Nursing Home Nurses Research Articles

Experiences and views of nursing home nurses in England regarding occupational role and status

The aim of this article was to explore nursing home (NH) nurses’ perceptions of what influences their occupational status. A hermeneutic phenomenological approach was taken, during which 13 nurses from 7 NHs for older people located in England were each interviewed up to five times using an episodic interview technique. Findings suggested that economic policies regarding funding long-term care, and perceptions of the nature of work undertaken in NHs, may together negatively impact the occupational status of nurses working in these settings. This reduced occupational status is proposed as a factor which shapes nurses’ perception of this role. Low occupational status may also impact on these nurses’ ability to enact the role. Finally, the article documents how NH nurses may attempt to manage issues of status in order to retain occupational esteem.

Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.

The ins and outs of ALCs

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.

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

BackgroundThe 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. MethodTwo-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs. Results58.6% (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. DiscussionThe findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources.

노인요양시설 거주 노인을 위한 한국형 근거기반 연하장애 간호 프로토콜 개발

Purpose: The purpose of this study was to develop an evidence-based dysphagia nursing care protocol for nursing home (NH) residents in Korea. Methods: The protocol was developed based on international guidelines and literatures. After testing content validity by experts, the protocol was applied to the intervention group (n=35) for 4 weeks at one NH in December, 2011, whereas the control group (n=34) received routine care. Results: The protocol was composed of one-page algorithm and detailed guidelines. Algorithm pathway was organized in 3 parts, including screening dysphagia risk, grouping by dysphagia risk level, and assigning nursing care into each group. The nursing care included positioning, oral care, meal time care, diet modification, providing exercise and maneuver, and checking dysphagia signs and symptoms. The experts verified the content validity. Protocol was revised to fit NH practice after the participant observation. Clinical validity was established upon evaluating usefulness, appropriateness, and convenience of the protocol by NH nurses. Dysphagia risk of the intervention group was significantly decreased. Conclusion: Developed protocol will improve the quality of dysphagia care in nursing homes as it can serve as a consistent and integrated standard for nursing care of residents with dysphagia.

Advance Care Planning and Dying in Nursing Homes in Flanders, Belgium: A Nationwide Survey

ContextIn Belgium, data on actual advance care planning (ACP) in nursing homes (NHs) are scarce. ObjectivesTo investigate the prevalence and characteristics of documented advance directives and physicians' orders for end-of-life care in NHs, and the authorization of a legal representative in relation to the residents' demographic and clinical characteristics and care received. MethodsThis was a retrospective cross-sectional study, including all NH residents deceased during September and October 2006 in all 594 NHs in Flanders, Belgium. Structured mail questionnaires about the resident's characteristics, hospital transfers, palliative care delivery, ACPs, and authorization of legal representatives were completed via the NH administrators and nurses involved in the care of the resident. ResultsAdministrators of 318 NHs (53.5%) reported 1303 deaths. Nurses provided information about 1240 (95.2%) of these deaths. At the end of life, NH residents often had dementia (65.2%) and were severely dependent (76.1%). Almost half (43.1%) had at least one hospital transfer during the last three months of life and two-thirds received palliative care. Half had an ACP, predominantly a physician's order and less often an advance directive. Having advance directives or physician's orders was associated with receiving palliative care. Residents with a physician's order more often died in the NH. Nine percent had an authorized legal representative. ConclusionPrevalence of ACPs and formal authorization of a legal representative was low among the deceased NH residents in Flanders, Belgium. There was a higher prevalence of physicians' orders, often established after the resident had lost capacity. Initiatives should be developed to stimulate more advance discussion on care options and making end-of-life decision with the residents while they retain capacity.

Evaluating the Cornell scale for depression in dementia as a proxy measure in nursing home residents with and without dementia

Objectives: We evaluated the use of the Cornell Scale for Depression in Dementia (CSDD) as a proxy measure. Study questions were: How do residents’ self-reports on the CSDD compare with the nurse proxy CSDD ratings of the resident? How do characteristics of depression as rated by the resident CSDD and the nurse CSDD compare? To what extent are demographic and clinical variables associated with resident CSDD, nurse CSDD, and the discrepancy between resident and nurse CSDD scores? Methods: Residents and nurse proxy pairs (n = 395 pairs) from 28 nursing homes (NHs) participated. We calculated discrepancy scores for total and subscale CSDD scores, examined correlations between resident and nurse CSDD scores, and described rates of clinical depression using each of the scores. We conducted multivariate analyses to examine factors associated with resident and nurse CSDD and discrepancy scores. Results: On average, participants had mild cognitive impairment, were White, and female. Associations between resident and nurse CSDD were low (r = 0.16). The mean discrepancy score was −2.03 (SD = 5.28, p < 0.001), indicating that nurses evaluated residents as less depressed than residents evaluated themselves. Discrepancy scores were not associated with residents’ cognitive status, but were associated with a measure of self-report reliability. Regression analyses indicated that depression diagnosis accounted for a small but significant association with resident CSDD, but was not significantly associated with nurse CSDD. Conclusion: These findings underscore the importance of obtaining resident input when assessing depression in NH residents with dementia, and educating NH nurses in the most effective ways to assess depression.

