Karantzas, Gery C.; Mellor, David; McCabe, Marita P.; Davison, Tanya E.; Beaton, Paul; Mrkic, Dejan
Purpose of the Study: The aged care industry experiences high rates of staff turnover. Staff turnover has significant implications for the quality of care provided to care recipients and the financial costs to care agencies. In this study, we applied a model of intention to quit to identify the contextual and personal factors that shape aged care…
Bauer, Michael; Fetherstonhaugh, Deirdre; Tarzia, Laura; Chenco, Carol
The aim of the study was to examine staff and family members' perceptions of each other's roles and responsibilities in the Australian residential aged care setting. Data was collected by interview and focus group from 27 staff and 14 family members at five residential aged care facilities in the state of Victoria, Australia. Findings highlight "communication" as the core category supporting the formation of constructive staff-family relationships, as described by three main themes; "building trust," "involvement," and "keeping the family happy." Staff attitudes, mutual cooperation, meaningful engagement, and shared expectations lay the foundation for relationships. Findings suggest that further efforts to establish and sustain good relationships with families are required by facilities. Characteristics, roles, and expectations of staff and family that can both promote and hinder the formation of constructive staff-family relationships are discussed.
Hang, Jo-Aine; Francis-Coad, Jacqueline; Burro, Bianca; Nobre, Debbie; Hill, Anne-Marie
Falls are a serious problem in residential aged care settings. The aims of the study were to determine the feasibility of surveying care staff regarding falls prevention, and describe care staff levels of knowledge and awareness of residents' risk of falls, knowledge about falls prevention, motivation and confidence to implement falls prevention strategies. A custom designed questionnaire was administered to care staff at one site of a large residential aged care organization in Australia. The survey response was 58.8%. Feedback from staff was used to inform the administration of the survey to the wider organization. Seven (29.2%) care staff reported they were unsure or thought residents were at low risk of falls. Only five (20.8%) care staff were able to suggest more than three preventive strategies. These preliminary findings suggest that education to change care staff behavior regarding falls prevention should target improving care staff knowledge and awareness of falls.
Lo, Raymond S K; Kwan, Bonnie H F; Lau, Kay P K; Kwan, Cecilia W M; Lam, L M; Woo, Jean
This study aims to explore in depth the needs, current knowledge, and attitudes of all ranks of old age home staff. A large-scale qualitative study with 13 semistructured focus groups was conducted in Hong Kong. Key themes were extracted by framework analysis. Three major themes were extracted, including role as a service provider, current knowledge, and attitude toward palliative care. There was a marked difference in familiarity with the concept of ''palliative care'' between different groups of staff, yet both shared the motivation for enhancement. The biggest concerns for the staff were elderly residents' readiness to accept palliative care, manpower, and resources. Care staff, regardless of rank, seemed to welcome and be ready to adopt a palliative care approach in caring for old age home residents, though not without worries and concerns.
Petriwskyj, Andrea; Gibson, Alexandra; Webby, Glenys
Aged care staff are often seen as holding power in care relationships, particularly in client engagement. Such a perception, however, may limit our understanding and analysis of the dynamics and politics within care spaces. This paper uses interview and focus group data from both staff and clients of an Australian aged care provider to identify the positions given to, and taken up by, staff in client engagement. Focusing on one of these positions, in which staff are seen as managing and negotiating constraints, the paper uses an ethic of care lens to examine the context in which engagement - and this position taking - occurs. Findings reflect the importance of the organisational and systemic context to the practice of care ethics and the potential vulnerability and disempowerment of care giving staff. Implications for the support of staff in client engagement and the role of care organisations beyond structures and processes to an active participant in an ethic of care are discussed.
Bennett, Michelle K.; Ward, Elizabeth C.; Scarinci, Nerina A.
Background: There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in…
Jones, Cindy; Moyle, Wendy
Expression of sexuality by older people, particularly those with dementia, can be challenging and confronting for aged-care staff. Education on this topic is often a low priority area for aged-care organizations, and there appears to be limited training programs available. Results from our study highlighted the value of an eLearning education…
Brownie, Sonya; Nancarrow, Susan
Background Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff. Methods We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes. Results The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents’ levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses’ sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the
Petriwskyj, Andrea; Gibson, Alexandra; Webby, Glenys
With increasing focus on client control and active client roles in aged care service provision, client engagement is highlighted as fundamental to contemporary care practice. Client engagement itself, however, is complex and is impacted by a range of issues including the relationships and power dynamics inherent in the care context. These dynamics do not simply reflect the roles that are available to or taken up by clients; just as important are the roles and positions that staff of aged care services are offered, and take up, in client engagement. This paper presents the findings of a study that explored client engagement practice within a large Australian service provider. Analysis of interview and focus group discussions addressed the ways in which staff were positioned - by both themselves and by clients - in terms of the roles that they hold within engagement practice and the power relations inherent within these. Analysis of power from the dominant policy perspective of choice and control, and the alternative perspective of an ethic of care suggests that power relations within the care context are dynamic, complex and involve on-going negotiation and regulation by clients and staff members in aged care. The use of these two contrasting perspectives reveals a more dynamic and complex understanding of power in care practice than dominant uni-dimensional approaches to critique suggest.
Fetherstonhaugh, Deirdre; Tarzia, Laura; Bauer, Michael; Nay, Rhonda; Beattie, Elizabeth
Respect for a person's right to make choices and participate in decision making is generally seen as central to quality of life and well-being. When a person moves into a residential aged care facility (RACF), however, decision making becomes more complicated, particularly if the person has a diagnosis of dementia. Little is known about how staff in RACFs perceive that they support decision making for people with dementia within their everyday practice, and this article seeks to address this knowledge gap. The article reports on the findings of a qualitative study conducted in the states of Victoria and Queensland, Australia with 80 direct care staff members. Findings revealed that the participants utilized a number of strategies in their intention to support decision making for people with dementia, and had an overall perception that "a little effort goes a long way."
Viney, Linda L.; And Others
Compared palliative care staff with staff from burn and neonatal units and with mature age general nursing trainees at end of training. Found that palliative care staff expressed better quality of life, in terms of significantly less anxiety and depression, as well as more good feelings than other staff groups. (Author/NB)
La qualite des services de garde en milieu scolaire: relation avec la formation et l'experience du personnel (Relationship between the Quality of School-Age Child Care and Training and Experience of Staff).
Baillargeon, Madeleine; Larouche, Helene; Roy, Chantal
Investigated the relationship between the quality of after-school child care programs in Quebec and the education and experience of staff. Based on questionnaire responses of teachers and administrators, 26 programs were rated using the School-Age Care Environment Rating Scale. Found correlations between program directors' experience and program…
Kwiecień, Katarzyna; Wujtewicz, Maria; Mędrzycka-Dąbrowska, Wioletta
Intensive care units and well-qualified medical staff are indispensable for the proper functioning of every hospital facility. Due to demographic changes and technological progress having extended the average life expectancy, the number of patients hospitalized in intensive care units increases every year [9,10]. Global shortages of nursing staff (including changes in their age structure) have triggered a debate on the working environment and workload the nursing staff are exposed to while performing their duties. This paper provides a critical review of selected methods for the measurement of the workload of intensive care nurses and points out their practical uses. The paper reviews Polish and foreign literature on workload and the measurement tools used to evaluate workload indicators.
Sikma, Suzanne K
Five themes of caring interventions emerged from the perspective of staff caregivers-valuing personhood and the work, belonging, knowing, acting together, and promoting quality. Three themes of caring organizational conditions identified by participants included communicating, providing resources, and trusting. The research-based Model of Caring in the Organizational Environment can be used to assess and improve the caring environment of nursing homes as well as to develop caring managers and staff. Organizational well-being for nursing homes is everyone's responsibility and requires formal and informal leaders who can create supportive caring organizational conditions, engage in caring interventions with staff, and inspire the synergy of caring.
Roy, Kelly; Brunet, Fabrice
This commentary discusses Laporta and coworkers analysis of a case study on the causes of and solutions for staff turnover in an intensive care setting. Staff turnover is a significant issue for health care leaders due to the shrinking workforce in Western countries and an increased demand for intensive care services as the population ages. The commentary considers reasons for turnover such as burnout and generational diversity, and highlights the importance of a team work approach to address the issue of turnover.
Austin, Wendy; Goble, Erika; Strang, Vicki; Mitchell, Agnes; Thompson, Elizabeth; Lantz, Helen; Balt, Linda; Lemermeyer, Gillian; Vass, Kelly
In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.
Venn, Martha L.; Wolery, Mark
Four paraprofessional staff members in a mainstreamed day care program were trained to engage in positive interactive behaviors during diaper changing. Results indicated that staff increased frequency of game playing and other interactive behaviors during diapering, but increases were not generalized to feeding routines. (Author/JDD)
As long-term post-acute care (LTPAC) settings continue to increase their adoption of electronic health records (EHRs), it is important to learn from end users currently working with the technology to identify clinical implications and opportunities to improve systems and surrounding processes. This study utilized one-on-one interviews of direct care nurses (n = 20) in a Midwest United States LTPAC setting to describe patterns of use, and areas to improve. The majority of respondents evaluated the EHR as easy to use, with a positive impact on quality of care, through efficiencies gained in communication with the care team. Staff responses outline desired modifications to the software, including fixes to data fields for more accurate medication administration and accurate reports on bowel protocol follow-up. Recommendations for LTPAC organizations are made regarding improved staff training on the EHR, and modifications to the EHR and related processes to improve quality of care and staff retention.
Lemp, G F; Woodward, W E; Pickering, L K; Sullivan, P S; DuPont, H L
Sixty randomly selected day-care centers in Houston, Texas, were surveyed for cases of diarrhea by weekly telephone calls during the period October 1980 to May 1981. Visits to each day-care center were made upon enrollment and again to collect self-administered questionnaires which had been mailed to the staff of each center. During the eight-month survey, 986 cases of diarrhea were reported, with an average day-care center incidence of 1.15 cases per 100 person-weeks of observation. A significant positive correlation (p less than 0.05 to p less than 0.01) was found between the incidence of diarrhea in a day-care center and each of the following variables reported by the day-care center staff: the average frequency of diapering, the average frequency of working with children less than two years of age, the average frequency of meal preparation, the average frequency of serving food to the children, and the percentage of staff who both diaper and either serve food or prepare meals daily. Day-care centers which accepted children less than two years of age had a 3.55-fold higher incidence of diarrhea compared with centers which did not accept children less than two years of age. Day-care centers in which one or more staff members prepared meals, served food, and diapered children on a daily basis had a 3.28-fold higher incidence of diarrhea compared with centers in which staff did not combine on a daily basis the duties of diapering children with either meal preparation or food service. The results suggest that staff members may play a role in the transmission of diarrhea in day-care centers through diapering, meal preparation, working with children less than two years of age, or a daily combination of diapering and either meal preparation or food service.
Acuña-Reyes, Raquel; Cigarroa-Martínez, Didier; Ureña-Bogarín, Enrique; Orgaz-Fernández, Jose David
Objectives: Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. Methods: Prospective descriptive study, questionnaire validation, and prevalence study. In the first stage, the questionnaire for the practice of preventive dentistry (CPEP, for the term in Spanish) was validated; consistency and reliability were measured by Cronbach's alpha, Pearson's correlation, factor analysis with intra-class correlation coefficient (ICC). In the second stage, the domain in preventive dental nurses was explored. Results: The overall internal consistency of CPEP is α= 0.66, ICC= 0.64, CI95%: 0.29-0.87 (p >0.01). Twenty-one subjects in the study, average age 43, 81.0% female, average seniority of 12.5 were included. A total of 71.5% showed weak domain, 28.5% regular domain, and there was no questionnaire with good domain result. The older the subjects were, the smaller the domain; female nurses showed greater mastery of preventive dentistry (29%, CI95%: 0.1-15.1) than male nurses. Public health nurses showed greater mastery with respect to other categories (50%, CI95%: 0.56-2.8). Conclusions: The CDEP has enough consistency to explore the domain of preventive dentistry in health-care staff. The domain of preventive dentistry in primary care nursing is poor, required to strengthen to provide education in preventive dentistry to the insured population. PMID:25386037
Sapountzi-Krepia, Despina; Lavdaniti, Maria; Psychogiou, Maria; Arsenos, Panagiotis; Paralikas, Theodossios; Triantafylidou, Paraskevi; Georgiadou, Charikleia
There is a broad variety of factors that are contributing to the nursing staff shortage. They include low wages, poor image of nursing, job satisfaction, ageing of the nursing workforce and cost reductions. In the Greek National Health System, there is a policy of open-visiting hours in hospitals. Family members stay with the patients for many hours and provide in-hospital informal care. The purpose of this study is to describe the perceptions of nursing staff about the nursing staff shortage and the in-hospital informal care in a Greek oncology hospital. For the data collection we used a 30-item questionnaire. The majority of the participants (82.9%) stated that most patients have a family member staying longer than the official visiting hours for assisting with care. A main reason according to the nurses' opinion (37.4%) is the nursing staff shortage. In addition, most nurses disagree with relatives providing some of the informal caregiving activities. The findings are consistent with the findings of other studies. They might be of interest to Greek health authorities, to nurses and to Greek citizens in order to implement possible solutions to improve the hospitalization in Greek hospitals.
Hutton, Scott; Gates, Donna
The purpose of this study was to examine incivility experienced by direct health care staff in their workplaces. The sample (N = 184) was 91% female and 77% White, with 71% of the participants having earned an associate degree or above and 81% being registered nurses. The Work Limitations Questionnaire and the Incivility in Healthcare Survey were distributed to all direct care staff at a major metropolitan hospital (22% response rate). Correlations were found between workplace incivility from direct supervisors and productivity (r = 0.284, p = .000) and workplace incivility from patients and productivity (r = 0.204, p = .006). Incivility from physicians, incivility from other direct care staff, and general environmental incivility were not shown to be significantly related to productivity. Demographics were not related to levels of workplace incivility. Workplace incivility from patients and management appears to have a greater impact on employees' productivity than workplace incivility from other sources.
Baltes, M M; Neumann, E M; Zank, S
Research has attested to the prevalence of a "dependency-support" and "independence-ignore" script characterizing the interactions between staff and elderly residents in long-term care institutions. To examine whether the scripts could be modified, a staff training program (focusing on communication skills, knowledge about aging, and basic behavior principles) was implemented in 3 different institutions. Observational data on staff-resident interactions in the context of self-care were collected pre- and postintervention. Findings revealed significant changes for the experimental group. Specifically, a decrease in dependence-supportive behavior of staff and an increase in their independence-supportive behavior, an increase in independent behavior of residents, and an increase in independence-related interaction patterns were demonstrated.
Couch, Elizabeth; Mead, Jean Marie; Walsh, Margaret M
Systematic oral care reduces oral complications among children in paediatric palliative care (PPC), yet little is known about the oral health perceptions of PPC nursing staff. This qualitative cross-sectional study used semi-structured interviews based on phenomenography to explore PPC nursing staff's perceptions of oral health and the relationship of oral care to comfort and quality of life. A purposive sample of nine nursing staff employed at a California PPC facility participated. Five themes emerged from the analysis of the interviews: signs of oral health, reasons for oral care, adaptation of oral care on a case-by-case basis, barriers to providing oral care, and facilitators of improving oral care. The perceived importance of oral health was the underlining similarity between the themes. A need for further research in the area of oral PPC is indicated. Collaboration with dental professionals may be needed to create oral PPC guidelines that fit the complex needs of children with life-limiting illnesses.
Background: Levels of burnout, job satisfaction and intended turnover of staff working in day care centres for adults with intellectual disabilities are investigated in relation to role clarity, staff support and supervision, and coping strategies used by staff. Materials and methods: Thirty six direct-care staff of four day care centres in the UK…
Friedman, Sandra L.; Choueiri, Roula; Gilmore, Dana
Staff carers in pediatric skilled nursing facilities (PSNF) deal directly with dying residents, and are on the forefront of communication with families. These providers have expressed misunderstandings regarding the meaning of resuscitation status and redirection of care. This descriptive study evaluated perceptions and understanding of end of…
Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.
Arnetz, J E; Arnetz, B B
Much of the research on violence in the health care sector has focused on the immediate and long-term effects of patient violence on staff victims. There is a lack of studies, however, examining whether individual reactions to violent episodes, such as anger and increased fear in one's work, have any measurable effect on staff behaviour toward their patients, and ultimately on the quality of patient care. The aim of the present study was to investigate whether an association exists between staff experiences with violence and patient-rated quality of patient care. A theoretical model was presented, suggesting that violence or threats experienced by health care staff have a negative effect on the quality of health care services offered, as measured by patients. In addition, it was theorised that there would be an association between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their work environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and quality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see which combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient perspective. Violence entered consistently as an important predictor into each of the three best regression equations for 1994, 1995, and 1997, respectively. The results of this analysis suggest that the violence experienced by health care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational health issue, but may have significant implications for the quality of care provided.
Bray, Jennifer; Evans, Simon; Bruce, Mary; Carter, Christine; Brooker, Dawn; Milosevic, Sarah; Thompson, Rachel; Woods, Catherine
This is the fourth and final article in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Dementia training in hospitals is often inadequate and staff do not always have sufficient knowledge of dementia to provide appropriate care. It can also be difficult for them to identify when patients with dementia are in pain, especially when their communication skills deteriorate. The case studies presented illustrate how two NHS trusts have worked to ensure that their staff are fully equipped to care for people with dementia in hospital. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex made dementia training a priority by including dementia awareness in staff induction across a range of roles and providing additional training activities tailored to meet staff needs. Nottingham University Hospitals NHS Trust focused on pain assessment, aiming to standardise its approach for patients with dementia. The pain assessment in advanced dementia tool was chosen and piloted, and is being implemented across the trust after a positive response.
Solimeo, Samantha L; Ono, Sarah S; Stewart, Kenda R; Lampman, Michelle A; Rosenthal, Gary E; Stewart, Greg L
International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority.
McCabe, Marita P.; Davison, Tanya; Mellor, David; George, Kuruvilla
The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care,…
This article reports on the results of a survey distributed in April 2007 to government special education schools and settings throughout Australia. The survey collected information about the age and special education qualifications of teaching staff. It followed a similar survey that was distributed in May 2006 to Victorian special schools that…
Simmons, Sandra F.; Rahman, Annie; Beuscher, Linda; Jani, Victoria; Durkin, Daniel W.; Schnelle, John F.
Purpose: To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. Design and Methods: This study…
Reymond, Liz; Israel, Fiona J; Charles, Margaret A
The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings.
Ingham, Barry; Riley, Jenny; Nevin, Helen; Evans, Gemma; Gair, Elodie
The emotional responses to challenging behaviour of direct care staff who support people with intellectual disabilities is thought to be an important mediating factor within the stress experienced by staff and a potential maintaining factor in challenging behaviour. A brief workshop to improve direct care staff resilience was developed and…
Brick, Thomas; Agbeko, Rachel S; Davies, Patrick; Davis, Peter J; Deep, Akash; Fortune, Peter-Marc; Inwald, David P; Jones, Amy; Levin, Richard; Morris, Kevin P; Pappachan, John; Ray, Samiran; Tibby, Shane M; Tume, Lyvonne N; Peters, Mark J
The role played by fever in the outcome of critical illness in children is unclear. This survey of medical and nursing staff in 35 paediatric intensive care units and transport teams in the United Kingdom and Ireland established attitudes towards the management of children with fever. Four hundred sixty-two medical and nursing staff responded to a web-based survey request. Respondents answered eight questions regarding thresholds for temperature control in usual clinical practice, indications for paracetamol use, and readiness to participate in a clinical trial of permissive temperature control. The median reported threshold for treating fever in clinical practice was 38 °C (IQR 38-38.5 °C). Paracetamol was reported to be used as an analgesic and antipyretic but also for non-specific comfort indications. There was a widespread support for a clinical trial of a permissive versus a conservative approach to fever in paediatric intensive care units. Within a trial, 58% of the respondents considered a temperature of 39 °C acceptable without treatment.
Hökerberg, Yara Hahr Marques; de Oliveira, Raquel de Vasconcellos Carvalhaes; Barros, Danielle Martins de Souza; Alexandria, Helenara Abadia Ferreira; Daumas, Regina Paiva; de Andrade, Carlos Augusto Ferreira; Passos, Sonia Regina Lambert; Brasil, Patrícia
Objective The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system. Methods Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0.05). Results The final sample comprised 474 participants (97%), mean age of 37 years (standard deviation = 10.3), mainly females (83.8%), physicians (40.1%) and from tertiary care (75.1%). The majority (91%) reported using warning signs for dengue in pediatrics clinical practice. The most widely used and highly valued signs were major hemorrhages (gastrointestinal, urinary), abdominal pain, and increase in hematocrit concurrent or not with rapid decrease in platelet count. Persistent vomiting as well as other signs of plasma leakage such as respiratory distress and lethargy/restlessness were not identified as having the same degree of importance, especially by nurse technicians and in primary or secondary care. Discussion Although most health care staff reported using dengue warning signs, it would be useful to extend the training for identifying easily recognizable signs of plasma leakage that occur regardless of bleeding. PMID:27716812
Figueiredo, Daniela; Barbosa, Ana; Cruz, Joana; Marques, Alda; Sousa, Liliana
This pilot-study aimed to assess a psychoeducational program for staff in care homes. The program was designed to increase knowledge regarding dementia care, promote skills to integrate motor and multisensory stimulation in daily care, and develop coping strategies to manage emotional work-related demands. Six staff members received eight…
Background The behaviour of individuals is affected by the social networks in which they are embedded. Networks are also important for the diffusion of information and the influence of employees in organisations. Yet, at the moment little is known about the social networks of nursing staff in healthcare settings. This is the first study that investigates informal communication and advice networks of nursing staff in long-term care. We examine the structure of the networks, how they are related to the size of units and characteristics of nursing staff, and their relationship with job satisfaction. Methods We collected social network data of 380 nursing staff of 35 units in group projects and psychogeriatric units in nursing homes and residential homes in the Netherlands. Communication and advice networks were analyzed in a social network application (UCINET), focusing on the number of contacts (density) between nursing staff on the units. We then studied the correlation between the density of networks, size of the units and characteristics of nursing staff. We used multilevel analyses to investigate the relationship between social networks and job satisfaction of nursing staff, taking characteristics of units and nursing staff into account. Results Both communication and advice networks were negatively related to the number of residents and the number of nursing staff of the units. Communication and advice networks were more dense when more staff worked part-time. Furthermore, density of communication networks was positively related to the age of nursing staff of the units. Multilevel analyses showed that job satisfaction differed significantly between individual staff members and units and was influenced by the number of nursing staff of the units. However, this relationship disappeared when density of communication networks was added to the model. Conclusions Overall, communication and advice networks of nursing staff in long-term care are relatively dense. This
Walker, Bonnie L.; Osgood, Nancy J.
The opinions of long-term care staff were surveyed regarding the importance of objectives of a program that would provide staff education and training regarding the sexuality of older people. A literature review determined what staff needed to know about elderly sexuality, the needs of elderly people related to their sexuality, and how caregivers…
Ahonen, Lia; Degner, Jurgen
One prerequisite for effective institutional care is that staff agree on how to deliver treatment and have a unified view of how to achieve change--in other words, to have staff group unanimity (SGU). This study used the Correctional Program Assessment Inventory (CPAI) 2000, interviews with key staff, and observations of daily activities to…
McDonald, Tracey; Russell, Frances
This study determined the impact of a computerized care documentation system on client outcomes, regulatory compliance, and staff workloads after 3 years of use. The survey was conducted at an 800-bed aged care facility, and staff using the computerized care system were invited to participate (n = 112). The survey was an adapted version of the Nurses Computer Attitudes to Technology Inventory, which was refined to make it relevant to the aged care workplace. Four multiple regression models were produced, assessing the impact of the computerized care management system on staff and workload; time; accuracy, and regulatory data; and resident care. The analysis showed that the perceived benefits of the computerized system were influenced by personal attitudes towards computer use and feelings of empowerment related to the computer system. Even those with poor computer skills and feelings of insecurity about using computers believed that there were significant benefits to be gained by using the system. This result has implications with regards to the training and recruitment of staff in the aged care sector, as facilities introduce computerized care systems.
Lee, Sook Y; Chaudhury, Habib; Hung, Lillian
This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident's behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents' quality of life and (b) an unsupportive physical environment contributes negatively to residents' quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care This study demonstrates the complex interrelationships among the dementia care setting's physical environment, staff experiences, and residents' quality of life.
Langhan, Melissa L; Riera, Antonio; Kurtz, Jordan C; Schaeffer, Paula; Asnes, Andrea G
Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology.
Brown, Elizabeth J.; Kangovi, Shreya; Sha, Christopher; Johnson, Sarah; Chanton, Casey; Carter, Tamala; Grande, David T.
