail, vulnerable nursing home residents.

The Skill Mix Model

: Nursing shortage is a critical problem worldwide. Using nurse aides (NAs) within a skill mix model has been applied in the healthcare delivery system as a strategy to improve nursing workforce shortages. : The purpose of this study was to investigate changes in nurse perceptions of their role functions under the skill mix model in Taiwan. : This was a cross-sectional designed study that employed a structured questionnaire. Participants included 38 registered nurses from three medical wards in three hospitals that had implemented the skill mix model for 6 months. The questionnaire gathered data on participant demographics, perceptions on the role functions, role and job satisfaction of nurses, and patient care quality. Nurses' role functions were grouped into independent, dependent, and interdependent categories. : Results demonstrate that nurses' perceptions of independent and interdependent role function have changed since the implementation of the skill mix model. The most significant role changes in the independent function category included the nurse as educator of NAs, supervisor for patient care, and evaluator for nursing care outcomes. The most significant role changes in the interdependent function category included the nurse as integrator of nursing work and coordinator of the healthcare team. Nurses' perceived changes increase in repetitive confirmation of patient conditions and patient care quality. : This study revealed that nurses working in skill mix model environments need more authority to delegate and educate NAs and to supervise and integrate nursing care. Study results may serve as a reference for hospital nursing practice in Taiwan.

Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly

Background Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes. Aim The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes. Design setting and participants The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009. Methods The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA ®) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA ® scale. This examination included a skin assessment and details about PUs were collected. Results The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA ® scores were found. Conclusion CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.

Preparedness for Students and Staff With Anaphylaxis

Schools are responsible for handling life-threatening events due to a variety of conditions, including anaphylaxis. California is one of a few states that permits school districts to stock emergency epinephrine auto-injectors and to train unlicensed assistive personnel to administer epinephrine for a life-threatening event. We surveyed school nurses in California to explore their experience with life-threatening anaphylaxis, implementation of allowable stock epinephrine auto-injector programs, and the barriers to program implementation. An exploratory, cross-sectional, descriptive design was used for this study. Data was obtained from a convenience sample of 171 credentialed California school nurses via an online survey service. Descriptive statistics and Pearson's chi-square were used to analyze the data. Thirty percent of school nurses reported using 1 student's prescribed medication to rescue another student in distress. Despite the frequency of using another student's rescue medication and California's permissive policy, only 13% of nurses reported having stock epinephrine programs. Barriers to stock epinephrine programs included: (a) limited availability of school nursing services, (b) lack of policies or guidelines, (c) inadequate funding for training and medication, and (d) lack of education. Limited awareness of susceptibility and the immediate life-threatening nature of anaphylaxis were also contributing factors. Legislative initiatives are sufficient to develop safe, effective policies and protocols to manage life-threatening allergic reaction in schools. The findings indicate that more education is needed for school personnel and research is needed to determine an effective mechanism to remove barriers for emergency care during school hours.

Caregiver Staffing in Nursing Homes and Their Influence on Quality of Care

There is inconclusive evidence that nursing home caregiver staffing characteristics influence quality of care. In this research, the relationship of caregiver staffing levels, turnover, agency use, and professional staff mix with quality is further examined using a longitudinal analysis to overcome weaknesses of earlier research. The data used came from a survey of nursing home administrators, Nursing Home Compare, the Online Survey Certification and Reporting data, and the Area Resource File. The staffing variables of Registered Nurses, Licensed Practical Nurses, and Nurse Aides were measured quarterly from 2003 through 2007, and came from 2839 facilities. Generalized method of moments estimation was used to examine the effects of changes in staffing characteristics on changes in 4 quality measures (physical restraint use, catheter use, pain management, and pressure sores). Regression analyses show a robust association between the staffing characteristic variables and quality indicators. A change to more favorable staffing is generally associated with a change to better quality. With longitudinal information and quarterly staffing information, we are able to show that for many nursing homes improving staffing characteristics will improve quality of care.

A Better Way of Determining Hand Hygiene Compliance by Counting BOTH Entering AND Exiting a Patient Room as One Compliant Episode

Methods: Using a descriptive survey design, a link to an electronic Survey Monkey questionnaire about nurses’ knowledge and compliance to catheter care policies was sent through hospital e-mail to 544 registered nurse (RN) and unlicensed assistive personnel (UAP) from 18 departments in three hospitals. A prevalence study was also conducted by infection control practitioners and their trained designees on 99 patients in June 2010 who had indwelling urinary catheters to assess documentation and compliance to urinary catheter protocols.