PC-FACS

PC-FACS

Strategies to improve care transitions between nursing homes and emergency departments.

To identify testable solutions that may improve the quality and safety of care transitions between nursing homes (NHs) and emergency departments (EDs). Structured focus group interviews. Group interviews took place in Indianapolis, Indiana. NH administrators, nurses, and physicians; emergency medical services directors, paramedics, and emergency medicine technicians; ED nurses and physicians; and a representative from the Indiana State Department of Health. Opinions, perceptions, and insights of participants. Eighteen participants were included. The central theme was the need for additional structure to support care transitions between NHs and EDs. Participants agreed that the structure afforded by hospital-to-hospital transfers would benefit patients and providers during transitions between NHs and EDs. Because transfer forms currently vary from NH to NH, participants recommended that the entire state use the same form. They recommended that the transfer form be useful in both directions by including a section for the ED provider to complete to support the ED-to-NH transition. Participants suggested that systems use a transfer checklist to help ensure that all processes occur as expected. They strongly recommended verbal communication across care settings to complement written communication and to improve on deficiencies that occur with transfer form-only strategies. Notably, participants suggested that the different care sites engage in relationship-building efforts to improve compliance with recommendations (eg, form completion) and collaborative problem solving. Participants advised additional structure to NH-ED care transitions, similar to hospital-to-hospital transfers, that includes a 2-way, statewide transfer form; a checklist; and verbal communication.

Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors of nursing regarding facility referral practices and conducted interviews with 34 NH nurses, 30 NH aides, and 17 hospice nurses knowledgeable about the factors that led to the hospice status of 32 NH decedents. Selected decedents varied by diagnosis and hospice status (received hospice for >7 days, <or=7 days, or not at all). We audiotaped, transcribed, and coded interviews for themes. NH staff members' recognition of terminal decline, beliefs about hospice, and initiative significantly influenced hospice referral and timing of referral. Staff members' recognition of familiar signs of decline facilitated hospice referral; in contrast, a perception that death was unexpected impeded referral, and a perception of uncertain prognosis delayed referral. Staff members' beliefs that hospice does not add value to NH care or is for crises only impeded referral, and a belief that hospice is only for the "very end" delayed referral. Residents received hospice for longer periods when staff believed that hospice complemented NH care and when staff took the initiative in raising the option of hospice. Enhanced training about recognizing terminal decline, hospice services in NHs, and the role of staff initiative would support NH staff in raising the option of hospice when appropriate.

Attitudinal barriers to effective treatment of persistent pain in nursing home residents.

To systematically explore nursing home (NH) resident and staff attitudes that serve as barriers to detection and management of persistent pain. Survey. Six community-based and one Veterans Affairs long-term care facility Seventy-five NH nurses, 75 certified nursing assistants (CNAs), and 75 communicative NH residents who reported some pain or discomfort "every day or almost every day." Three structured pain attitudes questionnaires (one each for NH residents, CNAs, and nurses) that incorporated constructs gleaned from a comprehensive literature review were designed. One-week test-retest reliability was calculated on a subsample of 25 residents, 19 CNAs, and 26 nurses. Attitudinal differences between the three groups were evaluated using multivariate analysis of variance (MANOVA). Of 12 constructs evaluated, 10 had fair to excellent reliability indices (residents 0.46-0.80; CNAs 0.57-0.76; nurses 0.62-0.94). Of these 10 reliable constructs, MANOVA indicated significant overall attitude differences between the three groups. Follow-up analyses indicated that attitudes endorsed most strongly by residents were that chronic pain does not change, belief in external pathology over pain reports, fear of addiction, and fear of dependence. CNAs attitudes endorsed most strongly were lack of time and complaints unheard. The nurse attitude endorsed most strongly was complaints unheard. These findings suggest that, if residents' fears regarding addiction, worsening dependence, and the immutable nature of persistent pain were quelled, and if CNAs could feel that adequate time is available for pain assessment, perhaps improved pain management in the NH would result.

Social Support, Home/Work Stress, and Burnout: Who can Help?

This study considered the nature of home/work stress and investigated the role of social support from both intra- and extraorganizational sources in reducing that stress and buffering its impact on burnout. Specifically, demographic factors affecting perceptions of home/work stress and the impact of various sources of social support were examined. Data were collected from nursing-home nurses and analyzed using regression techniques. Results suggested that participants with children and those cohabiting with their partners were particularly vulnerable to home/work stress. Results also indicated that different sources of social support worked in unique ways to relieve the strain of home/work stress. Implications of this research for theory on social support are considered, along with the pragmatic suggestions for using study results in dealing with home/work stress.