PURPOSE Previous studies suggest that the highest-risk patients value accessible, coordinated primary care that they perceive to be of high technical quality. We have limited understanding, however, of how low-income, chronically ill patients and the staff who care for them experience each individual step in the primary care process. METHODS We conducted qualitative interviews with uninsured or Medicaid patients with chronic illnesses, as well as with primary care staff. We interviewed 21 patients and 30 staff members with a variety of job titles from 3 primary care practices (1 federally qualified health center and 2 academically affiliated clinics).] RESULTS The interviews revealed 3 major issues that were present at all stages of a primary care episode: (1) information flow throughout an episode of care is a frequent challenge, despite systems that are intended to improve communication; (2) misaligned goals and expectations among patients, clinicians, and staff members are often an impediment to providing and obtaining care; and (3) personal relationships are highly valued by both patients and staff. CONCLUSIONS Vulnerable populations and the primary care staff who work with them perceive some of the same challenges throughout the primary care process. Improving information flow, aligning goals and expectations, and developing personal relationships may improve the experience of both patients and staff. PMID:26195680
Jones, W. L.
Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.
Reed, Cynthia; Carroll, Lee; Baccari, Susan; Shermont, Herminia
One of the most challenging aspects for nurses caring for incontinent children in spica casts is maintaining healthy skin integrity. Noting an increase in the number of phone calls from parents of discharged children in spica casts concerning diaper rash and skin breakdown, inpatient orthopedics staff nurses lead an interdisciplinary quality improvement and educational initiative. They standardized pediatric spica cast care and education by creating an intranet narrated PowerPoint presentation for staff and parents of children with spica casts. A take-home DVD of this education module is now produced and given to parents, reinforcing nursing discharge teaching and giving parents the opportunity to review these new skills at home as needed. The purpose of this article is to share this experience of improving patient outcomes and empowering other orthopedics nurses to develop creative educational solutions.
Simmons, Sandra F; Durkin, Daniel W; Rahman, Annie N; Schnelle, John F; Beuscher, Linda M
Allowing long-term care (LTC) residents to make choices about their daily life activities is a central tenet of resident-centered care. This study examined whether staff and family rated care episodes involving choice differently from care episodes not involving choice. Seventeen nurse aide and 15 family participants were shown paired video vignettes of care interactions. Participants were asked to rate their preferred care vignette using a standardized forced-choice questionnaire. Focus groups were held separately for staff and family members following this rating task to determine reasons for their preferences. Both staff and family rated the vignettes depicting choice as "strongly" preferred to the vignettes without choice. Reasons provided for the preference ratings during the focus group discussions related to resident well-being, sense of control, and respondents' own personal values. These findings have implications for LTC staff training related to resident-centered care to promote choice.
Elsaadani, Mohamed Abdelaziz
Current research seeks to understand the relationship between teaching staff' age and their attitude toward ICT. Survey methodology is facilitated through the use of the questionnaires. The survey domain is a random sampling of teaching staff in Egyptian HEI. The population for this study was 500 full-time Faculty staff, and only 412 returned and…
Goodman, Claire; L Davies, Sue; Norton, Christine; Fader, Mandy; Morris, Jackie; Wells, Mandy; Gage, Heather
A quasi-experimental study tested a clinical benchmarking tool (Essence of Care) to improve bowel-related care for older people living in six care homes. In the intervention care homes, district nurses and care home staff used the clinical benchmarking tool to discuss and plan how to improve bowel care for residents. In the control care homes, staff were provided with detailed information about the residents and continence services contact details. The intervention was acceptable to care home and district nursing staff, and possible to incorporate into existing working patterns. The study did not demonstrate a significant reduction in bowel-related problems, although there was evidence in one care home of reduction in episodes of avoidable faecal incontinence. At an individual level of care, there were observable benefits, and examples of person-centred care were prompted through participating in the intervention and improved staff awareness. Clinical benchmarking tools can be used to structure discussion between district nurses and care home staff to review and plan care for residents. However, it takes time to achieve change and embedding this kind of approach requires either robust pre-existing working relationships or the involvement of a facilitator.
Abe, Koji; Ohashi, Akira
This study aimed to examine the psychological effects of terminal care experience on nursing home staff and analyze the differences between staff who are experienced and those who are inexperienced in providing terminal care. A mailed survey was conducted in 2007. A total of 37% (N = 72) of the participants had experience in terminal care in nursing homes. Analysis of variance (ANOVA) revealed that the professional efficacy (a subscale of the Maslach Burnout Inventory-General Survey [MBI-GS]) and tenure (duration of service) of the experienced staff were significantly higher than those of the inexperienced staff. The high professional efficacy noted among the experienced staff suggests that the provision of terminal care in nursing homes does not necessarily lead to burnout among caregivers and may in fact serve as an important motivational factor.
Elliot, Victoria; Williams, Angelena; Meyer, Julienne
This article outlines the development of distress reaction training in a large care home charity, provided by directly employed My Home Life Admiral nurses, who are mental health nurses specialising in dementia. Reference is made to the limitations of a person-centred approach to care, and the importance of relationship-centred care, which underpins the My Home Life social movement for quality improvement in care homes. The authors argue that relationship-centred care is a more helpful approach to improve the lived experience and wellbeing of residents, relatives and staff. Potentially, it might also help to address high staff turnover in the care home sector.
Cook, Neil; Thomson, Gillian; Dey, Paola
Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives. PMID:24928585
Ollhoff, Jim; Ollhoff, Laurie
This document presents 17 philosophical statements regarding school-age care programs, staff, and challenges. The essence of school-age care is to understand childhood and to facilitate positive development. Because these programs provide a place where children have significant contact with adults within a multi-age peer group, they can teach…
Wåhlin, Ingrid; Ek, Anna-Christina; Idvall, Ewa
Experiences of critically ill patients are an important aspect of the quality of care in intensive care units. If next of kin and staff try to empower the patient, this is probably performed in accordance with their beliefs about what patients experience as empowering. As intensive care patients often have difficulties communicating, staff and next of kin need to interpret their wishes, but there is limited knowledge about how correct picture next of kin and staff have of the intensive care patient's experiences. The aim of this study was to compare intensive care patients' experiences of empowerment with next of kin and staff beliefs. Interviews with 11 intensive care patients, 12 next of kin and 12 staff were conducted and analysed using a content analysis method. The findings showed that the main content is quite similar between patient experiences, next of kin beliefs and staff beliefs, but a number of important differences were identified. Some of these differences were regarding how joy of life and the will to fight were generated, the character of relationships, teamwork, humour, hope and spiritual experiences. Staff and next of kin seemed to regard the patient as more unconscious than the patient him/herself did.
Kataoka-Yahiro, Merle R; McFarlane, Sandra; Koijane, Jeannette; Li, Dongmei
Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.
Briggs, Renee M.
Absenteeism of 130 direct-care staff in a residential facility for developmentally disabled persons was reduced by 27 percent through positive reinforcement for reliable attendance and punishment (progressive discipline) for attendance abuse. Reduced absenteeism was maintained for 12 months and overtime was reduced, but staff turnover increased.…
Hall, Philip S.; Hall, Nancy D.
This literature review finds that efforts since the 1950s to develop research-based selection tools for recruiting direct-care staff to work with people with developmental disabilities have not been successful. However, researchers have identified practices that can reduce staff turnover, such as articulating the mission and improving human…
Perrodeau, E.; Deneux-Tharaux, C.
Objective to identify staff and institutional factors associated with substandard care by midwives managing postpartum hemorrhage (PPH). Methods A multicenter vignette-based study was e-mailed to a random sample of midwives at 145 French maternity units that belonged to 15 randomly selected perinatal networks. Midwives were asked to describe how they would manage two case-vignettes about PPH and to complete a short questionnaire about their individual (e.g., age, experience, and full- vs. part-time practice) and institutional (private or public status and level of care) characteristics. These previously validated case-vignettes described two different scenarios: vignette 1, a typical immediate, severe PPH, and vignette 2, a severe but gradual hemorrhage. Experts consensually defined 14 criteria to judge adherence to guidelines. The number of errors (possible range: 0 to 14) for the 14 criteria quantified PPH guideline adherence, separately for each vignette. Results 450 midwives from 87 maternity units provided complete responses. Perfect adherence (no error for any of the 14 criteria) was low: 25.1% for vignette 1 and 4.2% for vignette 2. After multivariate analysis, midwives’ age remained significantly associated with a greater risk of error in guideline adherence in both vignettes (IRR 1.19 [1.09; 1.29] for vignette 1, and IRR 1.11 [1.05; 1.18] for vignette 2), and the practice of mortality and morbidity reviews in the unit with a lower risk (IRR 0.80 [0.64; 0.99], IRR 0.78 [0.66; 0.93] respectively). Risk-taking scores (IRR 1.41 [1.19; 1.67]) and full-time practice (IRR 0.83 [0.71; 0.97]) were significantly associated with adherence only in vignette 1. Conclusions Both staff and institutional factors may be associated with substandard care in midwives’ PPH management. PMID:27010407
Koerber, Kathryn L
Many nurses are uncertain of how to appropriately document wound information, and this may result in inconsistent wound care. A method of educating staff nurses on the importance of wound care documentation is needed. Through computerized self-study modules, staff nurses were educated on how to complete documentation accurately and completely, including how to identify the type of wound, stage the wound (for pressure ulcers), measure the wound, and describe exudate, wound base, odor, pain, temperature, tunneling, undermining, and maceration.
Ross, M M; Carswell, A; Dalziel, W B; Aminzadeh, F
The purpose of this study was to determine corporate philosophies of continuing education and approaches to meeting the learning needs of staff who strive to provide for the increasingly challenging care requirements of seniors who reside in long-term care facilities. In-depth interviews lasting approximately 1 hour were conducted with key informants at the administrative level from nine long-term care facilities. Content analysis revealed a commitment to continuing education for staff. While recognizing the importance of organizational responsibility for continuing education, administrators placed emphasis on the individual responsibility of staff. Learning needs were identified as affective, managerial, and physical in nature. Challenges to providing continuing education programs were derived from a general lack of fiscal and human resources. A variety of measures was suggested as important to supporting the continuing learning of staff. Implications of this study point to the need for long-term care facilities to incorporate into their strategic plans measures of ensuring continuing education as a basis for the ongoing competence and development of staff. In addition, there is a need for collaboration between long-term care facilities and other institutions of a long-term care, acute care, and educational nature in the development of strategies to operationalize a philosophy of continuing learning as a basis for the provision of optimal care to residents.
... This information in Spanish ( en español ) Paying for health care More information on paying for health care Better ... Coping without insurance More information on paying for health care Explore other publications and websites Age Page: Choosing ...
Wen, Aida; Gatchell, Greg; Tachibana, Yukako; Tin, Maung Maung; Bell, Christina; Koijane, Jeannette; Zeri, Kenneth; Masaki, Kamal
The purpose of this study was to examine nursing home staff perceptions of end-of-life (EOL) care skills after an educational intervention. IMPRESS (IMproving PRofessional Education and Sustaining Support) was a quality improvement EOL care educational intervention (six lectures on core palliative care concepts) for frontline nursing home staff at five community nursing homes. Questionnaires were completed to evaluate frequency of application of palliative care skills before and after the educational series. Nursing home staff reported applying palliative care skills significantly more frequently after the intervention. A significant dose-response association was noted between number of inservice sessions attended and improvement in scores: Scores increased 0.04 points for staff who attended two of the six sessions, 0.12 for four sessions attended, and 0.46 for five to six sessions attended (p = 0.03). The results indicate that frontline nursing home staff who attend inservice sessions on core palliative care topics can significantly increase self-reported application of palliative care skills.
Baerga Duperoy, Rachel; Castro Rojas, Nydia; Orta Rodríguez, Brenda; González Caraballo, Enid; Cruz González, Angel; Vázquez Fernández, José; Oliver Vázquez, Marlén
The purpose of this qualitative study was to explore and identify the basic training needs of nursing home staff, in terms of attitudes, knowledge and skills required to work effectively with geriatric patients. Three focus groups were performed, two groups of employees, and a group of elderly residents of the institution, in order to explore issues pertaining to the following topics: personal attributes required to work with geriatric patients, basic knowledge and skills needed to provide effective services. Group discussions were transcribed and themes were extracted through consensus reached by the investigators. Results indicated that the interviewed staff lack of formal preparation or continuing education in gerontology or geriatrics. Needs identified were the following: the aging process, caring behaviors, management of common health conditions, administration of medications, transference and mobility of residents, among others. Finding were use to design an educational program aimed in assisting nursing home staff in providing an effective service to their geriatric patients.
Mooney, Kelly; Moreno, Candice; Chung, Paul J.; Elijah, Jacinta; Coker, Tumaini R.
Background Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery. Objective To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years. Methods Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions. Results The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non–face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non–face-to-face (eg, phone) parent communication, and group visits. Conclusion CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations. PMID:24327599
Ron, Pnina; Lowenstein, Ariela
Paraprofessional staff in six Israeli institutions for the elderly received training in psychological and social aspects of aging, loneliness and loss, communication, multiprofessional staff work, and elders with disabilities. They expressed a need for additional training in following up on physiotherapy. (Contains 18 references.) (SK)
Haesler, Emily; Bauer, Michael; Nay, Rhonda
Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage
Scales, Kezia; Bailey, Simon; Middleton, Joanne; Schneider, Justine
The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings.
Gable, Sara; Rothrauff, Tanja C.; Thornburg, Kathy R.; Mauzy, Denise
The current study evaluates the Workforce INcentive Project (WIN), a programmatic effort to increase child care workforce stability in center- and home-based child care providers via the provision of bi-annual cash incentives based on educational attainment. Five hundred and thirteen center-based teaching staff (304 WIN and 209 comparison) and 167…
Nooren-Staal, W H; Frederiks, C M; te Wierik, M J
In a quasi-experimental study the effectiveness of the method Validation is evaluated. This approach for disoriented institutionalized old people was developed by Naomi Feil in the U.S.A. This study evaluated the effect of Validation on the behaviour of institutionalized 'old-old' suffering from dementia and of those who deliver care to them. The study group included 19 demented residents of a home for the aged and 29 nurses, of whom 15 nurses had followed the basic course in Validation. The other 14 nurses were selected as members of the control group. The behaviour of the residents was measured with the BPS (a scale for Mental and Social Problems). This measurement was performed by the nurses of the two groups on three different points of time (before the course, immediately after the course and 4 months after the course). At the same time the nurses evaluated their own behaviour by a questionnaire developed by Verpoort. Differences between pre- and post-testscores showed some improvement in behaviour of residents and staff. However, contamination, social desirability and enthusiasm of the researcher and the staff may have influenced the results. It is concluded that Validation contributes to an improvement of the attitude and job satisfaction of nurses too. This benefits the residents.
Background The current paper presents a pilot study of interactive assessment using information and communication technology (ICT) to evaluate the knowledge, skills and abilities of staff with no formal education who are working in Swedish elderly care. Methods Theoretical and practical assessment methods were developed and used with simulated patients and computer-based tests to identify strengths and areas for personal development among staff with no formal education. Results Of the 157 staff with no formal education, 87 began the practical and/or theoretical assessments, and 63 completed both assessments. Several of the staff passed the practical assessments, except the morning hygiene assessment, where several failed. Other areas for staff development, i.e. where several failed (>50%), were the theoretical assessment of the learning objectives: Health, Oral care, Ergonomics, hygiene, esthetic, environmental, Rehabilitation, Assistive technology, Basic healthcare and Laws and organization. None of the staff passed all assessments. Number of years working in elderly care and staff age were not statistically significantly related to the total score of grades on the various learning objectives. Conclusion The interactive assessments were useful in assessing staff members’ practical and theoretical knowledge, skills, and abilities and in identifying areas in need of development. It is important that personnel who lack formal qualifications be clearly identified and given a chance to develop their competence through training, both theoretical and practical. The interactive e-assessment approach analyzed in the present pilot study could serve as a starting point. PMID:24742168
Neale, Anne Victoria; And Others
Severe problems in turnover and absenteeism among workers in geriatric and long-term care organizations have sparked great interest in the impact of job satisfaction on the quality of care provided to the elderly. The Job Description Index (JDI) is a job satisfaction index which measures satisfaction with several dimensions of the job: co-workers,…
Haskard, Kelly B; DiMatteo, M Robin; Heritage, John
Verbal and nonverbal communication between nursing staff and patients has received scant research attention. This study examined patients' and nursing staff members' global affective and instrumental communication, mutual influence, and relationship to postvisit satisfaction. This study employed ratings of videotaped primary care visits of 81 nursing staff members with 235 patients, and assessed communication in 2 channels: nonverbal visual and speech including vocal tone. Communication channel differences and prediction of patient satisfaction were examined. The visual and vocal communication of nursing staff members and patients robustly predicted each other's satisfaction and reflected their own satisfaction with the dyadic visit. Affect was communicated more clearly through the speech with vocal tone channel, whereas instrumental communication was stronger in visual nonverbal behavior. Patients' and nursing staff members' behaviors of pleasantness and involvement frequently co-occurred.
Sims-Gould, Joanie; McKay, Heather A.; Feldman, Fabio; Scott, Victoria; Robinovitch, Stephen N.
The purpose of this study was to examine long-term care (LTC) resident and staff perceptions on the decision to use hip protectors and identify the factors that influence attitudes toward hip protector use. Staff (N = 39) and residents (N = 27) at two residential care facilities in British Columbia, Canada were invited to participate in focus groups on fall prevention and hip protector use. A total of 11 focus groups were conducted. Using framework analysis results show that residents and staff shared concerns on aesthetic and comfort issues with hip protectors. Residents also generally felt they did not need, or want to use, hip protectors. However, they also had desire to be cooperative within the LTC environment. Staff underscored their role in advocating for hip protector use and their desire to protect residents from harm. Practice considerations for facilities wishing to promote hip protectors within a patient centered framework are highlighted. PMID:24652886
Masters, Julie L; Magnuson, Thomas M; Bayer, Barbara L; Potter, Jane F; Falkowski, Paul P
The aging of the prison population presents corrections staff with unique challenges in knowing how to support inmates while maintaining security. This article describes a 2-day training program to introduce the aging process to select staff at all levels. While the results of a pre-posttest measure, using a modified version of Palmore's Facts on Aging Quiz, did not produce a statistically significant difference at the conclusion of the training, attendees did express satisfaction with the training and their newfound insight into the challenges faced by aging inmates. They also offered recommendations for future training to include more practical suggestions for the work environment.
Leino-Kilpi, Helena; Suominen, Tarja; Mäkelä, Merja; McDaniel, Charlotte; Puukka, Pauli
The purpose of this study was to describe ethical problems that are influenced by organizational factors in Finnish intensive care units (ICUs). The goal was to help nurses and administrators to analyse intensive care work, and to improve nurses' work motivation. Through these means the ultimate goal is to improve the quality of patient care. Data were collected in 35 hospital ICUs by means of the Ethics Environmental Questionnaire (EEQ). This gained access to the population of 1047 Finnish intensive care nurses. The response rate was 77% (n = 814). Data analysis was carried out using SAS-6 statistical software. The results provided scores for the 20 EEQ items. Reliability according to Cronbach's alpha was 0.87. The results revealed that organizational factors in Finnish ICUs have both positive and negative dimensions. Positively, nurses have the opportunity to discuss ethical problems in their work units, whereas, negatively, respondents noted that there is much concern about earning money. Nurses' work in Finnish hospital ICUs is ethically challenging; it is similar to that found in other countries and thereby supports international application of these findings.
Gendron, Tracey L; King Seymour, Lindsay; Welleford, E Ayn
Catch a Glimpse of Me is an ongoing project that uses video to help staff deliver more person-centered care for people with dementia living in long-term care. Focus groups consisting of residents, family and staff members were conducted to develop a template for the development of the videos. The five themes they identified as being important to include are: family; interests and hobbies; memories and moments; life space and getting personal. The article describes the process of developing the videos and discusses the ongoing potential of the Catch a Glimpse of Me project.
Ergas, Henry; Paolucci, Francesco
This article focuses on the provision and financing of aged care in Australia. Demand for aged care will increase substantially as a result of population aging, with the number of Australians aged 85 and over projected to increase from 400,000 in 2010 to over 1.8 million in 2051. Meeting this demand will greatly strain the current system, and makes it important to exploit opportunities for increased efficiency. A move to greater beneficiary co-payments is also likely, though its extent may depend on whether aged care insurance and other forms of pre-payment can develop. PMID:22312229
Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.
Robinson, James D.; Nussbaum, Jon F.
A study examined the impact of a simulated aging experience on nursing staff perceptions of job satisfaction and job performance. It was hypothesized that nurses and nurse aides who participated in the simulated aging experience would be more satisfied with their jobs and would receive fewer complaints from residents than those who did not…
This booklet examines four aspects of day care services for school-age children: (1) national availability and trends, (2) parents' views, (3) program planning, and (4) recommended program models. A nationwide survey of 58 day care programs enrolling school-age children was conducted, and the general findings are presented. Information on parents'…
Iluz, Reli; Adi-Japha, Esther; Klein, Pnina S.
Research Findings: Early child care policy and practice are grounded in a growing understanding of the importance of the first years of life. In earlier studies, associations between child-staff ratios and peer skills yielded inconsistent findings. The current study used data from the National Institute of Child Health and Human Development Study…
McMillan, Nancy S.
Camp health care staff can give basic health education to counselors, covering daily hygiene for young children, basic understanding of common chronic illnesses, observational skills to detect illnesses, elementary public health tutoring, and OSHA medical standards. Health personnel should be included in planning precamp and in-service counselor…
The nature, causes, consequences, and symptoms of stress and burnout among health-care staff working with people affected by HIV are identified. The extent to which these characteristics are specific to HIV/AIDS workers is discussed. Some options for prevention and management of burnout are presented. (Author)
Cruttenden, Kathleen E.
This planning study was designed and conducted in a predominantly rural Canadian province to examine the strengths and learning needs of four categories of nursing staff practising in New Brunswick nursing homes. Participants included directors of care, registered nurses, licensed practical nurses, and resident attendants. The nursing homes ranged…
Twohig, Aoife; Reulbach, Udo; Figuerdo, Ricardo; McCarthy, Anthony; McNicholas, Fiona; Molloy, Eleanor Joan
The infant-parent relationship has been shown to be of particular significance to preterm infant socioemotional development. Supporting parents and infants in this process of developing their relationships is an integral part of neonatal intensive care; however, there is limited knowledge of NICU staff perceptions about this aspect of care. To explore NICU staff perceptions about attachment and socioemotional development of preterm infants, experience of training in this area and the emotional impact of their work. A cross-sectional questionnaire survey of staff perceptions of the emotional experiences of parents and the developing parent-infant relationship in an NICU was conducted in a Level III NICU, after pilot testing, revision, and ethical approval. Fifty-seven (68%) of NICU staff responded to the survey. Respondents identified parents' emotional experiences such as "anxiety," "shock," "loss of control," and "lack of feelings of competence as parents" as highly prevalent. Infant cues of "responding to parent's voice" and "quieting-alerting" were ranked most highly; "crying" and "physiological changes" were ranked lowest. Preterm infant medical risk, maternal emotional state, and mental health are perceived to impact most highly on the developing relationship, as compared with infant state or behavior and socioeconomic factors. Fifty-three (93%) respondents felt confident, and 50 (87.8%) felt competent discussing their emotional experiences with parents. Fifty-four (95%) responded that attending to these areas was an integral part of their role; however, staff had seldom received education in this area. Respondents also perceived that specific psychological support for parents was lacking both during and after the infant's discharge. While all staff surveyed perceived the nature of their work to be emotionally stressful, there were differences among NICU staff disciplines and with years of experience in the NICU in terms of their perceptions about education in
Morandi, Alessandro; Lucchi, Elena; Turco, Renato; Morghen, Sara; Guerini, Fabio; Santi, Rossana; Gentile, Simona; Meagher, David; Voyer, Philippe; Fick, Donna M.; Schmitt, Eva M.; Inouye, Sharon K.; Trabucchi, Marco; Bellelli, Giuseppe
Objective Delirium superimposed on dementia (DSD) is common and potentially distressing for patients, caregivers, and health care staff. We quantitatively and qualitatively assessed the experience of informal caregiver and staff (staff nurses, nurse aides, physical therapists) caring for patients with DSD. Methods Caregivers’ and staff experience was evaluated three days after DSD resolution (T0) with a standardized questionnaire (quantitative interview) and open-ended questions (qualitative interview); caregivers were also evaluated at 1-month follow-up (T1). Results A total of 74 subjects were included; 33 caregivers and 41 health care staff (8 staff nurses, 20 physical therapists, 13 staff nurse aides/health care assistants). Overall, at both T0 and T1, the distress level was moderate among caregivers and mild among health care staff. Caregivers reported, at both T0 and T1, higher distress related to deficits of sustained attention and orientation, hypokinesia/psychomotor retardation, incoherence and delusions. The distress of health care staff related to each specific item of the Delirium-O-Meter was relatively low except for the physical therapists who reported higher level of distress on deficits of sustained/shifting attention and orientation, apathy, hypokinesia/psychomotor retardation, incoherence, delusion, hallucinations, anxiety/fear. The qualitative evaluation identified important categories of caregivers ‘and staff feelings related to the delirium experience. Conclusions This study provides information on the implication of the experience of delirium on caregivers and staff. The distress related to DSD underlines the importance of providing continuous training, support and experience for both the caregivers and health care staff to improve the care of patients with delirium superimposed on dementia. PMID:26286892
Briggs, R M
Absenteeism of 130 direct-care staff was reduced by 27% through a mixed consequence procedure consisting of positive reinforcement for reliable attendance and punishment (progressive discipline) for attendance abuse. Reduced rates of absenteeism were maintained over a 12-month period. A 17% reduction in overtime and an increase in annual staff turnover from 34% to 45% also occurred. Results extend the findings of mixed consequence procedures to residential facilities for persons with developmental disabilities. Development of a more powerful positive reinforcement component was discussed.
Spinelli, William M; Fernstrom, Karl M; Galos, Dylan L; Britt, Heather R
Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout.
Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, Julie
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents' quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.
Davis, Melinda M.; Bond, Lynne A.; Howard, Alan; Sarkisian, Catherine A.
Purpose: Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians' age expectations likely influence patients' expectations and care delivery patterns; yet, limited research has explored clinicians' age expectations. The Expectations Regarding Aging…
Bigby, C.; Bowers, B.; Webber, R.
Background: Planning for future care after the death of parental caregivers and adapting disability support systems to achieve the best possible quality of life for people with intellectual disability as they age have been important issues for more than two decades. This study examined perceptions held by family members, group home staff and…
Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A.
Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA. PMID:26880152
Gulliver, P; Towell, D; Peck, E
Following the closure of the last Victorian asylum in Somerset, the health authority and county council undertook a review of mental health services. A major outcome of this review was the creation of an integrated mental health and social care provider. The current paper explores the impact of this integration on the morale of staff members involved, using a conceptual model derived from the literature on organizational behaviour. During the year immediately following integration, the average ratings on all measures of role clarity and job satisfaction reduced. For staff members involved in the integration, by far the largest group of whom were mental health nurses, job satisfaction was related to team role clarity, team identification, emotional exhaustion and gender. These effects of the integration on staff morale are discussed in light of the wider research into the determinants of job satisfaction and the conditions for success in merging organizations. The study has significant implications for managerial and professional leadership during organizational change.
Wyse, Linda; Casarotto, Nadia
Australia's Aged Care Act of 1997 mandates a number of key reforms aimed at ensuring consistency in the quality of care and well-being for all residents of aged care facilities. The law required residential aged care facilities to provide high-quality care within a framework of continuous improvement which requires aged care workers to perform the…
Källman, Ulrika; Bergstrand, Sara; Ek, Anna-Christina; Engström, Maria; Lindgren, Margareta
The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.
Xie, Zhichao; Liao, Xuelian; Kang, Yan; Zhang, Jiangqian; Jia, Lingli
Background. Bedside radiological procedures pose a risk of radiation exposure to ICU staff. The perception of risk may increase the degree of caution among the health care staff and raise new barriers preventing patients from obtaining prompt care. Objective. The aim of this study was to estimate the annual cumulative radiation dose to individual ICU staff. Methods. In this prospective study, forty subjects were required to wear thermoluminescent dosimeter badges during their working hours. The badges were analyzed to determine the exposure after 3 months. Results. A total of 802 radiological procedures were completed at bedside during the study period. The estimated annual dosage to doctors and nurses on average was 0.99 mSv and 0.88 mSv (p < 0.001), respectively. Residents were subjected to the highest radiation exposure (1.04 mSv per year, p = 0.002). The radiation dose was correlated with day shift working hours (r = 0.426; p = 0.006) and length of service (r = -0.403; p < 0.01). Conclusions. With standard precautions, bedside radiological procedures-including portable CT scans-do not expose ICU staff to high dose of ionizing radiation. The level of radiation exposure is related to the daytime working hours and length of service.
Xie, Zhichao; Liao, Xuelian; Zhang, Jiangqian; Jia, Lingli
Background. Bedside radiological procedures pose a risk of radiation exposure to ICU staff. The perception of risk may increase the degree of caution among the health care staff and raise new barriers preventing patients from obtaining prompt care. Objective. The aim of this study was to estimate the annual cumulative radiation dose to individual ICU staff. Methods. In this prospective study, forty subjects were required to wear thermoluminescent dosimeter badges during their working hours. The badges were analyzed to determine the exposure after 3 months. Results. A total of 802 radiological procedures were completed at bedside during the study period. The estimated annual dosage to doctors and nurses on average was 0.99 mSv and 0.88 mSv (p < 0.001), respectively. Residents were subjected to the highest radiation exposure (1.04 mSv per year, p = 0.002). The radiation dose was correlated with day shift working hours (r = 0.426; p = 0.006) and length of service (r = −0.403; p < 0.01). Conclusions. With standard precautions, bedside radiological procedures—including portable CT scans—do not expose ICU staff to high dose of ionizing radiation. The level of radiation exposure is related to the daytime working hours and length of service. PMID:27556036
Calheiros, Maria Manuela; Patrício, Joana Nunes; Graça, João
The use of participatory approaches in designing services is still relatively uncommon. In this study, we helped design a service to support the transition of youth from residential care to independent living by exploring the perspectives of staff and of youth regarding: (a) the concept and development of autonomy; and (b) key factors in developing this type of service. We gathered the data through 10 interviews with staff (n=10) and 4 focus groups with youth (n=21), and subjected the data to a thematic content analysis. Staff defined autonomy as self-regulation and self-care, and identified three paths to foster autonomy--a sense of normality, meaningful relationships, and planning for emancipation. The staff and youth identified the following important aspects in designing the service: achieving normality (e.g. limited number of residents), promoting youth capacity (e.g. skill-building activities), providing social support (e.g. trust and respect between residents), and assuring guidance and boundaries (e.g. supervision of youth).
Flowers, Kimberlie; Howe, Judith L
Seventy-five percent of Americans support the idea of Advance Directives (ADs) but less than 20% complete one, resulting in increased hospitalization costs, unwanted treatment, and difficult family decisions. Engaging community resources for public education may be effective for increasing understanding and completion of ADs. This project focused on workers in an agency serving older adults. A training program was developed with the goal of increasing their understanding of the process and benefits of Health Care Proxies (HCPs) and ADs through hands-on experience, increasing relevant skills and willingness to discuss with consumers, and to implement an agency protocol increasing documentation of HCPs for consumers. After a small proof-of-concept pilot, all staff members were asked to participate in the educational program. The pilot program delivery found increased staff knowledge as well as motivation to complete HCPs among the staff themselves and their own families. This program resulted in increased staff knowledge of EOL documents, willingness to engage in EOL discussions, and an increase in documented HCPs. This program has relevance for workers in other agencies as they engage older consumers to encourage completion of ADs. This experiential approach to staff education increased their understanding and willingness to initiate EOL discussion with consumers.
Coogle, Constance L; Parham, Iris A; Rachel, Colleen A
This study investigated the relation between job satisfaction and career commitment among 262 Alzheimer's care staff working in long-term and community-based care settings. It was anticipated that the results would suggest whether career commitment could be enhanced to positively influence job satisfaction, and conversely, if improvements in job satisfaction might contribute to a deepened sense of vocational empowerment. Participants attended dementia-specific training and completed 2 short work-related questionnaires that measured job satisfaction and career commitment. The results of stepwise regression revealed interrelations between the 2 constructs. Congruence appeared to be reciprocal with respect to the overall scale scores and the intrinsic job satisfaction measure. Unexpected relations appeared in analyses of the extrinsic job satisfaction measure and the career planning subscale. Results are indicative of the fundamental distinction between job satisfaction and career commitment. Implications for efforts to reduce turnover and improve staff empowerment are also considered.
Joshi, Rita; Shah, Harshada; Sharma, Megha; Pathak, Ashish; Macaden, Ragini; Stålsby Lundborg, Cecilia
Background Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management. Method A qualitative study was conducted using 10 focus group discussions (FGDs), with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i) role of Health Care Waste Management (HCWM) in prevention of health care associated infections, (ii) awareness of and views about HCWM-related guidelines/legislation, (iii) current HCWM practices, (iv) perception and preparedness related to improvements of the current practices, and (v) proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi) and analysed using content analysis. Results Two themes were identified: Theme (A), ‘Challenges in integration of HCWM in organizational practice,’ with the categories (I) Awareness and views about HCWM, (II) Organizational practices regarding HCWM, and (III) Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to improve HCWM,’ with three categories, (I) Educational and motivational interventions, (II) Organizational culture change, and (III) Policy-related interventions. Conclusion A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings. PMID:26023783
Løyland, Borghild; Wilmont, Sibyl; Hessels, Amanda J.; Larson, Elaine
Background The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. Objectives The aims of this study were to explore direct care providers’ knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others’ hand hygiene practices, and their ideas and advice for improving infection prevention efforts. Methods This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. Results From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust “us” and “them” mentality between professionals. Discussion One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities. PMID:26938362
Bench, Suzanne; Cornish, Jocelyn; Xyrichis, Andreas
Background Understanding how patients and relatives can be supported after hospital discharge is a UK research priority. Intensive Care Unit (ICU) discharge summaries are a simple way of providing GPs with the information they require to coordinate ongoing care, but little evidence is available to guide best practice. Aim This study aimed at better understanding the information needs of GP staff (GPs and practice nurses) supporting former patients of ICUs and their families following discharge from hospital, and identifying the barriers/facilitators associated with ICU–primary care information transfer. Design and setting This was a qualitative exploratory study of practices and participants throughout the UK. Method Audiotaped focus group discussions, complemented by small-group/individual interviews, were conducted with 15 former patients of ICUs, four relatives, and 20 GP staff between June and September 2015. Demographic data were captured by questionnaire and qualitative data were thematically analysed. Results Findings suggest variability in discharge information experiences and blurred lines of responsibility between hospital and GP staff, and patients/relatives. Continuity of care was affected by delayed or poor communication from the hospital; GPs’ limited contact with patients from critical care; and a lack of knowledge of the effects of critical illness or resources available to ameliorate these difficulties. Time pressures and information technology were, respectively, the most commonly mentioned barrier and facilitator. Conclusion Effective rehabilitation after a critical illness requires a coordinated and comprehensive approach, incorporating the provision of well-completed, timely, and relevant ICU–primary care discharge information. Health professionals need an improved understanding of critical illness, and patients and families must be included in all aspects of the information-sharing process. PMID:27872086
Gindlesberger, Danielle R
A family medicine practice in a large multi-specialty clinic undertook a quality improvement initiative focusing on blood pressure control. Current rooming procedures were reviewed, including obtaining accurate and reliable blood pressures. All rooming staff were instructed how to take an accurate blood pressure and were observed at random over a 3-month period to ensure continued accuracy. Rooming staff (medical assistants and licensed practical nurses) were engaged to give patient education and to arrange a standard 2-week follow-up with a rooming staff team member (nurse visit) if the patient's blood pressure was elevated. Clinicians were educated briefly about the importance of managing hypertension regardless of reason for visit. Blood pressure control (<140/90) in patients age 18-85 without diabetes improved from 68.4% to 75.8% in 3 months.
Certain aspects of the economics of caring for the aged in South Africa are considered. The few years before an accelerated growth rate of the population in South Africa takes place should be used to prepare the economic and other resources of the country. The increasing per capita income of the non-White population should supply the resources to meet the needs of its aged. The use of various accommodations facilities is reviewed. Guidance of medical and paramedical experts, who are specially trained to care for the aged, is needed.
Cimino, Nina M; Lockman, Kashelle; Grant, Marian; McPherson, Mary Lynn
In long-term care and assisted living facilities, many groups of health care professionals contribute to the work of the health care team. These staff members perform essential, direct patient care activities. An educational needs assessment was conducted to determine the learning needs and preferences of staff members related to providing care for patients with life-limiting illnesses. Staff members placed importance on understanding topics such as principles of palliative care, pain assessment, pain management, and nonpain symptom management. The majority of survey respondents were also interested in learning more about these topics. The results of this educational needs analysis suggest staff members would benefit from a course tailored to these identified educational needs and designed to overcome previously identified educational barriers.
The impact of a longer life on future health care expenditures will be quite moderate because of the high costs of dying and the compression of mortality in old age. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not significantly affect lifetime health care expenditures, as death occurs only once in every life. A calculation of the demographic effect on health care expenditures in Germany up until 2050 that explicitly accounts for costs in the last years of life leads to a significantly lower demographic impact on per-capita expenditures than a calculation based on crude age-specific health expenditures.
Mansell, Jim; Beadle-Brown, Julie; Whelton, Beckie; Beckett, Celia; Hutchinson, Aislinn
Background: An important question in community living is what factors influence the extent to which staff provide "active support". Methods: Engagement, care practices and a range of staff and organizational characteristics were studied in 72 residential homes serving 359 adults with intellectual disabilities. Managers in 36 settings were trained…
Carlfjord, Siw; Johansson, Kjell; Bendtsen, Preben; Nilsen, Per; Andersson, Agneta
Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the…
Crosland, Kimberly A.; Dunlap, Glen; Sager, Wayne; Neff, Bryon; Wilcox, Catherine; Blanco, Alfredo; Giddings, Tamela
Objectives: An extensive literature base exists for behavioral parent training; however, few studies have focused on training direct care staff at group home and residential facilities for children. This study was conducted to determine whether a behavioral staff training program consisting of classroom training and in-home feedback would improve…
de Araújo, Thamiris Ricci; Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Castilho, Valéria; Chaves, Lucieli Dias Pedreschi; Laus, Ana Maria
ABSTRACT Objective: to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. Method: a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. Results: the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. Conclusion: the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution. PMID:27878219
Pizzacalla, Anne; Montemuro, Maureen; Coker, Esther; Martin, Lori Schindel; Gillies, Leslie; Robinson, Karen; Pepper, Heather; Benner, Jeff; Gusciora, Joanna
Gentle Persuasive Approaches in Dementia Care (GPA), a curriculum originally designed for long-term care, was introduced into an acute care setting. This person-centered approach to supporting and responding to persons with behaviors associated with dementia was shown to be applicable for staff on an orthopaedic surgery unit where they had reported significant challenges and care burdens when faced with behaviors such as shouting, explosiveness, and resistance to care. Staff confidence in their ability to care for persons with behaviors increased after attending the 1-day GPA workshop, and they reported being highly satisfied with the curriculum, found it to be applicable to their practice, indicated that it was also useful for patients with delirium, and would recommend it to others. Some of the staff on the orthopaedic unit became certified GPA coaches. The passion of those champions, along with demonstrated success of the program on their unit, contributed to its spread to other units, including rehabilitation and acute medicine.
Hart, Patricia; Davis, Nancy
This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.
The aim of this study of prison health care staff in Prison Health Care and Nursing Units is twofold. The first one is to consider those aspects of the legal system applicable to them as government employees of the General State Administration at the service of Prisons, highlighting the peculiarities of the legal regulations that can be applied as a result of providing said service. The second, based on the general regulations on prison health contained in Organic Law 1/1979, of 26 September, General Penitentiary Law and the implementing regulations thereof, approved by Royal Decree 190/1966, of 9 February, sets out to provide a critical analysis of the obligatory and functional framework for health care and nursing staff established in the old Penitentiary Regulations of 1981, to determine from a legal perspective if it is possible to impede or brake so that the Prison Administration may develop or carry out the functions for which it is responsible in terms of planning, organization and management of activities geared towards maintaining and improving hygiene and health in the prison environment.
Dockett, Sue; Perry, Bob
While a great deal of research has focused on children's experiences as they start school, less attention has been directed to their experiences--and those of their families and educators--as they start school age care. This paper draws from a recent research project investigating practices that promote positive transitions to school and school…
Watanabe, Go; Yamagiwa, Tetsuya; Nakayama, Shinya; Ito, Satoko; Fukuda, Akiko; Shiotani, Tomohiro; Yamaoka, Yoshio
Home hospice care is not merely an extension of hospital-based medical care administered at the hospital, but refers to hospice care for patients with life-threatening diseases that can only be given at their homes. The rapid growth of the elderly population in Japan has led to not only the need for home hospice care, but also social problems such as living alone, living with only one elderly family member, and problems that are particularly acute in cancer patients with dementia. We analyzed data for 262 patients for whom home hospice care was provided by our clinic. Overall, elderly persons with dementia tended to request admission before death, but most elderly persons living alone preferred home hospice care. We found that 58% of the patients living with only one elderly family member requested admission before death, which was lower than the rate of the study group as a whole. We further performed an in-depth analysis of the current situation in order to improve home hospice care of terminally ill patients in Japan, focusing on problems related to the aging population.
Xiao, Lily Dongxia; Willis, Eileen; Harrington, Ann; Gillham, David; De Bellis, Anita; Morey, Wendy; Jeffers, Lesley
Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home.
Belloir, Marie-Noëlle; Riou, Françoise
Preventive mouth care is essential for the well-being of palliative care patients, though it is not performed enough outside units devoted to these patients. Our study aimed at getting a better knowledge of carers' attitudes and knowledge regarding this basic care. A validated questionnaire was sent anonymously to nurses and nursing aides working in the medical units of ten hospitals in Brittany. Of the 2,467 questionnaires sent, 54% were validated for use. The years of experience have little influence on nursing staff's answers. One in twenty does not think that preventive mouth care is part of his/her duties. This care is considered unpleasant, and difficult, by 11% and 22% of nurses, and 13.5% and 20.5% of nursing aides, respectively. A lack of knowledge is openly expressed with regards to oral diseases and dental prostheses. More than one in four cannot say if he/she knows the functions of the mouth, or he/she can identify a healthy mouth. These results show the scope for improvement as well as the priorities. They will be used as baseline for our future program assessment.
Maeda, Sayuri Tanaka; Ciosak, Suely Itsuko
This study is about low-risk pregnant women attended by a family health unit. It aims to describe the time resource the health staff invested and to analyze its configuration in the prenatal monitoring process. Data were collected from 47 women between 20 and 29 years old, who were attended from 2001 to 2003, in the eastside of São Paulo City. The pregnant women were classified according to the health care they received: a first group without health problems, a second with early expert intervention and a third with patients needing dental treatment. In the three groups, more time was invested by health professionals with higher education, followed by community health agents during home visits. Average total time per pregnant woman was 10 hours for the first group and 12 hours for the second and the third group. The time invested in direct care ranged from 59.40% to 80.51%.
Rapaport, Penny; Livingston, Gill; Murray, Joanna; Mulla, Aasiya; Cooper, Claudia
Objectives This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes. Design A systematic review of qualitative and quantitative intervention studies was undertaken. Eligibility criteria for included studies We included primary research studies evaluating psychosocial interventions that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported staff and resident qualitative or quantitative outcomes. Methods We searched MEDLINE, PsychINFO and EMBASE electronic databases and hand-searched references up to May 2016. Quality of included papers was rated independently by 2 authors, using operationalised checklists derived from standard criteria. We discussed discrepancies and reached consensus. We conducted a narrative synthesis of quantitative and a thematic synthesis of qualitative findings to find what was effective immediately and in sustaining change. Results We identified 49 papers fulfilling predetermined criteria. We found a lack of higher quality quantitative evidence that effects could be sustained after psychosocial interventions finished with no evidence that interventions continued to work after 6 months. Qualitative findings suggest that staff valued interventions focusing on getting to know, understand and connect with residents with dementia. Successful elements of interventions included interactive training, post-training support, aiming to train most staff, retaining written materials afterwards and building interventions into routine care. Conclusions Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence
Perlman, Michal; Fletcher, Brooke; Falenchuk, Olesya; Brunsek, Ashley; McMullen, Evelyn; Shah, Prakesh S.
Child-staff ratios are a key quality indicator in early childhood education and care (ECEC) programs. Better ratios are believed to improve child outcomes by increasing opportunities for individual interactions and educational instruction from staff. The purpose of this systematic review, and where possible, meta-analysis, was to evaluate the association between child-staff ratios in preschool ECEC programs and children’s outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Cross-sectional or longitudinal studies that evaluated the relationship between child-staff ratios in ECEC classrooms serving preschool aged children and child outcomes were independently identified by two reviewers. Data were independently extracted from included studies by two raters and differences between raters were resolved by consensus. Searches revealed 29 eligible studies (31 samples). Child-staff ratios ranged from 5 to 14.5 preschool-aged children per adult with a mean of 8.65. All 29 studies were included in the systematic review. However, the only meta-analysis that could be conducted was based on three studies that explored associations between ratios and children’s receptive language. Results of this meta-analysis were not significant. Results of the qualitative systematic review revealed few significant relationships between child-staff ratios and child outcomes construed broadly. Thus, the available literature reveal few, if any, relationships between child-staff ratios in preschool ECEC programs and children’s developmental outcomes. Substantial heterogeneity in the assessment of ratios, outcomes measured, and statistics used to capture associations limited quantitative synthesis. Other methodological limitations of the research integrated in this synthesis are discussed. PMID:28103288
Melhuish, Ruth; Beuzeboc, Catherine; Guzmán, Azucena
Background There is an increasing focus on providing effective psychosocial interventions to improve quality of life in dementia care. This study aims to explore the attitudes and perceptions of staff who participated regularly in Music Therapy (MT) and Dance Movement Therapy (DMT) groups for residents with dementia in a nursing home. Method In-depth interviews were conducted with seven members of care home staff. Data were analysed using interpretative phenomenological analysis. Results A representation modelling the impact of MT and DMT in a nursing care home. Three main themes were identified. 1) Discovering residents' skills and feelings; 2) Learning from the therapists to change approaches to care practice with subthemes: time, space and pace, choice, following the residents' lead; 3) Connection between staff and residents. Conclusion The model indicated that both interventions performed in parallel helped staff to discover residents' skills and feelings. Although it is a small sample size, this study strongly suggests that MT and DMT can have a positive influence in helping care staff to provide a meaningful care environment.
Sadoughi, Farahnaz; Ebrahimi, Kamal
Background: Self esteem (SE) and organizational commitment (OC) have significant impact on the quality of work life. Aim: This study aims to gain a better understanding of the relationships between SE and OC among health information management staff in tertiary care hospitals in Tehran (Iran). Methods: This was a descriptive correlational and cross sectional study conducted on the health information management staff of tertiary care hospitals in Tehran, Iran. A total of 155 participants were randomly selected from 400 staff. Data were collected by two standard questionnaires. The SE and OC was measured using Eysenck SE scale and Meyer and Allen’s three component model, respectively. The collected data were analyzed with the SPSS (version 16) using statistical tests of of independent T-test, Pearson Correlation coefficient, one way ANOVA and F tests. Results: The OC and SE of the employees’ were 67.8, out of 120 (weak and 21.0 out of 30 (moderate), respectively. The values for affective commitment, normative commitment, and continuance commitment were respectively 21.3 out of 40 (moderate), 23.9 out of 40 (moderate), and 22.7 out of 40 (moderate). The Pearson correlation coefficient test showed a significant OC and SE was statistically significant (P<0.05). The one way ANOVA test (P<0.05) did not show any significant difference between educational degree and work experience with SE and OC. Conclusion: This research showed that SE and OC are moderate. SE and OC have strong correlation with turnover, critical thinking, job satisfaction, and individual and organizational improvement. Therefore, applying appropriate human resource policies is crucial to reinforce these measures. PMID:25716374
Hahn, Joan E.; Cadogan, Mary P.
Persons with intellectual and developmental disabilities (I/DD) face barriers and disparities at end of life. Among these barriers are limited educational opportunities and a paucity of targeted training materials on palliative care for staff who provide their day-to-day care. This paper reports on a three-phase project undertaken to develop,…
Burgio, Louis D.; Burgio, Kathryn L.
Asserts that, if long-term care is to progress from custodial model to therapeutic model of rehabilitation, role of nursing assistants must be redesigned. Reviews current methods of institutional staff training and management and proposes model for geriatric, long-term care facilities. Discusses organizational resistance and offers suggestions for…
Sangster-Gormley, Esther; Carter, Nancy; Donald, Faith; Misener, Ruth Martin; Ploeg, Jenny; Kaasalainen, Sharon; McAiney, Carrie; Martin, Lori Schindel; Taniguchi, Alan; Akhtar-Danesh, Noori; Wickson-Griffiths, Abigail
The number of people living longer is increasing, and those with physical or cognitive impairments may need admission into long-term care settings. In long-term care there is a need to increase nursing staff's capacity to meet the care needs of residents, develop a team approach to providing care and provide opportunities for staff to improve their knowledge and skills. One approach to meet these needs has been to employ a nurse practitioner (NP). The purpose of this paper is to examine nursing staff's perceptions of how working with an NP affected their ability to provide care, function as a team and increase their knowledge and skill. Data used in this paper were obtained from nursing staff and managers who participated in focus groups that were part of case studies conducted in the second phase of a larger sequential, two-phase mixed-methods study. NPs used multiple approaches to increase staff knowledge and skills and improve quality of care. These findings describe the benefits of employing NPs in long-term care settings.
Small, Jeff; Chan, Sing Mei; Drance, Elisabeth; Globerman, Judith; Hulko, Wendy; O'Connor, Deborah; Perry, JoAnn; Stern, Louise; Ho, Lorraine
Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from 'Communication Accommodation Theory'. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice.
Ducak, Kate; Denton, Margaret; Elliot, Gail
Montessori-based activities use a person-centred approach to benefit persons living with dementia by increasing their participation in, and enjoyment of, daily life. This study investigated recreation staff and multidisciplinary consultants' perceptions of factors that affected implementing Montessori Methods for Dementia™ in long-term care homes in Ontario, Canada. Qualitative data were obtained during semi-structured telephone interviews with 17 participants who worked in these homes. A political economy of aging perspective guided thematic data analysis. Barriers such as insufficient funding and negative attitudes towards activities reinforced a task-oriented biomedical model of care. Various forms of support and understanding helped put Montessori Methods for Dementia™ into practice as a person-centred care program, thus reportedly improving the quality of life of residents living with dementia, staff and family members. These results demonstrate that when Montessori Methods for Dementia™ approaches are learned and understood by staff they can be used as practical interventions for long-term care residents living with dementia.
Shunk, Rebecca; Dulay, Maya; Chou, Calvin L; Janson, Susan; O'Brien, Bridget C
Many outpatient clinics where health professionals train will transition to a team-based medical home model over the next several years. Therefore, training programs need innovative approaches to prepare and incorporate trainees into team-based delivery systems. To address this need, educators at the San Francisco Veterans Affairs (VA) Medical Center included trainees in preclinic team "huddles," or briefing meetings to facilitate care coordination, and developed an interprofessional huddle-coaching program for nurse practitioner students and internal medicine residents who function as primary providers for patient panels in VA outpatient primary care clinics. The program aimed to support trainees' partnerships with staff and full participation in the VA's Patient Aligned Care Teams. The huddle-coaching program focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches; building relationships among team members through team-building activities; and teaching core skills to support collaborative practice. A multifaceted evaluation of the program showed positive results. Participants rated training sessions and team-building activities favorably. In interviews, trainees valued their team members and identified improvements in efficiency and quality of patient care as a result of the team-based approach. Huddle checklists and scores on the Team Development Measure indicated progress in team processes and relationships as the year progressed. These findings suggest that the huddle-coaching program was a worthwhile investment in trainee development that also supported the clinic's larger mission to deliver team-based, patient-aligned care. As more training sites shift to team-based care, the huddle-coaching program offers a strategy for successfully incorporating trainees.
... Generators AGENCY: Nuclear Regulatory Commission. ACTION: Request for public comment. SUMMARY: The U.S...), LR-ISG-2011-02, ``Aging Management Program for Steam Generators,'' for public comment. This Draft LR... steam generator aging. The Draft LR-ISG revises the NRC staff's aging management...
Built on the premise that good school-age care jobs are the cornerstone of high-quality services for school-age youth and their families, this guide presents model work standards for school-age care providers. The guide begins with a description of the strengths and challenges of the school-age care profession. The model work standards are…
Dowey, Alan; Toogood, Sandy; Hastings, Richard P.; Nash, Susie
Background: The working culture surrounding challenging behaviour may have a strong effect on staff behaviour. As a first step to influencing staff talk about challenging behaviour, the aim of the present study was to explore whether a 1-day training workshop could have an effect on staff causal explanations. Methods: Fifty-four front line staff,…
Chavaglia, Suzel Regina Ribeiro; Borges, Cristiana Machado; do Amaral, Eliana Maria Scarelli; Iwamoto, Helena Hemiko; Ohl, Rosali Isabel Barduchi
This is a descriptive exploratory study with a quantitative approach. It aims to characterize the environment of the Intensive Care Center (ICC) in regard to its physical area, material resources and equipments, and to identify factors concerned to the work of nurses. It investigates environmental factors that contribute to an aesthetically harmonious, functional and humanized space and that favor the performance of nursing work. The units that make up the ICC meet the recommendations of the National Health Surveillance Agency (ANVISA) in the evaluated items. he following favorable work conditions were highlighted: thermal conditions, color of the ceiling, walls and floors, luminosity. The following unfavorable work conditions were highlighted: outdoor spaces, privacy and individuality of clients and noise. The conclusion is that the facilities of the units meet the minimum recommendations of ANVISA. Both favorable and unfavorable environmental work conditions were identified. The creation of better environmental conditions allows a better staff performance, influencing positively quality, safety, and job satisfaction.
Following the Scottish Stroke Services Audit published in 1999, Chest Heart and Stroke Scotland (CHSS) commissioned the Scottish Association of Health Councils to undertake a survey of patient and carers' views of Scottish stroke services. Survey results suggested stroke carers perceived that staff caring for stroke survivors often showed a lack of awareness of the specific challenges that stroke presented. The report recommended that Chest Heart and Stroke Scotland should work with professional bodies to develop awareness training for staff working in stroke care.
March, A; Aschbacher, R; Dhanji, H; Livermore, D M; Böttcher, A; Sleghel, F; Maggi, S; Noale, M; Larcher, C; Woodford, N
Long-term-care facilities (LTCFs) are reservoirs of resistant bacteria. We undertook a point-prevalence survey and risk factor analysis for specific resistance types among residents and staff of a Bolzano LTCF and among geriatric unit patients in the associated acute-care hospital. Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on chromogenic agar; isolates were typed by pulsed-field gel electrophoresis; resistance genes and links to insertion sequences were sought by PCR; plasmids were analysed by PCR, restriction fragment length polymorphism and incompatibility grouping. Demographic data were collected. Of the LTCF residents, 74.8% were colonized with ≥1 resistant organism, 64% with extended-spectrum β-lactamase (ESBL) producers, 38.7% with methicillin-resistant Staphylococcus aureus (MRSA), 6.3% with metallo-β-lactamase (MBL) producers, and 2.7% with vancomycin-resistant enterococci. Corresponding rates for LTCF staff were 27.5%, 14.5%, 14.5%, 1.5% and 0%, respectively. Colonization frequencies for geriatric unit patients were lower than for those in the LTCF. Both clonal spread and plasmid transfer were implicated in the dissemination of MBL producers that harboured IncN plasmids bearing bla(VIM-1), qnrS, and bla(SHV-12). Most (44/45) ESBL-producing Escherichia coli isolates had bla(CTX-M) genes of group 1; a few had bla(CTX-M) genes of group 9 or bla(SHV-5); those with bla(CTX-M-15) or bla(SHV-5) were clonal. Risk factors for colonization of LTCF residents with resistant bacteria included age ≥86 years, antibiotic treatment in the previous 3 months, indwelling devices, chronic obstructive pulmonary disease, physical disability, and the particular LTCF unit; those for geriatric unit patients were age and dementia. In conclusion, ESBL-producing and MBL-producing Enterobacteriaceae and MRSA were prevalent among the LTCF residents and staff, but less so in the hospital geriatric unit. Education of LTCF employees and better
Greenfield, Geva; Ignatowicz, Agnieszka; Gnani, Shamini; Bucktowonsing, Medhavi; Ladbrooke, Tim; Millington, Hugh; Car, Josip
Objectives General practitioner (GP)-led urgent care centres were established to meet the growing demand for urgent care. Staff members working in such centres are central in influencing patients’ choices about which services they use, but little is known about staff perceptions of patients’ motives for attending urgent care. We hence aimed to explore their perceptions of patients’ motives for attending such centres. Design A phenomenological, qualitative study, including semistructured interviews. The interviews were analysed using thematic content analysis. Setting 2 GP-led urgent care centres in 2 academic hospitals in London. Participants 15 staff members working at the centres including 8 GPs, 5 emergency nurse practitioners and 2 receptionists. Results We identified 4 main themes: ‘Confusion about choices’, ‘As if increase of appetite had grown; By what it fed on’, ‘Overt reasons, covert motives’ and ‘A question of legitimacy’. The participants thought that the centres introduce convenient and fast access for patients. So convenient, that an increasing number of patients use them as a regular alternative to their community GP. The participants perceived that patients attend the centres because they are anxious about their symptoms and view them as serious, cannot get an appointment with their GP quickly and conveniently, are dissatisfied with the GP, or lack self-care skills. Staff members perceived some motives as legitimate (an acute health need and difficulties in getting an appointment), and others as less legitimate (convenience, minor illness, and seeking quicker access to hospital facilities). Conclusions The participants perceived that patients attend urgent care centres because of the convenience of access relative to primary care, as well as sense of acuity and anxiety, lack self-care skills and other reasons. They perceived some motives as more legitimate than others. Attention to unmet needs in primary care can help in
Anstey, Sally; Powell, Tom; Coles, Bernadette; Hale, Rachel; Gould, Dinah
Background The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles. Objectives To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care. Design Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically. Results Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported. Conclusions There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis. PMID:27329513
Low, Lee-Fay; Fletcher, Jennifer; Goodenough, Belinda; Jeon, Yun-Hee; Etherton-Beer, Christopher; MacAndrew, Margaret; Beattie, Elizabeth
Background We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. Methods Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. Results Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). Conclusion Changing staff practice in nursing homes is possible but complex
Sugimoto, Kentaro; Ogata, Yasuko; Kashiwagi, Masayo
Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities.
Unco, Inc., Washington, DC.
This report provides some perspectives on existing school-age child care and proposes some alternative school-age care program models which maximize the use of community resources and, thus, reduce potentially high costs. Chapters One and Two examine the current school-age "child care" services both nationally and in Region X (Oregon, Washington…
...'' (GALL Report), for the aging management of Pressurized Water Reactors (PWR) reactor vessel internals... COMMISSION Final Interim Staff Guidance LR-ISG-2011-04; Updated Aging Management Criteria for Reactor Vessel Internal Components for Pressurized Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION:...
Feet are not necessarily the most attractive part of the body as it ages, and given the choice, most older adults would rather ignore them. In fact, many older adults cannot even see them, reach them, or care for them properly. And when they ache or look misshapen and oddly colored; well, that's just part of growing old, isn't it? The feet are important for weight bearing, balance, and mobility. Over an average life span, the feet are subject to considerable stress and trauma. Age-related changes of the foot predispose the older adult to discomfort if not pain, fungal infection, reduced range of motion, and itchy dry skin. More than three fourths of older adults (i.e., those age over 65 years) complain of foot pain that is associated with a significant foot problem and have evidence of arthritic changes on x-ray. Impaired ambulation can make the difference between independence versus dependency on others, engagement versus isolation. Assisted living is about choices. Being unable to get where one wants to go or do what one wants to do because of foot problems is a barrier to full enjoyment of the opportunities in assisted living communities. This article describes foot problems associated with aging, diabetes, nursing assessment of the feet, and nursing interventions in the service of accessing and optimizing choices for quality of life.
Verbeek, H; Zwakhalen, S M G; van Rossum, E; Kempen, G I J M; Hamers, J P H
Institutional dementia care is increasingly directed towards small-scale and homelike care environments, in The Netherlands as well as abroad. In these facilities, a small number of residents, usually six to eight, live together, and normal daily household activities and social participation are emphasized. In a quasi-experimental study, we studied the effects of small-scale, homelike care environments on residents (n = 259), family caregivers (n = 206) and nursing staff (n = 305). We compared two types of institutional nursing care during a 1 year period (baseline assessment and follow-up measurements at 6 and 12 months): (28) small-scale, homelike care environments and (21) psychogeriatric wards in traditional nursing homes. A matching procedure was applied to increase comparability of residents at baseline regarding functional status and cognition. This study was unable to demonstrate convincing overall effects of small-scale, homelike care facilities. On our primary outcome measures, such as quality of life and behaviour of residents and job satisfaction and motivation of nursing staff, no differences were found with traditional nursing homes. We conclude that small-scale, homelike care environments are not necessarily a better care environment than regular nursing homes and other types of living arrangements should be considered carefully. This provides opportunities for residents and their family caregivers to make a choice which care facility suits their wishes and beliefs best.
Ahrendt, Andrew; Sprankle, Eric; Kuka, Alex; McPherson, Keagan
The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers' approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults' perception of caregiver bias, as well as further investigation of caregivers' perceptions of older adults' sexual activity.
Larocque, Natasha; Schotsman, Chloe; Kaasalainen, Sharon; Crawshaw, Diane; McAiney, Carrie; Brazil, Emma
This study sought to evaluate a book chat intervention based on Lisa Genova's novel, Still Alice, to influence long-term care (LTC) staff perceptions and attitudes when caring for individuals with dementia. A qualitative descriptive design was used. Eleven participants partook in a 2.5-hour book chat at a southern Ontario LTC facility. Following the book chat, participants answered two open-ended questions to assess how the book chat influenced their views on dementia. Thematic content analysis was used to analyze the qualitative questionnaire. Content analysis of the participants' responses revealed that the book chat positively influenced their attitudes and perceptions toward dementia, particularly by providing more insight into the individual's personal struggle with the disease. Furthermore, participants found that the book chat influenced their care practices. By creating innovative learning opportunities, attitudes and perceptions about dementia care can be transcended and greatly benefit staff, family, and residents.
Clarke, Sue; Taylor, Georgina; Lancaster, Joanna; Remington, Bob
People diagnosed with a personality disorder (PD) are often a stigmatized patient group. This can affect the care they receive, their progression, and the well-being of staff caring for them. Interventions targeted at health care professionals that aim to improve attitudes toward these patients and improve staff well-being do exist; however, evidence for their effectiveness is limited. The present study compared a self-management, Acceptance and Commitment Therapy-based training intervention (ACTr) with a Psychoeducation Training (PETr) intervention in their effectiveness in improving attitudes toward PD patients, staff-patient relations, and staff well-being. Both interventions were successful at improving attitudes and measures of staff-patient relations up to 6 months after training; however, staff well-being did not change for either group. The implications for staff training and future research are discussed.
Sma Barn Pa Daghem: En studie av personalens samspel med barn och foraldrar vid lamning, hamtning och fri lek (Infants at Day Care: A Study of Staff Interaction with Children and Their Parents during Leaving, Collecting and Free Play).
Lothigius, Anita Holmstedt
This thesis presents a picture of how staff interact with infants (age group 1-3 years old) and parents at three day care centers. The study focused on the situations of leaving and collecting the children and the children's time of free play both in and outdoors. The theoretical content has an attachment/psycho-dynamical perspective with emphasis…
Andresen, Felicia J; Buchanan, Jeffrey A
-to-resident bullying has attracted attention in the media, but little empirical literature exists related to the topic of senior bullying. The aim of the current study was to better understand resident-to-resident bullying from the perspective of staff who work with older adults. Forty-five long-term care staff members were interviewed regarding their observations of bullying. Results indicate that most staff members have observed bullying. Verbal bullying was the most observed type of bullying, but social bullying was also prevalent. Victims and perpetrators were reported to commonly have cognitive and physical disabilities. More than one half of participants had not received formal training and only 21% reported their facility had a formal policy to address bullying. The implications of these results support the need for detailed policies and training programs for staff to effectively intervene when bullying occurs. [Journal of Gerontological Nursing, xx(x), xx-xx.].
Kydd, Angela; Fleming, Anne
Ageism and age discrimination are terms used in best practice statements and in the literature to define negative attitudes towards older people and towards people because of their age (whether old or young). However, 'old age' is a nebulous concept with definitions ranging from the over 50s to the over 85s. In seeking to explore ageism and age discrimination within health care, this paper discusses the concept of 'old' and discusses the findings of a narrative review of the literature on these two concepts. Results show that negative attitudes have been perceived by users of health care services, but the reasons are not clear. Such attitudes are usually reported in acute health care settings, where targets and quick turnover are encouraged. Thus people, usually those with complex needs, who require longer periods of recuperation and rehabilitation following an episode of ill health, are troublesome to staff working in a system geared up for early discharges. This type of service user is usually over the age of 85. Recommendations from this paper include the need for acute frailty units, with well trained staff, where frail older people can be comprehensively assessed, receive timely and targeted care, followed by a supported discharge.
Baernholdt, Marianne; Jennings, Bonnie Mowinski; Lewis, Erica Jeané
Knowledge is limited about quality of care (QOC) in rural hospitals, including the smallest hospitals, critical access hospitals. Staff nurses from 7 critical access hospitals identified items important for QOC across 4 levels of care: patients, microsystems, organizations, and environments. Several items were unique to critical access hospitals. Most QOC items were at the microsystem level, yet few of these items are routinely measured. These findings offer beginning evidence about how to advance QOC evaluations in rural hospitals.
Carrillo-García, C; Ríos-Rísquez, M I; Martínez-Hurtado, R; Noguera-Villaescusa, P
The objective was to determine the work stress level among nursing staff in the Intensive Care Unit of a university hospital and to analyse its relationship with the various sociodemographic and working variables of the studied sample. A study was designed using a quantitative, descriptive and cross-sectional approach. The target population of the study was the nursing staff selected by non-random sampling. The instrument used was the Job Content Questionnaire. Data analysis was performed using SPSS 20. The mean, ranges and standard deviation for each of the variables were calculated. A bivariate analysis was also performed on the social and occupational variables of the sample. The participation rate was 80.90% (N=89). The mean of the Social support dimension was 3.13±0.397, for the Psychological demands at work dimension it was 3.10±0.384, with a mean of 2.96±0.436 being obtained for the Control over the work dimension. In the analysis of sociodemographic and work variables of the sample, only the professional category was significant, with nurses recording higher values in perception of job demands and control over their work compared to nursing assistants. In conclusion, there is a moderate perception of work stress in the analysed group of professionals. Among the sources of stress in the workplace was the low control in decision-making by practitioners, as well as the need to continually learn new things. On the other hand, the support received from colleagues is valued positively by the sample.
Evans, Kathryn; Law, Heather; Turner, Roisin Elizabeth; Rogers, Andrew; Cohen, Keren
The aim of this study was to conduct a preliminary evaluation of a mental health consultation process provided to staff working in residential care settings for young people. Using a semi-structured interview approach, qualitative information was gathered from six participants about their experiences of the consultation. A thematic analysis of the…
Bailey, B. A.; Hare, D. J.; Hatton, C.; Limb, K.
Background: Previous studies have attempted to apply Weiner's attributional model of helping behaviour to care staff who work with service users with intellectual disabilities and challenging behaviours by using studies based on vignettes. The aims of the current study were to investigate the application of Weiner's model to "real" service users…
Lundstrom, Mats; Graneheim, Ulla H.; Eisemann, Martin; Richter, Jorg; Astrom, Sture
Explored are the relationships among personality and emotional reactions, work-related strain, and experiences of burnout among staff exposed vs. not exposed to violence when caring for people with intellectual disabilities (ID). Questionnaires measuring personality, emotional reactions, strain and burnout, and exposure to violence were…
Joos, E.; Mehuys, E.; Van Bocxlaer, J.; Remon, J. P.; Van Winckel, M.; Boussery, K.
Background: Guidelines for the safe administration of drugs through enteral feeding tube (EFT) are an important tool to minimise the risk of errors. This study aimed to investigate knowledge of these guidelines among staff of residential care facilities (RCF) for people with ID. Method: Knowledge was assessed using a 13-item self-administered…
Bruzzese, Jean-Marie; Evans, David; Wiesemann, Sandra; Pinkett-Heller, Marcia; Levison, Moshe J.; Du, Yunling; Fitzpatrick, Cecilia; Krigsman, Gary; Ramos-Bonoan, Carmen; Turner, Levonne; Mellins, Robert B.
School-based asthma interventions delivered by nonschool staff have been successful but are limited in their reach because of the cost and effort of bringing in outside educators and their inability to establish improved communication about asthma between schools, families, and primary care providers (PCPs). To address these problems, Columbia…
Robison, Julie; Curry, Leslie; Gruman, Cynthia; Porter, Martha; Henderson, Charles R., Jr.; Pillemer, Karl
Purpose: This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs. Design and Methods: Participants included 388 family members and 384…
Forster, Della A; McLachlan, Helen L; Yelland, Jane; Rayner, Jo; Lumley, Judith; Davey, Mary-Ann
Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on
Chen, Wen-Ching; Sun, Yu-Hua; Lan, Tsuo-Hung; Chiu, Hsien-Jane
This one-year follow-up study determined the incidence and risk factors of workplace violence against nursing staff in a psychiatric hospital. The cohort members had a website to report events whenever they came across violence. A total of 971 events were reported. The incidence rates of physical violence, verbal abuse, bullying/mobbing, sexual harassment, and racial harassment were 1.7, 3.7, 0.2, 0.3, and 0 per staff-year, respectively. Young age, female sex, lower education, shorter duration of employment, and high level of anxiety of staff seemed to be the determinants of violence. Pre-placement education should focus on these staff to reduce workplace violence.
Eika, Marianne; Espnes, Geir Arild; Hvalvik, Sigrun
Working in long-term care units poses particular staff challenges as these facilities are expected to provide services for seriously ill residents and give help in a homelike atmosphere. Licensed and unlicensed personnel work together in these surroundings, and their contributions may ease or inhibit a smooth transition for recently admitted residents. The aim of the study was to describe and explore different nursing staff's actions during the initial transition period for older people into a long-term care facility. Participant observation periods were undertaken following staff during 10 new residents' admissions and their first week in the facility. In addition 16 interviews of different staff categories and reading of written documents were carried out. The findings show great variations of the staff's actions during the older residents' initial transition period. Characteristics of their actions were (1) in the preparation period: "actions of sharing, sorting out, and ignoring information"; (2) on admission day: "actions of involvement and ignorance"; and (3) in the initial period: "targeted and random actions," "actions influenced by embedded knowledge," and "actions influenced by local transparency."
Eika, Marianne; Espnes, Geir Arild; Hvalvik, Sigrun
Working in long-term care units poses particular staff challenges as these facilities are expected to provide services for seriously ill residents and give help in a homelike atmosphere. Licensed and unlicensed personnel work together in these surroundings, and their contributions may ease or inhibit a smooth transition for recently admitted residents. The aim of the study was to describe and explore different nursing staff's actions during the initial transition period for older people into a long-term care facility. Participant observation periods were undertaken following staff during 10 new residents’ admissions and their first week in the facility. In addition 16 interviews of different staff categories and reading of written documents were carried out. The findings show great variations of the staff's actions during the older residents’ initial transition period. Characteristics of their actions were (1) in the preparation period: “actions of sharing, sorting out, and ignoring information”; (2) on admission day: “actions of involvement and ignorance”; and (3) in the initial period: “targeted and random actions,” “actions influenced by embedded knowledge,” and “actions influenced by local transparency.” PMID:25301634
Middleton, M. -J.; Kitchen, S. S.
Background: Physiotherapists for adults with intellectual disabilities often work in day centres, relying on care staff to support programmes. This study investigates factors affecting physiotherapy delivery in 4 day centres in one London borough. Materials and Method: Semi-structured interviews were carried out with day centre care staff,…
Perlman, Michal; Fletcher, Brooke A.
Research Findings: The amount and quality of communication between staff and guardians in child care centers was examined using extensive naturalistic observations. Interactions between staff and more than 1,000 guardians who dropped their child off at their child care center were captured through a series of 20-s time-sampled observations.…
Björkman, Tommy; Angelman, Therese; Jönsson, Malin
Stigma and discrimination have been identified as important obstacles to the integration of people with mental illness in society. In efforts to reduce stigma and discrimination, health professionals play an important role as they have frequent contact with and responsibility for treatment and rehabilitation of consumers. The aim of the present study was to investigate attitudes towards mental illness and people with mental illness among nursing staff working in psychiatric or somatic care. The sample consisted of 120 registered or assistant nurses who were interviewed about intimacy with mental illness and attitudes about seven different mental illnesses. The results showed that nursing staff in somatic care, to a higher degree than nursing staff in mental health, reported more negative attitudes with regard to people with schizophrenia as being more dangerous and unpredictable. In contrast, professional experience, intimacy with mental illness and type of care organization were found to be more associated with attitudes to specific mental illnesses concerning the prospect of improvement with treatment and the prospect of recovery. In conclusion, attitudes among nursing staff are in several respects comparable with public opinions about mental illness and mentally ill persons. In order to elucidate if negative attitudes about dangerousness and unpredictability of persons with specific mental illnesses are associated with realistic experiences or with prejudices further studies with a qualitative design are suggested.
Olsson, A; Hallberg, I R
This study aimed to illuminate both the content of and the care given to demented people and the reflections of home care staff about it as revealed in two clinical group supervision sessions (n = 36). Verbatim transcriptions were analysed using a phenomenological hermeneutic approach and the following were found to be reflected on: the pensioners' personal situation--disease-related behaviour, ADL-functions, social network and self-esteem; the pensioners' environment--their relationships to significant others, adequate level of housing/care, access to activities, and satisfactory personal space; pensioner/staff interaction--their relations to each other, the staffs' relation to the pensioners' family, and the balance between reality-orientation vs. validation; the staff's situation--co-operation with other professionals, in primary health care, hospital, and within the social services; job satisfaction, lack of knowledge and sharing of knowledge, and lack of resources, especially time. The reasoning of the participants under supervision was found to be based on medical, historical, psychological, and environmental explanations, or personal beliefs. Feelings explored during supervision were directed towards the pensioners or the pensioners' families, towards themselves or towards the management. The findings were interpreted within a nursing model based on the four central concepts of nursing; person, environment, nursing intervention and health. The reasoning about nursing care revealed in the supervision sessions reflected a holistic approach and the relationship between the staff and the demented person stood out as central for care quality. Thus focusing on what promotes or, respectively, obstructs this relationship is likely to be one important focus in clinical supervision not only to achieve improvement and high quality in home care but also to develop and enhance the quality of the working life of the staff. Since the results could be understood within a
Nickell, Leslie A.; Crighton, Eric J.; Tracy, C. Shawn; Al-Enazy, Hadi; Bolaji, Yemisi; Hanjrah, Sagina; Hussain, Ayesha; Makhlouf, Samia; Upshur, Ross E.G.
Background The outbreak of SARS in 2003 had a dramatic effect on the health care system in Toronto. The main objective of this study was to investigate the psychosocial effects associated with working in a hospital environment during this outbreak. Methods Questionnaires were distributed to all willing employees of Sunnybrook and Women's College Health Sciences Centre between Apr. 10 and 22, 2003. The survey included questions regarding concern about SARS, precautionary measures, personal well-being and sociodemographic characteristics; a subsample also received the 12-item version of the General Health Questionnaire (GHQ-12). Results Of the 4283 questionnaires distributed, 2001 (47%) were returned, representing 27% of the total hospital employee population of 7474. The proportions of respondents who were allied health care professionals, nurses and doctors and who worked in areas other than patient care were representative of the hospital staff population as a whole. Of the 2001 questionnaires, 510 contained the GHQ-12. Two-thirds of the respondents reported SARS-related concern for their own or their family's health. A total of 148 respondents (29%) scored above the threshold point on the GHQ-12, indicating probable emotional distress; the rate among nurses was 45%. Masks were reported to be the most bothersome infection control precaution. Logistic regression analysis identified 4 factors as being significantly associated with increased levels of concern for personal or family health: perception of a greater risk of death from SARS (adjusted odds ratio [OR] 5.0, 95% confidence interval [CI] 2.6–9.6), living with children (adjusted OR 1.8, 95% CI 1.5–2.3), personal or family lifestyle affected by SARS outbreak (adjusted OR 3.3, 95% CI 2.5–4.3) and being treated differently by people because of working in a hospital (adjusted OR 1.6, 95% CI 1.2–2.1). Four factors were identified as being significantly associated with the presence of emotional distress
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Rose, John; Mills, Sophie; Silva, Daniel; Thompson, Lauren
A broad range of factors have been identified as having an impact on burnout and performance. To improve our understanding of how these factors interact, a model of carer stress is tested. Staff were surveyed in residential units, assessments included burnout, organizational factors, staff cognitions and ratings of resident challenging behavior.…
Robinson, Andrew; See, Catherine; Lea, Emma; Bramble, Marguerite; Andrews, Sharon; Marlow, Annette; Radford, Jan; McCall, Michael; Eccleston, Claire; Horner, Barbara; McInerney, Fran
This paper reports on the design of a program that aims to prototype teaching aged care facilities in Australia. Beginning in two Tasmanian residential aged care facilities, the intent of the program is to support large-scale inter-professional student clinical placements, positively influence students' attitudes toward working in aged care and drive development of a high-performance culture capable of supporting evidence-based aged care practice. This is important in the context of aged care being perceived as an unattractive career choice for health professionals, reinforced by negative clinical placement experiences. The Teaching Aged Care Facilities Program features six stages configured around an action research/action learning method, with dementia being a key clinical focus.
Netting, F E; Wilson, C C; Stearns, L R; Branch, L G
State units on aging (SUAs) from 29 states with continuing care retirement community (CCRC) legislation were surveyed to (a) assess staff familiarity with CCRC legislation, (b) examine interdepartmental working relationships surrounding such legislation and ask what role(s) ombudspersons are playing in CCRC oversight, (c) determine what role(s) aging units have had in developing legislation, and (d) gain insights regarding legislative impact. Results indicate that SUAs have been active in legislative development but vary greatly in the intensity of their involvement with the implementation and enforcement of CCRC regulation and in their perception of legislative impact.
Ryan, Karen; McEvoy, John; Guerin, Suzanne; Dodd, Philip
Research suggests that shortcomings exist in the provision of palliative care to people with intellectual disabilities. This mixed-methods study aimed to describe the experience, confidence and attitudes of staff to the provision of palliative care to people with intellectual disabilities. The sample was drawn from the population of one Health Service Executive area in Ireland. Staff from intellectual disability and palliative care services completed surveys and participated in focus group discussions. Three hundred and eighty-nine questionnaires were distributed and 16 focus groups were held. Fifty-nine per cent of palliative care staff and 67% of intellectual disability services staff had cared for someone with intellectual disability who had died but level of experience was low. Both palliative care and intellectual disability services staff lacked confidence in their ability to provide palliative care. Staff were challenged by perceived 'differences' and 'difficulties' in the provision of care. They endorsed a partnership approach to care but focus group discussions revealed that a shared desire to cooperate was insufficient to guarantee effective collaboration.
Adriaansen, Marian; Van Achterberg, Theo; Borm, George
In communicating with patients, especially patients receiving palliative care, empathy plays an important role. Little research has as yet been conducted into the development of the empathetic capacity of nursing students at various educational levels. An instrument that may be suitable for such research is the Staff-Patient Interaction Response Scale for Palliative Care Nursing (SPIRS-PCN). The purpose of the article is to determine the validity and reliability of the SPIRS-PCN, an instrument measuring empathy in palliative care. The criterion-related validity, homogeneity, and interrater reliability of the SPIRS-PCN were determined in nursing students (n = 357) who varied in gender, age, religious orientation, educational level, and experience in patient care. The validity of the SPIRS-PCN was underlined by identification of differences for religious orientation and the amount of experience. The variables gender, age, and educational level were not significant in relation to SPIRS-PCN scores. The homogeneity (Cronbach's alpha = .80) and interrater reliability (.74) of the instrument were adequate. We conclude that validity of the SPIRS-PCN was partially supported, whereas reliability was demonstrated. The instrument is feasible in educational situations; we recommend further research into the instrument's validity, especially in the progression of students' scores during the study program.
Nichols, Pam; Horner, Barbara; Fyfe, Katrina
This study explored how culture shapes relationships in aged care and the extent to which the residential aged care sector supports a cohesive multicultural workforce. An exploratory methodology utilising semi-structured questionnaires collected data from 58 participants comprising: staff who provide direct care to residents; managers; and family members from six residential care facilities in Perth, Western Australia. Communication issues emerged as an over-arching theme, and included interpersonal communication, the effect of cultural norms on communication and the impact of informal and formal workplace policies relating to spoken and written language. Sixty percent of participants from a culturally and linguistically diverse (CaLD) background had experienced negative reactions from residents with dementia, linked to visible cultural difference. They used a range of coping strategies including ignoring, resilience and avoidance in such situations. CaLD participants also reported prejudicial treatment from non-CaLD staff. The findings highlight the need for organisations to incorporate explicit processes which address the multiple layers of influence on cross cultural communication: internalised beliefs and values; moderating effects of education, experience and social circumstance; and factors external to the individuals, including workplace culture and the broader political economy, to develop a cohesive multicultural workplace.
Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs
Prescott, Elizabeth; Milich, Cynthia
This report on group day care is designed to: (1) examine the kinds of group programs for school-age children which exist in Los Angeles County, (2) describe the conditions necessary for program operation, and (3) consider the issue of quality as it relates to community expansion of day care services for children of school age. The report is…
Gao, Fengsong; Tilse, Cheryl; Wilson, Jill; Tuckett, Anthony; Newcombe, Peter
The residential aged care industry faces shortages and high turnover rates of direct care workers. This situation is further complicated by the increasing cultural diversity of residents and staff. To retain direct care workers, it is crucial to explore their perceptions of the rewards and difficulties of care work, and their employment intentions in multicultural environments. A qualitative descriptive study was used to understand perceptions of the rewards and difficulties of residential aged care work for core direct care workers (i.e. nurses and nursing assistants), how these were related to their intentions to stay or leave, and how these varied between nurses and nursing assistants, and between locally and overseas born workers. Individual interviews were conducted between June and September 2013 with 16 direct care workers in an Australian residential aged care facility with a specific focus on people from culturally and linguistically diverse backgrounds. It was found that direct care workers' employment intentions were related to their perceptions and management of the rewards and difficulties of care work. Their experiences of care work, the employment characteristics, and the organizational resources that fitted their personality, ability, expectations, and essential needs were viewed as rewards. Evaluating their jobs as meaningful was a shared perception for direct care workers who intended to stay. Individual workers' perceptions of the rewarding aspects of care work served to counterbalance the challenges of care work, and promoted their intentions to stay. Perceptions and employment intentions varied by occupational groups and by cultural backgrounds. Overseas born direct care workers are valuable resources in residential aged care facility rather than a limitation, but they do require organizational support, such as cultural awareness of the management, English language support, a sense of family, and appropriate job responsibility. The findings
Clark, Alex; Browne, Sarah; Boardman, Liz; Hewitt, Lealah; Light, Sophie
UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty-six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire…
In this electronically wired world of the 21 st century, the health care system has tapped into technology available at the touch of a button. Scientific discoveries, high-tech equipment, electronic medical records, Smarticards, and long distance diagnosis using telehealth technology have all been embraced. But Natalie Dragon asks, what are the implications for nurses and the outcomes on patient care?
Hanna, Tuvesson; Mona, Eklund
The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics--Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience--are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff's perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.
Background Sexuality is a key component of quality of life and well-being and a need to express one’s sexuality continues into old age. Staff and families in residential aged care facilities often find expressions of sexuality by residents, particularly those living with dementia, challenging and facilities often struggle to address individuals’ needs in this area. This paper describes the development of an assessment tool which enables residential aged care facilities to identify how supportive their organisation is of all residents’ expression of their sexuality, and thereby improve where required. Methods Multi-phase design using qualitative methods and a Delphi technique. Tool items were derived from the literature and verified by qualitative interviews with aged care facility staff, residents and families. The final item pool was confirmed via a reactive Delphi process. Results A final item pool of sixty-nine items grouped into seven key areas allows facilities to score their compliance with the areas identified as being supportive of older people’s expression of their sexuality in a residential aged care environment. Conclusions The sexuality assessment tool (SexAT) guides practice to support the normalization of sexuality in aged care homes and assists facilities to identify where enhancements to the environment, policies, procedures and practices, information and education/training are required. The tool also enables facilities to monitor initiatives in these areas over time. PMID:24980463
Lea, Emma; Marlow, Annette; Bramble, Marguerite; Andrews, Sharon; Crisp, Elaine; Eccleston, Claire; Mason, Ron; Robinson, Andrew
The residential aged care sector is reportedly a less attractive career choice for nursing students than other sectors. Research shows that students are often fearful of working with residents with dementia when they are inadequately supported on clinical placements by aged care staff. Thirty first-year nursing students attended a 2-week placement in one of two Tasmanian aged care facilities as part of the Wicking Dementia Research and Education Centre Teaching Aged Care Facilities Program, which aims to provide students with a quality aged care placement focusing on dementia palliation. Placement experience and dementia knowledge were evaluated through preplacement and postplacement questionnaires and weekly feedback meetings with mentors and students. Students had more positive attitudes related to aged care and higher dementia knowledge at the end of placement. Students described their interactions with residents with dementia and thought that the placement had increased their capacity to provide quality care to these residents. The findings indicate that residential aged care placements can be productive learning environments for novice nursing students.
O'Connell, Beverly; Hawkins, Mary; Considine, Julie; Au, Catherine
This research aimed to describe the number and type of residents admitted to emergency departments (EDs) over 2 years; and to explore nurses' perceptions of the reasons why residential aged care facility (RACF) residents are referred to EDs. The research objective was addressed in a retrospective exploratory study using data on admissions to EDs from RACFs (N = 3,094) at the participating organisation over a 2-year period, and interview data on seven RACF and four ED nurses' perceptions of the issues involved. Most residents presenting at EDs required urgent medical attention. Major themes identified by RACF and ED nurses included issues related to staff competency, availability of general practitioners, lack of equipment in RACFs, residents and family members requesting referrals, communication difficulties, and poor attitudes towards RACF staff. There is a need to use strategies to detect residents whose conditions are deteriorating and treat them promptly in RACFs.
Freeman, Michele; Kaye, Jeffrey; Vuckovic, Nancy; Buckley, David I.
Abstract Objective: Remote monitoring technology (RMT) may enhance healthcare quality and reduce costs. RMT adoption depends on perceptions of the end-user (e.g., patients, caregivers, healthcare providers). We conducted a systematic review exploring the acceptability and feasibility of RMT use in routine adult patient care, from the perspectives of primary care clinicians, administrators, and clinic staff. Materials and Methods: We searched the databases of Medline, IEEE Xplore, and Compendex for original articles published from January 1996 through February 2013. We manually screened bibliographies of pertinent studies and consulted experts to identify English-language studies meeting our inclusion criteria. Results: Of 939 citations identified, 15 studies reported in 16 publications met inclusion criteria. Studies were heterogeneous by country, type of RMT used, patient and provider characteristics, and method of implementation and evaluation. Clinicians, staff, and administrators generally held positive views about RMTs. Concerns emerged regarding clinical relevance of RMT data, changing clinical roles and patterns of care (e.g., reduced quality of care from fewer patient visits, overtreatment), insufficient staffing or time to monitor and discuss RMT data, data incompatibility with a clinic's electronic health record (EHR), and unclear legal liability regarding response protocols. Conclusions: This small body of heterogeneous literature suggests that for RMTs to be adopted in primary care, researchers and developers must ensure clinical relevance, support adequate infrastructure, streamline data transmission into EHR systems, attend to changing care patterns and professional roles, and clarify response protocols. There is a critical need to engage end-users in the development and implementation of RMT. PMID:24731239
Burgio, Louis D.; Fisher, Susan E.; Fairchild, J. Kaci; Scilley, Kay; Hardin, J. Michael
Purpose: The purpose of this study was to compare a variety of resident and staff outcomes across two types of staffing patterns, permanent and rotating assignment, and work shift. Although studies have examined these staffing patterns as part of multicomponent intervention packages, few studies have examined the isolated effects of staffing…
This article provides a framework for understanding and supporting lesbian, gay, bisexual, and transgendered students in community colleges. It should be noted that many of the understandings and structural supports often apply to lesbian, gay, bisexual, transgender, and questioning (LGBTQ) faculty and staff as well. The study is based upon…
Schewe, C D; Spotts, H E
The health-care marketplace is aging by leaps and bounds and bringing with it new and different medical needs. As costs soar and public assistance programs dwindle in impact, health-care providers will need better marketing strategies to bring treatments to patients/consumers. This article looks at the research findings of behavioral scientists and offers guidelines for effective communication with aging audiences. Health-care providers can use these findings to design more effective advertising, promotional brochures, newsletters, and a host of other communication tools targeted at an older market. Health-care managers and other professionals should find the guidelines useful in their daily interactions with patients and colleagues.
Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be
Center for the Child Care Workforce, Washington, DC.
This document presents model work standards articulating components of the child care center-based work environment that enable teachers to do their jobs well. These standards establish criteria to assess child care work environments and identify areas to improve in order to assure good jobs for adults and good care for children. The standards are…
Joint Legislative Audit and Review Commission, Richmond, VA.
A mandated study was made of Virginia's roles in child day care regulation and the promotion of high quality care. The primary objectives of the study were to: (1) examine the state's goals in regulating child day care and determine whether changes to the regulatory system were needed to meet those goals; and (2) review the state's role in…
Bellm, Dan; Whitebook, Marcy
Addressed to teachers, administrators, resource and referral workers, and substitutes, this booklet offers advice about finding and retaining good substitute child care workers. Sections concern (1) causes of the "crisis" in substitute care, including the expansion of child care, provider turnover, shortage of elementary school teachers, low pay,…
Cherry, Ralph L.
Compared effects of ombudsman programs on quality of nursing home care on random sample of 134 Medicare/Medicaid-certified long-term care facilities in Missouri. Found that presence of ombudsman program was most important factor associated with quality for intermediate-care facilities, and was significantly associated with quality for skilled…
You, Emily Chuanmei; Dunt, David; Doyle, Colleen
Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.
Luque, Y; Crockett, K
In summary, the VNA of Los Angeles has found that the pay-per-visit system provides tremendous costsavings and that it has eliminated visit productivity problems. Additionally, field staff have found that the system can improve their earning power. Although the development, initiation, and maintenance of the pay-per-visit system requires a significant commitment of both time and effort, it is a system that we highly recommend to other home health organizations.
Heflin, Mitchell T
North Carolina's aging population will require a health care workforce prepared to meet patients' complex care needs. The keys to training this workforce include continuing to mobilize the state's educational infrastructure to provide interprofessional, community-based experiences and maximizing exposure to new models of care.
Carlsson, Eva; Ehnfors, Margareta; Eldh, Ann Catrine; Ehrenberg, Anna
Continuity of care is a key issue in the care for elderly people, for example, those having experienced stroke, particularly with regards to informational and managerial continuity based on patient record data. The study aim was to explore municipal nursing staff’s (n=30) perceptions of discharge information provided to them for stroke patients with eating difficulties. Structured interviews were used and data were analysed by content analysis and descriptive statistics. Results showed that nursing staff perceived informational continuity and accuracy of information on patients’ eating difficulties as poor and that little information on eating difficulties reached licensed practical nurses, who instead relied on their own assessments of patients’ eating ability. Co-ordinated care planning and management continuity were largely lacking, increasing the risk for undernutrition and related complications for the patients. PMID:24199052
Abbott, Katherine M.; Heid, Allison R.; Van Haitsma, Kimberly
Knowledge of a nursing home resident's everyday living preferences provides the foundation for ongoing individualized care planning. Objective The purpose of this study is to identify nursing home (NH) staff perceptions of facilitators and barriers to learning about and meeting residents’ preferences and reasons why staff feel residents change their minds about preferences. Methods Focus group sessions and interviews were conducted with 36 NH staff members working in a facility that has been actively assessing resident preferences for five years. Results Thematic codes classifying facilitators, barriers, and dependencies were identified. Staff shared ways they are able to help meet residents’ preferences as well as barriers to fulfilling resident preferences through their own behaviors, facility characteristics, the social environment, and resident characteristics. In addition, staff believe that residents change their minds about important preferences ‘depending on’ several factors including; global environmental characteristics, social environment, resident characteristics, and general staff perceptions. Conclusions This work identifies key facilitators and barriers to consider when implementing quality improvement efforts designed to improve the person-centered nature of care in nursing homes and is intended to further inform the culture change movement, which aims to transform NHs by empowering staff and delivering person-centered care. PMID:27134341
Hyman, R B
It has been previously established that human service workers often suffer from emotional exhaustion, which has been conceptualized by Maslach and Jackson as burnout. Burnout may be a particularly great risk in workers providing long-term geriatric care. The current study evaluated the effects of a series of three 3-hour sessions designed to address team building, communication skills, self-esteem, and stress management on a random sample of 51 of the 188 long-term care staff who participated. Using a retrospective pretest design, a statistically significant improvement from "then" to "today" was found for the three components of burnout: Depersonalization, Emotional Exhaustion, and Personal Accomplishment. Responses to an open-ended question about workshop effects corroborated the quantitative data, and effects noted were highly related to the defined objectives of the workshops.
This article examines the results of an audit into recovery nurse knowledge and understanding of paediatric care standards. It will critically analyse the availability of current standards for children's services in the recovery room and discuss the need for a national document specifically dedicated to standards of practise for the care of the child in the recovery room providing immediate post operative care. The article will also look at the development of such a document.
Cherrington, Andrea L.; Andreae, Lynn; Prince, Candice; Holt, Cheryl L.; Halanych, Jewell H.
Objectives. We qualitatively assessed patients’ perceptions of discrimination and patient satisfaction in the health care setting specific to interactions with nonphysician health care staff. Methods. We conducted 12 focus-group interviews with African American and European American participants, stratified by race and gender, from June to November 2008. We used a topic guide to facilitate discussion and identify factors contributing to perceived discrimination and analyzed transcripts for relevant themes using a codebook. Results. We enrolled 92 participants: 55 African Americans and 37 European Americans, all of whom reported perceived discrimination and lower patient satisfaction as a result of interactions with nonphysician health care staff. Perceived discrimination was associated with 2 main characteristics: insurance or socioeconomic status and race. Both verbal and nonverbal communication style on the part of nonphysician health care staff were related to individuals’ perceptions of how they were treated. Conclusions. The behaviors of nonphysician health care staff in the clinical setting can potentially contribute to patients’ perceptions of discrimination and lowered patient satisfaction. Future interventions to reduce health care discrimination should include a focus on staff cultural competence and customer service skills. PMID:26270291
DiBartolo, Mary C
Although not generally a primary admission diagnosis, Parkinson's disease (PD) can be a significant comorbidity during hospitalization. Hospitalized individuals with PD can experience a variety of complications, such as confusion, pneumonia, and urinary infections. More than 20% of patients experience deterioration in symptoms and hospital stays are extended by an average of 4 days. Late, omitted, or inappropriate medications are frequent culprits leading to serious consequences, including falls and aspiration. To address an identified gap in staff knowledge about PD, a formal educational program was developed to review its etiology, symptoms, treatments, and unique considerations in care and medication administration. This 2-hour intervention comprises a knowledge pre-test, PowerPoint® presentation, two concise handouts for reference, discussion of an unfolding case study, and review of the Aware in Care kit. Nurses can play a key role in educating staff to reduce avoidable hospital-related complications and enhance outcomes for this vulnerable group. [Journal of Gerontological Nursing, xx(x), xx-xx.].
Knickman, James R; Snell, Emily K
Objective To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. Study Setting A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society. Study Design A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long-term care, healthy aging, and cultural views of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns of the Baby Boom generation are developed. Principal Findings The economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boom children in the 1960s. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life. Conclusions To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care. PMID:12236388
Polivka, Larry; Zayac, Helen
Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer…
Dunn, Loraine; And Others
Examined how preschoolers' experiences with mixed-age peers in family child care homes affect development. Found that interaction with younger and same-age peers was associated with less complex social and cognitive play and lower receptive language scores. Interaction with older peers was related to more complex cognitive play. The setting…
Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L
This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the "outshopping theory," where respondents select services in larger regional economic centers rather than local "mom and pop" providers, now extends to older adult health care selection.
Francis-Coad, Jacqueline; Etherton-Beer, Christopher; Bulsara, Caroline; Nobre, Debbie; Hill, Anne-Marie
Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action.Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention.Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy.Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice.What is known about the topic? Audit and feedback is an effective way of measuring clinical quality and safety. CoPs have been established in healthcare using workplace staff to address clinical problems but little is known about their ability to audit and influence practice change.What does this paper add? This study contributes to the body of knowledge on CoPs in healthcare by evaluating the
Self-care is a central concept in health care and may be considered as a means to maintain, restore, and improve one’s health and well-being. When performed effectively, self-care contributes not only to human functioning but also to human structural integrity and human development (ie, to a dynamic and holistic state of health). Self-care as a clinical concept is relevant for health care professionals, and it should be meaningful to investigate it at a philosophical level and to further elaborate upon this concept. The aim of this article is to discuss and elaborate upon a phenomenological perspective on self-care in aging that is relevant for the health sciences. Self-care may be preliminarily regarded as a fundamental perspective for the conscious older individual, and as a way of being in the world with both the objective body and with the lived body. The lived body is the personal center of perception and the field of action, and it is also the center of self-care. The potentiality or ability for self-care activity and self-care activity itself are structures given to perception, with self-care ability as an integral part of the lived body. The actualization of self-care ability comes about through a certain meaning, which can be regarded as an important driving force. It is constituted by communication, a healthy lifestyle, and by building meaning and socializing. Successful self-care involves having contacts with the health care system, being conscious of a sound lifestyle, being physically and mentally active, being engaged, having social contacts with family and others, as well as being satisfied, positive, and being able to look forward. One fundamental cornerstone is serenity on behalf of the individual. Self-care can facilitate transitions, and it may also be an outcome of transitions. PMID:23807842
MacKinlay, Elizabeth B; Trevitt, Corinne
Providing spiritual care is about tapping into the concept of spirituality: core meaning, deepest life meaning, hope and connectedness. The search for meaning, connectedness and hope becomes more significant as older people are faced with the possibilities of frailty, disability and dementia. Spirituality, ageing and meaning in life can be discussed in the context of an alternative view of "successful ageing". A model of spiritual tasks in older age can help explain the spiritual dimension and provide a starting point for spiritual assessment.
Rosenstein, Alan H; O'Daniel, Michelle
Disruptive behavior can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behavior occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behavior in neurologists compared to most other nonsurgical specialties. Disruptive behavior causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Health care organizations need to be aware of the significance of disruptive behaviors and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behavior. Having a better understanding of what contributes to, incites, or provokes disruptive behaviors will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team.
Care staff training in residential homes for managing behavioural and psychological symptoms of dementia based on differential reinforcement procedures of applied behaviour analysis: a process research.
Noguchi, Dai; Kawano, Yoshiyuki; Yamanaka, Katsuo
Previous studies of care staff training programmes for managing behavioural and psychological symptoms of dementia (BPSD) based on the antecedent-behaviour-consequence analysis of applied behaviour analysis have not included definite intervention strategies. This case study examined the effects of such a programme when combined with differential reinforcement procedures. We examined two female care home residents with dementia of Alzheimer's type. One resident (C) exhibited difficulty in sitting in her seat and made frequent visits to the restroom. The other resident (D) avoided contact with others and insisted on staying in her room. These residents were cared for by 10 care staff trainees. Using an original workbook, we trained the staff regarding the antecedent-behaviour-consequence analysis with differential reinforcement procedures. On the basis of their training, the staff implemented individual care plans for these residents. This study comprised a baseline phase and an intervention phase (IN) to assess the effectiveness of this approach as a process research. One month after IN ended, data for the follow-up phase were collected. In both residents, the overall frequency of the target behaviour of BPSD decreased, whereas the overall rate of engaging in leisure activities as an alternative behaviour increased more during IN than during the baseline phase. In addition, the overall rate of staff actions to support residents' activities increased more during IN than during the baseline phase. However, the frequency of the target behaviour of BPSD gradually increased during IN and the follow-up phase in both residents. Simultaneously, the rate of engaging in leisure activities and the staff's treatment integrity gradually decreased for C. The training programme was effective in decreasing BPSD and increasing prosocial behaviours in these two cases. However, continuous support for the staff is essential for maintaining effects.
Integrating chronic care with primary care activities: enriching healthcare staff knowledge and skills and improving glycemic control of a cohort of people with diabetes through the First Line Diabetes Care Project in the Philippines
Ku, Grace Marie V.; Kegels, Guy
Background This study investigated the effects of integrating primary chronic care with current healthcare activities in two local government health units (LGHU) of the Philippines on knowledge and skills of the LGHU staff and clinical outcomes for people with diabetes. Design Integration was accomplished through health service reorganization, (re)distribution of chronic care tasks, and training of LGHU staff. Levels of the staff's pre- and post-training diabetes knowledge and of their self-assessment of diabetes care-related skills were measured. Primary diabetes care with emphasis on self-care development was provided to a cohort of people with diabetes. Glycosylated hemoglobin (HbA1c) and obesity measures were collected prior to and one year after full project implementation. Results The training workshop improved diabetes knowledge (p<0.001) and self-assessed skills (p<0.001) of the LGHU staff. Significant reductions in HbA1c (p<0.001), waist–hip ratio (p<0.001) and waist circumference (p=0.011) of the cohort were noted. Although the reduction in HbA1c was somewhat greater among those whose community-based care providers showed improvement in knowledge and self-assessed skills, the difference was not statistically significant. Conclusions Primary care for chronic conditions such as diabetes may be integrated with other healthcare activities in health services of low-to-middle-income countries such as the Philippines, utilizing pre-existing human resources for health, and may improve clinical endpoints. PMID:25361726
Polivka, Larry; Zayac, Helen
Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer cost-effective community programs while operating within fixed, capped budgets. They have also been able to identify and maintain roles for informal caregivers, draw on community resources through donations and the use of volunteers, and create substantial political support. In this article we argue that the aging network should draw on these strengths to develop integrated long-term-care systems designed to shift the balance of state long-term-care systems from institutional to home- and community-based services. We also argue that the nonprofit aging network, because it is made up of area agencies on aging and service providers, provides a potentially more effective framework for the integration of long-term-care resources than do proprietary managed care organizations.
In 2014, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 60% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%). Aides accounted for 75% of all staffing hours in residential care communities, in contrast to activities staff members (11%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%). In adult day services centers, aides provided 41% of all staffing hours, followed by activities staff members (32%), registered nurses (12%), licensed practical or vocational nurses (9%), and social workers (6%).
Johnston, Kadija; Brinamen, Charles
As babies, toddlers, and preschoolers spend more and more time in child care programs, those programs have an increasingly significant effect on their healthy social and emotional development. The impact and quality of caregivers' relationships with children contribute to the quality of young children's mental health. A mental health consultant…
Walker, Bonnie L.; Harrington, Susan S.
Residential care board members, administrators, and caregivers were randomly assisted to injury prevention training: 38 computer based, 40 instructor led. Both groups significantly increased knowledge. The computer group enjoyed the training and had no difficulties even if they lacked computer experience. (Contains 20 references.) (SK)
Stefanski, Kasia E; Tracy, C Shawn; Upshur, Ross EG
Background The improvement of the quality of the evidence used in treatment decision-making is especially important in the case of patients with complicated disease processes such as HIV/AIDS for which multiple treatment strategies exist with conflicting reports of efficacy. Little is known about the perceptions of distinct groups of health care workers regarding various sources of evidence and how these influence the clinical decision-making process. Our objective was to investigate how two groups of treatment information providers for people living with HIV/AIDS perceive the importance of various sources of treatment information. Methods Surveys were distributed to staff at two local AIDS service organizations and to family physicians at three community health centres treating people living with HIV/AIDS. Participants were asked to rate the importance of 10 different sources of evidence for HIV/AIDS treatment information on a 5-point Likert-type scale. Mean rating scores and relative rankings were compared. Results Findings suggest that a discordance exists between the two health information provider groups in terms of their perceptions of the various sources of evidence. Furthermore, AIDS service organization staff ranked health care professionals as the most important source of information whereas physicians deemed AIDS service organizations to be relatively unimportant. The two groups appear to share a common mistrust for information from pharmaceutical industries. Conclusions Discordance exists between medical "experts" from different backgrounds relating to their perceptions of evidence. Further investigation is warranted in order to reveal any effects on the quality of treatment information and implications in the decision-making process. Possible effects on collaboration and working relationships also warrant further exploration. PMID:15245578
Tyler, Denise A; Parker, Victoria A
The purpose of this study was to describe the organizational factors associated with high and low amounts of teamwork among direct-care workers in long-term care (LTC) facilities. A systematic analysis of observation data collected at 20 LTC facilities was first used to categorize facilities as high-, moderate-, or low-teamwork facilities. Next, qualitative analysis of 59 interviews collected in 4 high-teamwork and 5 low-teamwork facilities was used to identify the organizational factors associated with high and low teamwork. Findings showed that high- and low-teamwork LTC facilities in this study differed in three organizational areas: management style, training, and feedback and recognition. As such, improved teamwork in LTC facilities may result from changes to basic management practices, such as training and employee feedback.
Hillen, Jodie B; Vitry, Agnes; Caughey, Gillian E
Given the growing aged care population, the complexity of their medication-related needs and increased risk of adverse drug events, there is a necessity to systematically monitor and manage medication-related quality of care. The aim of this systematic review was to identify and synthesise medication-related quality of care indicators with respect to application to residential aged care. MEDLINE (Ovid), Psychinfo, CINAHL, Embase and Google® were searched from 2001 to 2013 for studies that were in English, focused on older people aged 65+ years and discussed the development, application or validation of original medication-related quality of care indicators. The quality of selected articles was appraised using the Critical Appraisal Skills Program and psychometric qualities extracted and synthesised using content analysis. Indicators were mapped to six medication-related quality of care attributes and a minimum indicator set derived. Thirty three articles describing 25 indicator sets met the inclusion criteria. Thirteen (52%) contained prescribing quality indicators only. Eight (32%) were developed specifically for aged care. Twenty three (92%) were validated and seven (28%) assessed for reliability. The most common attribute addressed was medication appropriateness (n = 24). There were no indicators for evaluating medication use in those with limited life expectancy, which resulted in only five of the six attributes being addressed. The developed minimum indicator set contains 28 indicators representing 22 of 25 identified indicator sets. Whilst a wide variety of validated indicator sets exist, none addressed all aspects of medication-related quality of care pertinent to residential aged care. The minimum indicator set is intended as a foundation for comprehensively evaluating medication-related quality of care in this setting. Future work should focus on bridging identified gaps.
Takahashi, Ikuko; Turale, Sue
Internationally, it has been found that regular and timely hand washing is part of hand-hygiene practices that can reduce rates of infection in health-care facilities, but research has shown that there is a low level of compliance with hand washing in hospitals worldwide, including Japan. The number of aged-care facilities is growing throughout the world as our populations age, but hand-washing compliance appears even lower in such settings where there are vulnerable and frail elderly persons. This study used a correlational, cross-sectional design to clarify, for the first time, individual and facility factors related to the hand-washing behaviors of care staff at Japanese aged-care facilities. In 56 facilities (31 special nursing homes and 25 health-service facilities) in Yamaguchi Prefecture, data were gathered through survey questionnaires from care staff and facility managers. A total of 1323 (79.6%) questionnaires were returned and 1016 (61.1%) were analyzed. Using logistical regression analysis, two individual factors were investigated ("willingness to practice standard precautions" and "attendance at seminars") and two facility factors were investigated ("implementation of hand-washing evaluation" and "hand-washing environment"). These factors were found to promote hand washing, but no single factor was particularly related to its promotion in aged-care settings. If the health of elderly residents is to be better protected and infection rates lowered, especially in an era of increasing pandemics and epidemics, the compliance rate of health-care workers needs to be increased. We conclude that diverse approaches to both individual and facility factors are necessary to improve compliance with hand washing.
Noonan, Kelly; Corman, Hope; Schwartz-Soicher, Ofira; Reichman, Nancy E.
Objectives The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child’s development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Methods Using data from a national urban birth cohort study in the U.S., we estimate the effects of prenatal care on four markers of child health at age 5—maternal-reported health status, asthma diagnosis, overweight, and height. We implement a number of different strategies to address the issue of potential omitted variables bias as well as a large number of specification checks to validate the findings. Results and Conclusions Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children’s health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime helathcare on child health. PMID:22374319
Noonan, Kelly; Corman, Hope; Schwartz-Soicher, Ofira; Reichman, Nancy E
The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5-maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.
Guberman, Nancy; Lavoie, Jean-Pierre; Blein, Laure; Olazabal, Ignace
Purpose: Many Baby Boomers are faced with the care of aging parents, as well as that of disabled or ill spouses or children. This study examines how Baby Boomers in Quebec, Canada, perceive and play their role as caregivers and how this might differ from their parents' generation. Design and methods: This was a qualitative and empirical study…
ERS Spectrum, 1992
Innovative school-age day care programs include Tennessee's Extended School Program; Hawaii's After-School Plus program; San Antonio's Kid's Involvement Network (offering middle school supervision); Aurora, Colorado's state-licensed Year-Round School Recreation Plan; and Pomona, California's Child Development Program. These public school programs…
Chou, Shu-Chiung; Boldy, Duncan P.; Lee, Andy H.
Purpose: The aim of this study was to identify the important factors influencing residents' satisfaction in residential aged care and to provide a better understanding of their interrelationships. Design and Methods: A cross-sectional survey design was used to collect the required information, including resident satisfaction, resident dependency…
Hindle, Elise M; Henning, J D
Modern travel and military operations have led to a significant increase in the need to provide medical care in extreme climates. Presently, there are few data on what happens to the doctor, their drugs and equipment when exposed to these extremes. A review was undertaken to find out the effects of 'extreme heat or cold' on anaesthesia and critical care; in addition, subject matter experts were contacted directly. Both extreme heat and extreme cold can cause a marked physiological response in a critically ill patient and the doctor treating these patients may also suffer a decrement in both physical and mental functioning. Equipment can malfunction when exposed to extremes of temperature and should ideally be stored and operated in a climatically controlled environment. Many drugs have a narrow range of temperatures in which they remain useable though some have been shown to remain effective if exposed to extremes of temperature for a short period of time. All personnel embarking on an expedition to an extreme temperature zone should be of sufficient physical robustness and ideally should have a period of acclimatisation which may help mitigate against some of the physiological effects of exposure to extreme heat or extreme cold. Expedition planners should aim to provide climatic control for drugs and equipment and should have logistical plans for replenishment of drugs and medical evacuation of casualties.
East, Debora; Jacoby, Katherine
Complications related to central venous line use are known to increase patient morbidity and mortality and increase costs and length of hospital stay. Education programs to promote best central line practice have been shown to reduce central line complications. The purpose of this research was to demonstrate the effectiveness of an education module on staff compliance regarding central line care policy in the pediatric cardiovascular intensive care unit (CVICU). A quasi-experimental pre and post-test design was conducted in the CVICU at a major pediatrics hospital in the Southwest. A self-study module was distributed to all RN's working in the CVICU. Pre and post-test results were used to analyze the effectiveness of the education module. Compliance with central line care policy was scored as a "yes" or "no" based upon 10 observable policy requirements. Data was collected on 47 patients over a 1 to 2-month period pre and post intervention during rounds in the CVICU. Results show a marked improvement in compliance with policy.
Collins, Sandra K; Collins, Kevin S
With the workforce growing older and the supply of younger workers diminishing, it is critical for health care managers to understand the factors necessary to capitalize on their vintage employees. Retaining this segment of the workforce has a multitude of benefits including the preservation of valuable intellectual capital, which is necessary to ensure that health care organizations maintain their competitive advantage in the consumer-driven market. Retaining the aging employee is possible if health care managers learn the motivators and training differences associated with this category of the workforce. These employees should be considered a valuable resource of human capital because without their extensive expertise, intense loyalty and work ethic, and superior customer service skills, health care organizations could suffer severe economic repercussions in the near future.
Mort, Maggie; Roberts, Celia; Callén, Blanca
In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. 'Telecare' technologies are heavily promoted to assist ageing-in-place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the 'telehome' as the solution to the problem of the 'age dependency ratio'. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of 'technogenarians' and 'shared work' to illuminate our analysis of telecare in use. Drawing on European-funded research we argue that home-monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non-use and 'misuse' in daily practice. We propose that re-imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co-production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.
O'Donnell, Marguerite; Harris, Tony; Horn, Terancita; Midamba, Blondelle; Primes, Vickie; Sullivan, Nancy; Shuler, Rosalyn; Zabarsky, Trina F; Deshpande, Abhishek; Sunkesula, Venkata C K; Kundrapu, Sirisha; Donskey, Curtis J
Hand hygiene by patients may prevent acquisition and dissemination of health care-associated pathogens, but limited efforts have been made to engage patients in hand hygiene interventions. In a long-term care facility, we found that residents were aware of the importance of hand hygiene, but barriers, such as inaccessible products or difficult to use products, limited compliance. A dramatic and sustained improvement in meal time hand hygiene was achieved through engagement of staff and residents.
Hession, Peter M; Millward, Cynthia J; Gottesfeld, Joyce E; Rehring, Thomas F; Miller, Kevin B; Chetham, Paul M; Muckleroy, S Kel; Bates, Christopher A; Hollis, Harris W
Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge. The purpose of this article is to share a care pathway developed by a multidisciplinary group at a community teaching hospital. Post hoc analysis of a complicated case of AFE resulted in development of this pathway, which addresses many of the major consequences of AFE. We offer this algorithm as a template for use by any institution willing to implement a clinical pathway to treat AFE. It is accompanied by the remarkable case outcome that prompted its development.
Hession, Peter M; Millward, Cynthia J; Gottesfeld, Joyce E; Rehring, Thomas F; Miller, Kevin B; Chetham, Paul M; Muckleroy, S Kel; Bates, Christopher A; Hollis, Harris W
Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge. The purpose of this article is to share a care pathway developed by a multidisciplinary group at a community teaching hospital. Post hoc analysis of a complicated case of AFE resulted in development of this pathway, which addresses many of the major consequences of AFE. We offer this algorithm as a template for use by any institution willing to implement a clinical pathway to treat AFE. It is accompanied by the remarkable case outcome that prompted its development. PMID:27541321
Lee, Tzong-Nan; Lin, Jin-Ding; Yen, Chia-Feng; Loh, Ching-Hui; Hsu, Shang-Wei; Tang, Chi-Chieh; Wu, Jia-Ling; Fang, Wen-Hui; Chu, Cordia M.
The purposes of the present study were to determine whether extrinsic high-effort/low-reward conditions at work are associated with personal characteristics and the organizational environments. A cross-sectional survey was conducted (76.7% response rate, N = 1243) by recruiting the staff caring for people with intellectual disabilities of Taiwan…
Madsen, Emily K.; Peck, Janelle A.; Valdovinos, Maria G.
In working with individuals with intellectual and developmental disabilities (IDDs), it is direct care staff who are often required to collect data on individuals' behavior which is used as the basis for implementation of empirically based approaches for intervention and treatment. Due to limited resources, indirect and descriptive measures of…
Schreyer, Inge; Krause, Martin
This article investigates links between staff working conditions in children's day care centres ("Kindertageseinrichtungen"--known as "Kitas" in Germany), job satisfaction, commitment and perceived stress at work. Data are based on the nationwide, representative questionnaire survey AQUA ("Arbeitsplatz und Qualität in…
Wiese, Michele; Stancliffe, Roger J.; Balandin, Susan; Howarth, Glennys; Dew, Angela
Background: The aim of this study was to explore the current status of end-of-life care and dying of people with intellectual disability based on the experiences of staff in community living services. Materials and Methods: Focus groups and individual interviews were conducted, guided by grounded theory methodology. Results: The current status of…
Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham
Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support people with ID to engage in physical activity. Regression analyses indicated that perceived behavioural control was the most significant predictor of both care staff intention to facilitate physical activity and reported physical activity levels of the people they supported. Attitudes significantly predicted care staff intention to support physical activity, but this intention was not itself significantly predictive of reported activity levels. Increasing carers' sense of control over their ability to support clients' physical activity may be more effective in increasing physical activity than changing their attitudes towards promoting activity.
Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham
Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy…
Engström, Maria; Ljunggren, Birgitta; Lindqvist, Ragny; Carlsson, Marianne
We measured staff members' satisfaction with their work before and after increased information technology (IT) support in dementia care. Comparisons were also performed of perceived life satisfaction and sense of coherence. Data were collected before, and 6 and 12 months after implementation of the first part of an IT support project. Instruments used were the Satisfaction with Work Questionnaires, the Life Satisfaction Questionnaire (LSQ) and the Sense of Coherence (SOC) scale. The study was performed in a residential home for persons with dementia. The participants were 33 staff members. The IT technology included general and individualized passage alarms, sensor-activated night-time illumination, fall detectors and Internet communication. Results showed that staff members' job satisfaction and perceived quality of care improved in comparison with the control group. Personal development, workload, expectations and demands, internal motivation and documentation, as well as the total scores for "psychosocial aspects of job satisfaction" and "quality of care aspects", increased in the experimental group. There were significant interaction effects for the factors family relation, close friend relation (LSQ), the total SOC scale and the meaningfulness subscale. The study showed that IT support in dementia care increased staff members' satisfaction with their work in several ways.
Maggio, Lauren A.; Steinberg, Ryan M.; Willinsky, John
Introduction Through funding agency and publisher policies, an increasing proportion of the health sciences literature is being made open access. Such an increase in access raises questions about the awareness and potential utilization of this literature by those working in health fields. Methods A sample of physicians (N=336) and public health non-governmental organization (NGO) staff (N=92) were provided with relatively complete access to the research literature indexed in PubMed, as well as access to the point-of-care service UpToDate, for up to one year, with their usage monitored through the tracking of web-log data. The physicians also participated in a one-month trial of relatively complete or limited access. Results The study found that participants' research interests were not satisfied by article abstracts alone nor, in the case of the physicians, by a clinical summary service such as UpToDate. On average, a third of the physicians viewed research a little more frequently than once a week, while two-thirds of the public health NGO staff viewed more than three articles a week. Those articles were published since the 2008 adoption of the NIH Public Access Policy, as well as prior to 2008 and during the maximum 12-month embargo period. A portion of the articles in each period was already open access, but complete access encouraged a viewing of more research articles. Conclusion Those working in health fields will utilize more research in the course of their work as a result of (a) increasing open access to research, (b) improving awareness of and preparation for this access, and (c) adjusting public and open access policies to maximize the extent of potential access, through reduction in embargo periods and access to pre-policy literature. PMID:26200794
Mackinlay, Elizabeth; Trevitt, Corinne
Spiritual reminiscence is a way of telling a life story with emphasis on meaning. Spiritual reminiscence can identify meaning associated with joy, sadness, anger, guilt, or regret. Exploring these issues in older age can help people to reframe some of these events and come to new understanding of the meaning and purpose of their lives. A total of 113 older adults with dementia, living in aged-care facilities, participated in this study. They were allocated to small groups for spiritual reminiscence, to meet weekly over 6weeks or 6months. Quantitative data were gathered using a behavioural scale before and after each spiritual reminiscence session. Qualitative data included taped and transcribed reminiscence sessions, individual interviews, and observer journals. A facilitator led the small-group discussion based on spiritual reminiscence. New relationships were developed among group members that improved life for these people in aged care. This paper examines aspects of the qualitative data around the themes of 'meaning in life' and 'vulnerability and transcendence'. Spiritual reminiscence offers nursing staff a way of knowing those with dementia in a deeper and more meaningful way.
By 2050, it is predicted that 26% of the population will be aged 80 and over. Although older people have much to contribute, one challenging aspect of an aging population is the increasing rate of dementia. Palliative care is now included as part of the care pathway of a wide variety of nonmalignant diseases. The European Association for Palliative Care (EAPC) and the European Union Geriatric Medicine Society (EUGMS) have jointly called for every older citizen with chronic disease to be offered the best possible palliative care approach wherever they are cared for. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D
Vascular access infections are of concern to hemodialysis patients and nurses. Best demonstrated practices (BDPs) have not been developed for home hemodialysis (HHD) access use, but there have been generally accepted practices (GAPs) endorsed by dialysis professionals. We developed a survey to gather information about training provided and actual practices of HHD patients using the NxStage System One HHD machine. We used GAP to assess training used by nurses to teach HHD access care and then assess actual practice (adherence) by HHD patients. We also assessed training and adherence where GAPs do not exist. We received a 43% response rate from patients and 76% response from nurses representing 19 randomly selected HHD training centers. We found that nurses were not uniformly instructing HHD patients according to GAP, patients were not performing access cannulation according to GAP, nor were they adherent to their training procedures. Identification of signs and symptoms of infection was commonly trained appropriately, but we observed a reluctance to report some signs and symptoms of infection by patients. Of particular concern, when aggregating all steps surveyed, not a single nurse or patient reported training or performing all steps in accordance with GAP. We also identified practices for which there are no GAPs that require further study and may or may not impact outcomes such as infection. Further research is needed to develop strategies to implement and expand GAP, measure outcomes, and ultimately develop BDP for HHD to improve infectious complications. PMID:25154423
Longo, G; Bembi, B; Benussi, G; Carrara, F
A system for auditing quality of care and increasing effectiveness was applied to a health screening program for school-age children and the results were analyzed during 2 subsequent years. A problem-oriented record to be filled in whenever the screening was positive represented the basic tool for the evaluation. The record was sent to the specialist who was requested to make a diagnostic assessment and a treatment plan. The same record returned back to the first-level staff thus providing feedback information about diagnostic accuracy and effectiveness of the screening. Periodic self-evaluation meetings and a tutorial system for diagnostic procedures were instituted leading to a general improvement in quality indexes.
Kaiser, Robert M; Kaiser, Susan L
As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous. The patient and family are not consistently listened to, or integrated, into the clinical team. We recount our experiences of one hospitalization and how we addressed the recurring obstacles we faced. Our training and experience gave us a firm understanding of the hazards of hospitalizing an elderly person and the need to be present, engaged, attentive, active, and vigilant. We caught and corrected major mistakes: failure to follow-up abnormal test results, multiple medication errors, undertreatment of pain, poor fall prevention, and inappropriate assessment and placement for rehabilitation. In a dysfunctional health care system, the family is, and must be, the ultimate fail-safe mechanism. We identify potentially effective solutions for the problems we encountered: adoption of dementia-sensitive and patient- and family-centered care, improved communication, better management of information (including better systems for monitoring lab results and for dispensing and reconciling medications), expediting care, changing reimbursement and regulation, and improving discharge planning and placement.
Shah, Melissa Ford; Liu, Qinghua; Mark Eddy, J; Barkan, Susan; Marshall, David; Mancuso, David; Lucenko, Barbara; Huber, Alice
This study examines risk and protective factors associated with experiencing homelessness in the year after "aging out" of foster care. Using a state-level integrated administrative database, we identified 1,202 emerging adults in Washington State who exited foster care between July 2010 and June 2012. Initial bivariate analyses were conducted to assess the association between candidate predictive factors and an indicator of homelessness in a 12-month follow-up period. After deploying a stepwise regression process, the final logistic regression model included 15 predictive factors. Youth who were parents, who had recently experienced housing instability, or who were African American had approximately twice the odds of experiencing homelessness in the year after exiting foster care. In addition, youth who had experienced disrupted adoptions, had multiple foster care placements (especially in congregate care settings), or had been involved with the juvenile justice system were more likely to become homeless. In contrast, youth were less likely to experience homelessness if they had ever been placed with a relative while in foster care or had a high cumulative grade point average relative to their peers.
Camp directors can motivate staff by showing they are valued. Acknowledging positive actions, throwing a staff party, providing relief time, and being a good role model are all good motivators. Weekly staff meetings keep staff informed and provide time to air problems and get feedback. Keeping in touch with staff during the off-season is also…
Liebig, Phoebe S
Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve nonaged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.
Baker, Jess Rose; Harrison, Fleur; Low, Lee-Fay
The aim of the study was to develop and validate measures of client engagement in aged homecare. The Homecare Measure of Engagement-Staff questionnaire (HoME-S) is a self-complete measure of six dimensions of client engagement: client acceptance, attention, attitude, appropriateness, engagement duration and passivity. The Homecare Measure of Engagement-Client/Family report (HoME-CF) is a researcher-rated interview which obtains client and/or family perspectives regarding frequency and valence of conversational and recreational engagement during care worker visits. Care workers (n = 84) completed the HoME-S and a measure of relationship bond with client. Researchers interviewed clients (n = 164) and/or their family (n = 117) and completed the HoME-CF, and measures of agitation, dysphoria, apathy and cognitive functioning. The HoME-S and HoME-CF demonstrated good test-retest and inter-rater reliability, and showed significant negative correlations with apathy, agitation and non-English-speaking background. Controlling for client and care service characteristics, a stronger care worker-client relationship bond and English-speaking background were independently associated with higher HoME-S scores, and apathy was independently associated with higher HoME-CF scores. In conclusion, the HoME-S and HoME-CF are psychometrically sound engagement measures for use in homecare. Clients who are apathetic or from non-English-speaking backgrounds may be less responsive to traditional care worker engagement strategies. Engagement may be augmented in clients who have stronger relationships with their care workers.
... Neutron-Absorbing Materials Other Than Boraflex; Notice of Availability AGENCY: Nuclear Regulatory... Interim Staff Guidance (LR-ISG), LR-ISG-2009-01, ``Aging Management of Spent Fuel Pool Neutron-Absorbing... loss of material and loss of neutron-absorbing capability of certain nuclear power plant spent...
Tzeng, Yu-Fen; Gau, Bih-Shya
This research applied the Ecological System Theory of Dr. Bronfenbrenner (1979) to evaluate and analyze the impact of a school-age asthmatic child's ecological environment on the child's development. This project ran from March 16th to April 16th, 2010. A full range of data was collected during clinical care, outpatient follow-up services, telephone interviews, home visits, and school visits and then identified and analyzed. Results indicated that the family, household environment, campus, teachers, classmates, physical education program, and medical staffs comprised the most immediate microsystem and that parents, school nurses, teachers, and classmates formed the child's mesosystem. Researchers found a lack of understanding and appreciation in the mesosystem regarding asthmatic patient care needs. Hidden factors in the environment induced asthma, which eventually caused the child to be unable to obtain necessary medical care assistance. The exosystem reflected adequacy of the family social economy. The father's flexible working hours allowed him to allocate more time to childcare responsibilities. The government Asthma Medical Payment program also facilitated effective care. The macrosystem demonstrated parental cognition related to asthma treatment and caring to be deeply influenced by local customs. Thus, rather than using advanced medical treatments, parents preferred to follow traditional Chinese medicinal practices. Evaluation using the Ecological of Human Development Theory showed the subject's ecology environment relationships as based upon a foundation of family and school. Therefore, active family and school support for an asthma management plan appropriate to the subject's needs was critical. Asthma symptoms were better controlled after the child and his parents invested greater effort in mastering asthma management protocols.
DuBeau, Catherine E.; Ouslander, Joseph G.; Palmer, Mary H.
Purpose: We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. Design and Methods: We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home…
Suarez, Alicia Elena; Redmond, Deidre
Staff who work in facilities such as health care, dentistry, drug treatment, and tattoo/body piercing are likely to encounter persons with hepatitis C virus (HCV) and be privy to their HCV status. The purpose of this paper is to assess staff comfort with varying levels of intimacy (i.e., social distance) with people who have HCV. We examine how previous contact with persons with HCV and knowledge of HCV including HCV specific training affect desire for social distance. Data are from a 2007 sample of 82 individuals working in health care, dentistry, drug treatment, or tattoo/body-piercing studios located in the Pacific Northwest region of the United States. Multivariate analyses indicate that staff desire social distance from persons with HCV, but contact of certain types reduce desire for social distance. We discuss how the findings have implications for people employed in these fields, as they point to the need to dispel myths and reduce fear among staff working in facilities that may serve persons with HCV.
... Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing Dressing & Grooming Dental Care Medical ... communicate with staff Staffing Medical care is provided Personal care and assistance is provided Staff recognize persons ...
Peisah, Carmelle; Weaver, Judith; Wong, Lisa; Strukovski, Julie-Anne
Background Pain is common in older people, particularly those in residential aged care facilities (RACF) and those with dementia. However, despite 20 years of discourse on pain and dementia, pain is still undetected or misinterpreted in people with dementia in residential aged care facilities, particularly those with communication difficulties. Methods A topical survey typology with semistructured interviews was used to gather attitudes and experiences of staff from 15 RACF across Northern Sydney Local Health District. Results While pain is proactively assessed and pain charts are used in RACF, this is more often regulatory-driven than patient-driven (eg, prior to accreditation). Identification of pain and need for pain relief was ill defined and poorly understood. Both pharmacological and non-pharmacological regimes were used, but in an ad hoc, variable and unsystematic manner, with patient, staff, and attitudinal obstacles between the experience of pain and its relief. Conclusion A laborious “pain communication chain” exists between the experience of pain and its relief for people with severe dementia within RACF. Given the salience of pain for older people with dementia, we recommend early, proactive consideration and management of pain in the approach to behaviors of concern. Individualized pain measures for such residents; empowerment of nursing staff as “needs interpreters”; collaborative partnerships with common care goals between patients where possible; RACF staff, doctors, and family carers; and more meaningful use of pain charts to map response to stepped pain protocols may be useful strategies to explore in clinical settings. PMID:25342895
Acquavita, Shauna P.; Stershic, Sandra; Sharma, Rajni; Stitzer, Maxine
Interventions for improving transition from short-term residential to outpatient treatment were examined. Usual care (UC; N = 114) was referral to a preferred outpatient program with advance appointment optional. Client Incentive (CI; N = 97) offered up to $100 in gift cards for intake and attendance during the first 30 days of treatment. Contracting with staff incentives (CSI; N = 49) consisted of meeting with an outpatient counselor prior to residential discharge, signing an attendance contract, receiving an appointment and payment to staff if clients attended. CSI significantly improved rates of successful transition (84%) and admission (74%) compared to UC (64% contact; 49% admitted). CI did not result in significantly improved outcomes (74%; 60%). CSI was likely mediated by the reliability (92% vs 52% in UC) and immediacy (1.0 vs 3.9 days) of appointment scheduling. This study supports use of CSI for improving rates of transition between residential and outpatient continuing care treatment. PMID:23375361
Background The subject site (Ian George Court) caters for clients from a socially disadvantaged background. All clients have been homeless or at risk of homelessness and have a history of alcohol and substance abuse often linked to mental health issues. This project was developed to examine if the site provided best practice in the promotion of smoking cessation. Objectives The first objective of this project was to improve client knowledge to make informed choice about smoking cessation, ensuring that client advice was given in line with best available evidence and assist the client in accessing community programs. The second objective was to fully review the current assessment tool used in relation to gathering baseline data about smoking habits and act on the information provided. Search strategy The search strategy sought to find published studies and papers. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of the text words contained in the title and abstract. A second extensive search was then undertaken using all identified keywords. Conclusion A smoking assessment tool was developed and is now in use across all Anglicare sites in South Australia. This provides staff with consistent baseline information and offers evidence-based health care in a package format to aid clients in smoking cessation.
Walker, Bonnie L.; Harrington, Donna
Four learning modules on elderly sexuality were pilot tested with 109 long-term care staff. On pretests men and whites scored higher than women and African-Americans. Knowledge and attitude improvements resulted from use of modules on the need for sexuality/intimacy, sex and dementia, and sex and aging, but not the family/personal issues module.…
Chang, Yin-Yu; Yu, Shu-Man; Lai, Yun-Ju; Wu, Ping-Lun; Huang, Kuo-Chin; Huang, Hsien-Liang
Since implementation of the New Smoking Cessation Policy in Taiwan, more patients are attending smoking cessation clinics. Many of these patients were referred by hospital staff. Thus, factors which influence the hospital staff's willingness to refer are important. In this study, we aim to understand the relation between smoking cessation knowledge and willingness for referral. A cross-sectional study using a questionnaire was conducted with staff of a community hospital during the year 2012-2013. Willingness to provide smoking cessation referral and relevant correlated variables including demographic data, knowledge of basic cigarette harm, and knowledge of resources and methods regarding smoking cessation were measured. A total of 848 of 1500 hospital staff returned the questionnaire: 249 physicians (29.4%), 402 nursing staff (47.4%), and 197 administration staff (23.2%). 790 (93.2%) staff members have never smoked, 19 (2.2%) had quit smoking, and 39 (4.6%) still smoke. 792 (93.4%) members had interest in receiving smoking cessation education. The mean total score (highest potential score of 6) of basic cigarette harm knowledge was 4.56 (± 1.25). The mean total score (highest potential score of 7) of resources and methods about smoking cessation was 4.79 (± 1.35). The significant variable correlated with willingness to refer was total score of resources and methods about smoking cessation. Hospital staff who knew more about resources and methods about smoking cessation were more willing to refer smoking patients to the smoking cessation service. Thus, continuing medical education for hospital staff should include resources and methods about smoking cessation to promote smoking cessation.
Khatutsky, Galina; Anderson, Wayne L; Wiener, Joshua M
We analyzed survey data from 2,325 Medicaid home and community-based services (HCBS) beneficiaries in six States to estimate satisfaction with personal care services. We constructed an eight-item scale rating various aspects of paid assistance and estimated satisfaction for the total sample and for older and younger persons with disabilities. Younger persons with significant health problems and those residing in group settings were less satisfied. Higher unmet need for assistance with activities of daily living (ADLs), and instrumental activities of daily living (IADLs) was associated with decreased satisfaction, and matching race between a client and paid caregiver was associated with significantly increased satisfaction in all age groups.
Smith, Thomas J; Schoenbeck, Kathleen; Clayton, Sandra
This study collected staff responses to an occupancy quality survey before, and 6 and 22 months after, St. Paul Children's Hospitals and Clinics (CHC) replaced an open bay (OB) with a private room (PR) neonatal intensive care unit (NICU) design. Staff interview responses and task activity observations also were collected. The goal was to assess how this change would influence staff perceptions and performance. As a result of the transition from the OB to the PR environment: (1) rankings of overall physical environment, patient care, job, technology, and off-the-job quality significantly improved; but (2) rankings of patient care team interaction quality significantly declined. Results for the 22-month PR survey indicate essentially no meaningful changes in rankings of occupancy quality from the 6-month survey, suggesting no consolidation of quality gains in the intervening 16-month period. Written comments pertaining to private room NICU design issues by survey respondents, targeting problems with unit operations, may explain this finding. Collectively, the findings suggest that NICU operational management was not effectively modified to deal with the new design, and that an OB to PR NICU transition requires a systems approach to macroergonomic challenges imposed by the new design.
Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen
Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes.
This manual was designed to assist concerned individuals and organizations within communities in New Mexico to develop and plan effective school-age child care programs. Emphasized are the first steps in initiating and implementing school-age child care in a community. Chapter I discusses the need for school-age child care programs and the…
Aberdeen, Sue; Angus, Jocelyn
The concept of leadership is frequently used in aged-care service provision. Yet, it is a concept that is not well understood or defined. This paper reports on a systematic review of national and international multi- disciplinary aged-care literature (1999 to 2004) to identify the attributes and functions of leaders in aged-care delivery systems.…
Kaur, Harsheen; Rohlik, Gina M; Nemergut, Michael E; Tripathi, Sandeep
Noise and excessive, unwanted sound in the Pediatric Intensive Care Unit (PICU) is common and has a major impact on patients' sleep and recovery. Previous research has focused mostly on absolute noise levels or included only staff as respondents to acknowledge the causes of noise and to plan for its reduction. Thus far, the suggested interventions have not ameliorated noise, and it continues to serve as a barrier to recovery. In addition to surveying PICU providers through internet-based software, patients' families were evaluated through in-person interviews utilizing a pretested instrument over 3 months. Families of patients admitted for more than 24 h were considered eligible for evaluation. Participants were asked to rank causes of noise from 1 to 8, with eight being highest, and identified potential interventions as effective or ineffective. In total, 50 families from 251 admissions and 65 staff completed the survey. Medical alarms were rated highest (mean ± standard deviation [SD], 4.9 ± 2.1 [2.8-7.0]), followed by noise from medical equipment (mean ± SD, 4.7 ± 2.1 [2.5-6.8]). This response was consistent among PICU providers and families. Suggested interventions to reduce noise included keeping a patient's room door closed, considered effective by 93% of respondents (98% of staff; 88% of families), and designated quiet times, considered effective by 82% (80% of staff; 84% of families). Keeping the patient's door closed was the most effective strategy among survey respondents. Most families and staff considered medical alarms an important contributor to noise level. Because decreasing the volume of alarms such that it cannot be heard is inappropriate, alternative strategies to alert staff of changes in vital signs should be explored.
Lee, Tzong-Nan; Lin, Jin-Ding; Yen, Chia-Feng; Loh, Ching-Hui; Hsu, Shang-Wei; Tang, Chi-Chieh; Wu, Jia-Ling; Fang, Wen-Hui; Chu, Cordia M
The purposes of the present study were to determine whether extrinsic high-effort/low-reward conditions at work are associated with personal characteristics and the organizational environments. A cross-sectional survey was conducted (76.7% response rate, N=1243) by recruiting the staff caring for people with intellectual disabilities of Taiwan in 2006. Conditions at work were measured using Siegrist's Effort-Reward Imbalance (ERI) model, the questionnaire included 23 Likert scaled items and it divided into three scales: effort, reward and overcommitment. Multiple logistic regression modeling was conducted for extrinsic high-effort/low-reward status in relation to staff and working environmental factors. We found that 15.1% staff were in the low-effort/low-reward group, 35.9% was in the low-effort/high-reward group, 17.9% belonged to the high-effort/high-reward group and 31.1% was included in the high-effort/low-reward group. Controlling for many personal demographic and organizational characteristics, the factors of perceived job support (OR=0.91; 95% CI=0854-0.97), job control (OR=0.954, 95% CI=0.934-0.974), job demand (OR=1.155, 95% CI=1.109-1.203) and job stress (felt sometimes stressful compare to no stress at all, OR=2.305, 95% CI=1.161-4.575) of the staff were significantly correlated to the extrinsic high effort/low reward at work in the multiple logistic regression model. The present study highlights that the service providers need to be aware and understand the experiences that their staff encounters in the organizational, interpersonal and personal level regarding unfair working conditions such as high effort/low reward to improve the positive health of the staff.
LaMantia, Michael A; Perkins, Anthony J; Gao, Sujuan; Austrom, Mary G; Alder, Cathy A; French, Dustin D; Litzelman, Debra K; Cottingham, Ann H; Boustani, Malaz A
Objective To evaluate the effect of the Aging Brain Care (ABC) Medical Home program’s depression module on patients’ depression severity measurement over time. Design Retrospective chart review. Setting Public hospital system. Participants Patients enrolled in the ABC Medical Home program between October 1, 2012 and March 31, 2014. Methods The response of 773 enrolled patients who had multiple patient health questionnaire-9 (PHQ-9) scores recorded in the ABC Medical Home program’s depression care protocol was evaluated. Repeatedly measured PHQ-9 change scores were the dependent variables in the mixed effects models, and demographic and comorbid medical conditions were tested as potential independent variables while including random effects for time and intercept. Results Among those patients with baseline PHQ-9 scores >10, there was a significant decrease in PHQ-9 scores over time (P<0.001); however, the effect differed by gender (P=0.015). On average, women’s scores (4.5 point drop at 1 month) improved faster than men’s scores (1 point drop at 1 month). Moreover, both men and women had a predicted drop of 7 points (>50% decline from baseline) on the PHQ-9 at 6 months. Conclusion These analyses demonstrate evidence for the sustained effectiveness of the ABC Medical Home program at inducing depression remission outcomes while employing clinical staff who required less formal training than earlier clinical trials. PMID:27826188
Hanssen, Helene; Norheim, Anne; Hanson, Elizabeth
It is a central feature of current Norwegian health and social care policy to see informal carers as active partners. However, research has revealed that carers often experience a lack of recognition by professionals. In 2010, the Norwegian Directorate of Health initiated a web-based competence-building programme (CBP) for health and social care practitioners aimed at facilitating collaboration with carers. The programme comprised case presentations, e-lectures, exercises and topics for discussion, and was introduced in 2012. It was flexible and free of charge. This article is based on a study (2012-2013) that followed the piloting of this CBP in four settings. The study aimed to explore factors that influenced the implementation of the programme and whether or not using it affected health and social care practitioners' attitudes and perceived capacity for collaboration with carers. The study employed a mixed-methods design. A questionnaire was distributed to all staff before and 5 months after the CBP was introduced, followed by focus group interviews with a sample of staff members and individual interviews with the leadership in the involved settings and those who introduced the programme. The quantitative data were analysed using descriptive statistics, which subsequently formed the basis for the focus group interviews. The qualitative data were analysed by means of content analysis. The programme's introduction was similar across all research settings. Nevertheless, whether or not it was adopted depended to a large extent on leadership commitment and engagement. In settings where the programme's use was monitored, supported by management and formed part of on-the-job training, there seemed to be a positive impact on staff attitudes concerning collaboration with carers. Participant staff reported that their awareness of, motivation for and confidence in collaboration with carers were all strengthened. In contrast, the programme was of minimal benefit in
da Motta, Luciana Branco; Caldas, Célia Pereira; de Assis, Mônica
The training of professionals in the field of healthcare for the aged is one of the priorities of the national policy for the aged in Brazil due to the accelerated aging of the population. The Núcleo de Atenção ao Idoso (NAI), a unit of the Open University of the Third Age/UERJ (UNATI/UERJ) develops an educational program in this field, based on practical care delivery with emphasis to inter-disciplinarity and teamwork. The program includes different training levels and modalities: Residency, Specialization, Professional Practice and Graduation. The program includes an introductory course in gerontology and geriatrics common to all areas, and specific theoretical-practical qualification coordinated by the professional staff from the respective areas. The practical activities occur in different sceneries: long term care institutions, health promotion educational settings, outpatient facilities and the university hospital. Interdisciplinary thinking and acting is a continuous exercise, and the team should be open to innovative strategies. The experience is a contribution to the increasing social demand for qualified professionals committed with the principles of the Unified Health System and integrated health care.
Sellen, P N; Jagger, D C; Harrison, A
As part of the development of a guide to aid the undergraduate in the selection of artificial teeth, the aim of this study was to investigate the variability in choice of dental staff to select teeth appropriate to the age and sex of the individual with the aid of a series of three-dimensional guides. Four three-dimensional guides were produced for use in the study. Fifty dentists were asked to complete a questionnaire designed to assess the variability in selection of anterior teeth appropriate for the age and sex of an individual. From this study it can be concluded that there was little consistency in the selection of the shade, mould and arrangement of anterior teeth appropriate for the age and sex of the individual by qualified dental staff. The development and implementation of an aesthetic proforma to guide dental staff, dental undergraduates and patients through the process of choosing tooth mould, shade and arrangement based on age and sex may be helpful.
You, Emily Chuanmei; Dunt, David; Doyle, Colleen
This study aimed to explore the perceptions of case managers about their roles in providing community aged care in Australia. Purposeful sampling was used and 33 qualitative semi-structured interviews with 47 participants were conducted. Participants were drawn from a list of all case managers working in aged care organisations that provided publicly funded case-managed community aged care programmes in the State of Victoria, Australia. Participant selection criteria included age, gender, job titles, professional backgrounds, practice locations, organisational attributes and organisational size. Data collection was implemented between September 2012 and March 2013. Thematic analysis was performed. Participants believed that case managers performed diverse roles based on clients' needs. They also articulated 16 important roles of case managers, including advisors, advocates, carers, communicators, co-ordinators, educators, empowering clients, engaging clients and families, liaising with people, managing budgets, navigators, negotiators, networking with people, facilitators, problem solvers and supporters. However, they were concerned about brokers, mediators and counsellors in terms of the terminology or case managers' willingness to perform these roles. Moreover, they perceived that neither gatekeepers nor direct service provision was case managers' role. The findings of this study suggest that case managers working in community aged care sectors may be more effective if they practised the 16 roles aforementioned. With the value of helping rather than obstructing clients to access services, they may not act as gatekeepers. In addition, they may not provide services directly as opposed to their peers working in medical care settings. The findings will also assist organisations to design job descriptions specifying case managers' roles and associated job responsibilities. Clear job descriptions will further benefit the organisations in staff recruitment, orientation
Bergqvist, Anette; Karlsson, Maria; Foldemo, Anniqa; Wärdig, Rikard; Hultsjö, Sally
The aim of this study was to explore mental health staffs' experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the person's cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patient's terms and in his or her home environment.
Hutchison, Shari L; Terhorst, Lauren; Murtaugh, Stephanie; Gross, Sarah; Kogan, Jane N; Shaffer, Sherry L
The current study describes physical and mental health outcomes during a health promotion program for individuals with serious mental illness (SMI). A sample of 43 adults in a long-term residential facility volunteered for an individualized, healthy lifestyle program designed to promote physical activity and combat premature mortality among individuals with SMI. Nurses and residential counselors were trained in the program and encouraged to work collaboratively with the program's personal trainers. Weekly nutrition and activity logs were obtained over the year-long evaluation. Assessments of physical and psychological health indicators were collected quarterly. Qualitative data through focus groups described staff experience. Self-report of moderate and vigorous physical activity improved over time as did fitness level as measured through a walking challenge (p = .001). Significant decreases in weight (p < .001), BMI (p = .001), and total cholesterol (p < .001) were observed from baseline through 12 months. Mean recovery scores (RMQ) were significantly higher between baseline and all time points (p < .001). Participants reported decreasing levels of depression (PHQ-9) by the 12-month time point (p < .001). Staff encouraged participation in physical activity and observed improved motivation and socialization among participants. A health promotion program with participation encouraged by health care staff is effective for increasing physical activity and improving physical and mental health outcomes in individuals with SMI in long-term residential care.
Hunt, R W
Daniel Callahan has argued that economic and social benefits would result from a policy of withholding medical treatments which prolong life in persons over a certain age. He claims 'the real goal of medicine' is to conquer death and prolong life with the use of technology, regardless of the age and quality of life of the patient, and this has been responsible for the escalation of health care expenditure. Callahan's proposal is based on economic rationalism but there is little evidence to suggest that substantial economic savings could be achieved. Moreover, his argument raises serious moral objections. A policy of withholding treatments from members of a social group involves elements of compulsion and discrimination, both of which would intrude on the doctor-patient relationship, undermine the autonomy of elderly patients, and invoke the slippery slope towards involuntary forms of euthanasia. Life-death decisions should be based on more than the one criterion of age, and take account of more relevant factors such as the patient's usual state of well-being, her/his expressed wishes, informed consent and the type of illness. Any move to the implementation and enforcement of the policy Callahan recommends would be rejected by health professionals and the public. PMID:8459434
Wurm, Susanne; Wolff, Julia K; Schüz, Benjamin
Self-perceptions of aging, important indicators of successful aging, are closely linked to health. Previous research has mainly examined the role of individual factors on self-perceptions of aging, but health is partly dependent on contextual factors such as primary care supply. This study therefore examined whether the impact of diseases on self-perceptions of aging is buffered by primary care supply in the district, as it ensures sustained health care continuity. Nationally representative German survey data on health and self-perceptions of aging (N = 4,442, 40-85 years) were linked to primary care supply (general practitioner density in regional districts). Multilevel modeling shows that the impact of disease burden (multiple illnesses) was buffered by primary care supply: Disease burden was less strongly associated with negative self-perceptions of aging in districts with good primary health care supply. This underlines the importance of health care resources for successful aging.
Elbing, U; Rohmann, U H
This study evaluates the effects of an intensive therapy program designed for mentally handicapped persons with severely disturbed or autistic behavior on their staff personal which had an active role in the program. The staff members rated their professional competence, quality of interaction with the client, team culture and work satisfaction before and after being engaged in the program, with additional ratings of their personal aims at the beginning of the program. Three sets of data were obtained with the program being conducted three times in a row. The testings of the related as well as the independent samples show differentiated program effects. The main effect is an increase of the professional competence and quality of interaction, especially by the qualified staff members. Trainees put emphasis on the development of their personal relationship with the client. The results are discussed in terms of the impact of learning processes specific to the roles of the staff members and motivational factors on learning and therapy outcome, along with institutional conditions influencing successful learning. Thus the program facilitates the professional and interpersonal learning process of staff members in a specific way with success as well as with limitations.
Bergstrom, Joan M.; Dreher, Donna L.
As part of an evaluation of the existing Federal Interagency Day Care Requirements (FIDCR), this paper reviews the current regulations and presents recommendations for modifications in the requirements as they relate to group or family day care services for school age children from 5 to 14 years of age. The paper is divided into five major…
Madsen, Emily K; Peck, Janelle A; Valdovinos, Maria G
In working with individuals with intellectual and developmental disabilities (IDDs), it is direct care staff who are often required to collect data on individuals' behavior which is used as the basis for implementation of empirically based approaches for intervention and treatment. Due to limited resources, indirect and descriptive measures of challenging behaviors are employed to analyze the function of individuals' behaviors in place of the preferred method of multimodal assessment, which includes experimental functional analysis. To ensure the most effective services and support to individuals with IDDs, accurate and consistent data collection is critical. In this article, we highlight the importance of accurate data collection practices, conduct a comparison of data collection methods, and discuss limitations .… and barriers for staff. The article concludes with recommendations for best practices and future research.
Focuses on alternative self-care practices in terms of collaboration with the primary care physician and individual exploration of self-care practices such as acupuncture, meditation, and nutrition counseling. (JOW)
Delivery, immediate newborn and cord care practices in Pemba Tanzania: a qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices
Background Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial. Methods 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2. Results Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby’s first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and
Rus, Adrian V; Stativa, Ecaterina; Pennings, Jacquelyn S; Cross, David R; Ekas, Naomi; Purvis, Karyn B; Parris, Sheri R
The objective of this study was to determine whether children's characteristics and/or institutional characteristics were predictors of severe punishments (including beatings) and/or frequency of punishments that children received from staff in Romanian institutions. The data was hierarchical with institutionalized children (N=1391) nested within 44 institutions, and the measurement of punishments by the staff and frequency of punishments had a binary distribution. Thus, multilevel logistic regression models were used to examine the effects of individual and institutional level variables on reported punishments and to account for the clustering of the children within institutions. Two general patterns of results emerged. First, regarding individual level variables, it was found that: (1) amount of time spent by children in their current institutions had a significant effect on the probability of being punished by staff and the frequency of this punishment; (2) the probability of being punished was higher for boys than for girls; and (3) having no siblings in the institution increased the odds of being punished several times. Second, regarding institutional level variables: (4) being in placement centers for school-aged children with a traditional type of institutional organization increased the odds of severe punishment compared to a familial/mixed type. The results of the present study highlight the importance of understanding the consequences of institutionalization in a broader way, where children not only experienced early severe psychosocial deprivation as documented in other studies, but also high levels of severe punishments administered by institutional staff.
... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry and FDA Staff: Processing...: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is... with processing or reprocessing labeling. This draft guidance is not final; nor is it in effect at...
Singh, Nirbhay N.; Lancioni, Giulio E.; Winton, Alan S. W.; Singh, Ashvind N.; Adkins, Angela D.; Singh, Judy
Background: The use of physical restraints has generated immense controversy in the delivery of services to individuals with intellectual disabilities. The current "zeitgeist" is that effective positive approaches obviate the need for using physical restraints. In a multiple baseline design, we sought to assess how training staff members in…
Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon
Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.
... Piping and Tanks'' AGENCY: Nuclear Regulatory Commission. ACTION: Interim staff guidance; issuance....M41, `Buried and Underground Piping and Tanks'.'' This LR-ISG provides changes to the recommendations... applications' buried and underground piping and tanks AMPs and stakeholder input. The LR-ISG revises NRC...
Pain, Tilley; Stainkey, Lesley; Chapman, Sue
This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers.
... April 18, 2012 Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over ... and Roberto Valverde, M.P.H., Division of Health Care Statistics Abstract Objective —This report presents national estimates ...
Hutchison, Andrew; Kroese, Biza Stenfert
Research evidence reveals that adults with learning disabilities who live in residential care facilities are being exposed to considerable variation in the standards of care they receive. High profile cases of substandard care have also raised concerns regarding the appropriateness of existing care provisions and practices. While attempts have…
Novotná, Gabriela; Urbanoski, Karen A; Rush, Brian R
In this article we discuss the findings from a series of focus groups conducted as part of a 3-year, mixed-method evaluation of clinical programs in a large mental health and substance use treatment facility in Canada. We examined the perceptions of clinical personnel on the physical design of new treatment units and the impact on service delivery and the work environment. The new physical design appeared to support client recovery and reduce stigma; however, it brought certain challenges. Participants reported a compromised ability to monitor clients, a lack of designated therapeutic spaces, and insufficient workspace for staff. They also thought that physical design positively facilitated communication and therapeutic relationships among clinicians and clients, and increased team cohesion. We suggest that, from these findings, new avenues for research on achieving the important balance between client and staff needs in health facility design can be explored.
Aisling, Diamond; David, Curran
Setting Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? Participants Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107). Primary and secondary outcome measures The General Health Questionnaire (GHQ-12, Goldberg, 1972, 1978), Secondary Traumatic Stress Scale (STSS, Bride, 2004) and an assessment of need questionnaire were completed and explored using mixed method analysis. Results Results showed elevated levels of psychological distress within each profession except ambulance service clinical support officers (CSOs). Elevated levels of secondary trauma symptomatology were also found; the highest were within some nursing grades and junior doctors. Decreased enjoyment in job over time was significantly associated with higher scores. Analysis of qualitative data identified sources of stress to include low morale. A total of 65% of participants thought that work related stressors had negatively affected their mental health. Participants explored what they felt could decrease psychological distress including improved resources and psychoeducation. Conclusion There were elevated levels of distress and secondary traumatic stress within this population as well as an expressed level of need, on both systemic and support levels. PMID:27601762
Karner, Karen J.; Rheinheimer, David C.; DeLisi, Anne Marie; Due, Celestina
Hospital employees (n=95) who attended experiential workshops on aging had significantly higher posttest scores on the Palmore Facts on Aging Quiz, indicating increased knowledge and improved attitudes about aging. (SK)
Peters, Clark; Bell, Katie S. Claussen; Zinn, Andrew; Goerge, Robert M.; Courtney, Mark E.
Research has found that foster youth who remain in care beyond age 18 are more likely to participate in services and tend to have better outcomes than those who do not. However, not all youth eligible to remain in care beyond age 18 do so. This study examines Illinois, one of the few states that extends care up to age 21, to identify the major…
Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H
Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation.
Kemball-Cook, D.; Vaughan, J. P.
This report outlines a basic operational research model for estimating the coverage achieved by different distributions of primary health care staff and facilities, using antenatal home visiting as an illustrative example. Coverage is estimated in terms of the average number of patient contacts achieved per annum. The model takes into account such features as number of facilities and health workers per 10 000 population, the radius of the health facility area, the overall population density in the region, the number of working days in the year, and the health worker's travelling time and work rate. A theoretical planning situation is also presented, showing the application of the model in defining various possible strategies, using certain planning norms for new levels of staff and facilities. This theoretical model is presented as an example of the use of operational research in primary health care, but it requires to be tested and validated in known situations before its usefulness can be assessed. Some indications are given of the ways in which the model could be adapted and improved for application to a real planning situation. PMID:6602666
Deo, Maneka S; Vandal, Alain C; Jarrett, Paul
Objectives To estimate the prevalence of dermatological disease in aged care facilities, and the relationship between cognitive or physical disability and significant disease. Setting 2 large aged care facilities in Auckland, New Zealand, each providing low and high level care. Participants All 161 residents of the facilities were invited to participate. The only exclusion criterion was inability to obtain consent from the individual or designated guardian. 88 participants were recruited—66 females (75%), 22 males (25%) with average age 87.1 years (SD 5.5 years). Primary and secondary outcome measures Primary—presence of significant skin disease (defined as that which in the opinion of the investigators needed treatment or was identified as a patient concern) diagnosed clinically on full dermatological examination by a dermatologist or dermatology trainee. Secondary—functional and cognitive status (Rehabilitation Complexity Scale and Abbreviated Mental Test Score). Results 81.8% were found to have at least one significant condition. The most common disorders were onychomycosis 42 (47.7%), basal cell carcinoma 13 (14.8%), asteototic eczema 11 (12.5%) and squamous cell carcinoma in situ 9 (10.2%). Other findings were invasive squamous cell carcinoma 7 (8%), bullous pemphigoid 2 (2.3%), melanoma 2 (2.3%), lichen sclerosus 2 (2.3%) and carcinoma of the breast 1 (1.1%). Inflammatory disease was more common in those with little physical disability compared with those with serious physical disability (OR 3.69; 95% CI 1.1 to 12.6, p=0.04). No significant association was found between skin disease and cognitive impairment. Conclusions A high rate of dermatological disease was found. Findings ranged from frequent but not life-threatening conditions (eg, onychomycosis), to those associated with a significant morbidity (eg, eczema, lichen sclerosus and bullous pemphigoid), to potentially life-threatening (eg, squamous cell carcinoma, melanoma and breast cancer
Bourgeois, Michelle S; Brush, Jennifer; Elliot, Gail; Kelly, Anne
Efforts to improve the quality of life of persons with dementia in long-term care through the implementation of various approaches to person-centered care have been underway for the past two decades. Studies have yielded conflicting reports evaluating the evidence for these approaches. The purpose of this article is to outline the findings of several systematic reviews of this literature, highlighting the areas of improvement needs, and to describe a new person-centered care model, DementiAbility Methods: The Montessori Way. This model focuses on the abilities, needs, interests, and strengths of the person and creating worthwhile and meaningful roles, routines, and activities for the person within a supportive physical environment. This is accomplished through gaining the commitment of the facility's leaders, training staff, and monitoring program implementation. The potential for a culture change in long-term care environments is dependent on the development and rigorous evaluation of person-centered care approaches.
Wilkins, Linda; Laragy, Carmel; Zadeh, Hossein S.
The growing challenge and diversity of ageing populations is a key global issue for struggling health systems. Consumer Directed Care (CDC), an innovative service delivery system, opens up possibilities for re-defining consumer expectations, prompting change in how health service providers operate. As a service delivery model, CDC offers improved responsiveness to individual requirements; and increased transparency in the use of allocated funding. Where implemented, CDC has established new relationships and interactions between key stakeholders, co-creating value for older citizens. This chapter reviews some drivers for the development of service innovation, surveys various in-country approaches, highlights current trends in CDC delivery and describes an EU policy impact assessment instrument to aid funding bodies. The chapter concludes by speculating on organizational outcomes from CDC and the likelihood that the introduction of this innovative service delivery model will require closer collaborative relationships between service providers and information technology specialists.
Conway, T; Hu, T C; Mason, E; Mueller, C
A 1991 study of 115 internal medicine and 28 family practice residents at a large inner-city public hospital finds that both groups would perform poorly in providing preconception counseling to women of reproductive age. More than 40% of residents failed to indicate that they would provide a healthy woman with information on rubella immunization and family planning or counseling on sexually transmitted diseases and safer sex. When counseling a diabetic woman seeking pregnancy, 74% would not have discussed congenital anomalies with her and 45% would not have considered discontinuing oral hypoglycemics if she became pregnant. Furthermore, 58% would have neglected to review or change hypertension medications in a newly diagnosed pregnant woman. Although both internal medicine and family practice residents had positive attitudes toward offering preconception care, family practice residents had significantly higher attitude scores. No clear improvement was found in patient management, attitude or knowledge scores as residents progressed from their first to their third year of training.
Puthoopparambil, Soorej J.; Bjerneld, Magdalena
Background Immigration detention has been shown to negatively affect the health and well-being of detainees. The aim of the study was to describe and compare policies and practices that could affect the health and well-being of immigrant detainees in the Benelux countries (Belgium, the Netherlands, and Luxembourg) to those in Sweden. Design This was a case study. Data were collected in two phases using a questionnaire developed particularly for this study. In the first phase, authorities in the Benelux countries responded to the questionnaire via email. During the second phase, a research team visited detention centres in the Benelux countries to observe and further explore, strengthening findings through triangulation. Data on Swedish detention centres were collected in previous studies. Results Compared to the Benelux countries, Sweden has limited health care provision available in the detention centres. Swedish detention centres did not have mental health care professionals working at the centres and had fewer restrictions within the centres with regard to access to mobile phone, internet, and various recreational activities. Compared to Sweden, the detention centres in the Benelux countries have more staff categories providing services to the detainees that are provided with relevant and timely on-the-job training. All the countries, except Belgium, provide subsistence allowances to detainees. Conclusion Despite the Common European Asylum System framework, differences exist among the four European Union member states in providing services to immigrant detainees. This study highlights these differences, thereby providing a window on how these diverse approaches may serve as a learning tool for improving services offered to immigrant detainees. In Sweden, the health care available to detainees and training and recruitment of staff should be improved, while the Benelux countries should strive to reduce restrictions within detention centres. PMID:26950568
Puthoopparambil, Soorej J; Bjerneld, Magdalena
Background Immigration detention has been shown to negatively affect the health and well-being of detainees. The aim of the study was to describe and compare policies and practices that could affect the health and well-being of immigrant detainees in the Benelux countries (Belgium, the Netherlands, and Luxembourg) to those in Sweden. Design This was a case study. Data were collected in two phases using a questionnaire developed particularly for this study. In the first phase, authorities in the Benelux countries responded to the questionnaire via email. During the second phase, a research team visited detention centres in the Benelux countries to observe and further explore, strengthening findings through triangulation. Data on Swedish detention centres were collected in previous studies. Results Compared to the Benelux countries, Sweden has limited health care provision available in the detention centres. Swedish detention centres did not have mental health care professionals working at the centres and had fewer restrictions within the centres with regard to access to mobile phone, internet, and various recreational activities. Compared to Sweden, the detention centres in the Benelux countries have more staff categories providing services to the detainees that are provided with relevant and timely on-the-job training. All the countries, except Belgium, provide subsistence allowances to detainees. Conclusion Despite the Common European Asylum System framework, differences exist among the four European Union member states in providing services to immigrant detainees. This study highlights these differences, thereby providing a window on how these diverse approaches may serve as a learning tool for improving services offered to immigrant detainees. In Sweden, the health care available to detainees and training and recruitment of staff should be improved, while the Benelux countries should strive to reduce restrictions within detention centres.
Munro, Michelle L.
Research indicates that only a small fraction of sexual assault survivors seek comprehensive care afterward, including physical and mental health care, forensic evidence collection, victim services, and legal support. This integrative review was conducted to identify barriers that may be keeping sexual assault survivors of childbearing age from receiving such comprehensive care. PMID:25664329
Kosberg, Jordan I.
This paper addresses issues related to the care of the aged by informal caregivers, government support of such care, and policy changes that might result in improved care of the elderly population. In its treatment of family responsibility for the elderly, it calls attention to several trends: (1) family members will be increasingly unavailable to…
Mintzer, Janet L.
The Delaware Valley Child Care Council (DVCCC) developed this booklet to help Philadelphia school principals plan and develop privately run after-school centers in their schools. First, an executive summary documents the need for school-age day care nationwide and in the Philadelphia area. Section I offers guidance on planning a school-age child…
Wellesley Coll., MA. Center for Research on Women.
Collected are seven technical assistance papers concerning the development and implementation of community school age day care programs. The first paper provides a step-by-step guide to organizing a school-age child care program and the second paper focuses on developing a high quality program. Paper 3 explores administrative, policy, and legal…
In 2001, Arizona's Children's Action Alliance (CCA) developed a resource for community groups interested in exploring the need for care for school-age children. Titled "School-Age Care Tool Kit: A Guide for Measuring Needs in Your Community," the resource provided step-by-step advice to community organizations on how to identify the need…
Noting that the population of foster children who "age out" of the foster care system may be even more at risk than other foster children, this research brief summarizes a longer report examining trends in foster care in the United States, the number and needs of those aging out of the system, and public policy implications. The brief indicates…
Westerberg, Kristina; Tafvelin, Susanne
Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.
Marten, Marie Lucille
Proposes a series of university nursing education programs developed to increase knowledge and skills relevant to nursing care of elderly and chronically ill persons who reside in nursing homes. Briefly describes five programs intended for persons engaged in long-term care or in preparation for such roles. (EM)
Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J
Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.
Vvedenskaia, E S; Kobzeva, L F; Vvedenskaia, I I
The article presents a detailed analysis of health care provision to both general and retirement age population (RAP) in the Nizhny Novgorod region. For the past 10 years, the organization and use of different types of health care for RAP have not changed. The availability of inpatient health care for RAP is high whereas the availability of nursing and outpatient health care is low and palliative care service is not available. In order to enhance availability and ensure quality of medical services it is necessary to implement restructuring of health care for RAP at the municipal level herewith a key attention will be paid to out-patient types of health care expansion and palliative care development. The authors formulate some proposals aimed at improving the organization of medical and social care for RAP which should be included in the health care restructuring program at the municipal level.
Flood, A B; Scott, W R; Ewy, W; Forrest, W H
In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes. PMID:7152960
Adams, Mary; Robert, Glenn; Maben, Jill
We trace the legacies of filmed patient narratives that were edited and screened to encourage engagement with a participatory quality improvement project in an acute hospital setting in England. Using Gabriel's theory of "narrative contract," we examine the initial success of the films in establishing common grounds for participatory project and later, and more varied, interpretations of the films. Over time, the films were interpreted by staff as either useful sources of learning by critical reflection, dubious (invalid or unreliable) representations of patient experience, or as "closed" items available as auditable evidence of completed quality improvement work. We find these interpretations of the films to be shaped by the effect of social distance, the differential outcomes of project work, and changing organizational agendas. We consider the wider conditions of patient narrative as a form of quality improvement knowledge with immediate potency and fragile or fluid legitimacy over time.
Snooks, H; Kearsley, N; Dale, J; Halter, M; Redhead, J; Foster, J
Aim: To describe emergency ambulance crews' views about (1) how they make decisions on whether to convey patients to hospital; (2) an intervention enabling them to triage patients to non-conveyance; and (3) their experience of using new protocols for undertaking such triage. Methods: Two focus groups were held at the outset of an evaluation of Treat and Refer (T&R) protocols: one with staff based at an ambulance station who were to implement the new service (intervention station), and the other with staff from a neighbouring station who would be continuing their normal practice during the study (control station). A third session was held with staff from the intervention station following training and 3 months' experience of protocol usage. Results: Before the introduction of the T&R protocols, crews reported experience, intuition, training, time of call during shift, patient preference, and home situation as influencing their decisions concerning conveyance. Crews were positive about changing practice but foresaw difficulties with advising patients who wanted to go to hospital, and with referral to other agencies. Following experience of T&R protocol use, crews felt they had needed more training than had been provided. Some felt their practice and job satisfaction had improved. Problems with referral and with persuading some patients that they did not need to go to hospital were discussed. There was consensus that the initiative should be introduced across the service. Conclusions: With crews generally positive about this intervention, an opportunity to tackle this difficult area of emergency care now exists. This study has, however, highlighted the complexity of the change in practice and service delivery, and professional and organisational constraints that need to be considered. PMID:16076788
Gershoff, Elizabeth T; Font, Sarah A; Taylor, Catherine A; Foster, Rebecca H; Garza, Ann Budzak; Olson-Dorff, Denyse; Terreros, Amy; Nielsen-Parker, Monica; Spector, Lisa
Several medical professional organizations, including the American Academy of Pediatrics, recommend that parents avoid hitting children for disciplinary purposes (e.g., spanking) and that medical professionals advise parents to use alternative methods. The extent to which medical professionals continue to endorse spanking is unknown. This study is the first to examine attitudes about spanking among staff throughout medical settings, including non-direct care staff. A total of 2580 staff at a large general medical center and 733 staff at a children's hospital completed an online survey; respondents were roughly divided between staff who provide direct care to patients (e.g., physicians, nurses) and staff who do not (e.g., receptionists, lab technicians). Less than half (44% and 46%) of staff at each medical center agreed that spanking is harmful to children, although almost all (85% and 88%) acknowledged that spanking can lead to injury. Men, staff who report being religious, and staff who held non-direct care positions at the medical center reported stronger endorsement of spanking and perceived their co-workers to be more strongly in favor of spanking. Non-direct care staff were more supportive of spanking compared with direct care staff on every item assessed. All staff underestimated the extent to which their co-workers held negative views of spanking. If medical centers and other medical settings are to lead the charge in informing the community about the harms of spanking, comprehensive staff education about spanking is indicated.
Numer, Matthew; Macleod, Anna; Sinclair, Douglas; Frank, Blye
The medical community is giving increasing attention to issues of social class, gender, race, ethnicity, culture and other areas of difference in interprofessional education and patient care. The Changing Worlds: Diversity and Health Care Project, an interprofessional diversity education initiative, was designed with the aim of exploring social issues in the medical professions. This project brought together the Faculties of Medicine, Dentistry and Health Professions at Dalhousie University in an effort to address issues of difference related to multiplicities of races, ethnicities, cultures, languages, sexualities and religions. The findings of this paper include methods for the project implementation and future direction for education initiatives aimed at issues of social justice and equity in health care.
Joseph Tham, S; Letendre, Marie Catherine
This paper addresses three factors that have contributed to shifts in decision making in health care. First, the notion of patient autonomy, which has changed due to the rise of patient-centred approaches in contemporary health care and the re-conceptualization of the physician-patient relationship. Second, the understanding of patient autonomy has broadened to better engage patient participation. Third, the need to develop cross-cultural health care ethics. Our paper shows that the shift in the West from the individual to the relational self indicates an important change in the understanding of autonomy through the lens of culture. Practices that recognize the notion of the relational self allow for a more balanced view of autonomy and a richer conception of moral agency.
Bougea, Anastasia; Kleisarchakis, Manolis Kostas; Spantideas, Nikolaos; Voskou, Panagiota; Thomaides, Thomas; Chrousos, George; Belegri, Sophia Andreas
Aims and method To identify correlates between burnout and job stress of care staff at Leros PIKPA Asylum. Forty-nine asylum employees were assessed by Maslach's Burnout Inventory, a sociodemographic questionnaire, the Perceived Stress Scale and the Job Content Questionnaire. Results Emotional exhaustion is related negatively to social support (P = 0.010, r = −0.362). Lack of job achievements is related positively to overall job responsibility (P = 0.040) and negatively to lack of job satisfaction (r = −0.430). Depersonalisation was negatively associated with support from superiors (P = 0.036). Employees with high levels of perceived stress reported higher levels of fatigue (P = 0.050). Positive associations of perceived stress with depression (P = 0.011) and sleep problems (P<0.001) were also detected. Positive correlation was found between monthly salary and lack of sense of personal achievement (P = 0.020). Clinical implications It is necessary to address these issues through staff education and stress management. PMID:28377806
Shaw, N T; Mador, R L; Ho, S; Mayes, D; Westbrook, J I; Creswick, N; Thiru, K; Brown, M
The Intensive Care Unit (ICU) is a complex and dynamic tertiary care environment that requires health care providers to balance many competing tasks and responsibilities. Inefficient and interruption-driven workflow is believed to increase the likelihood of medical errors and, therefore, present a serious risk to patients in the ICU. The introduction of a Critical Care Information System (CCIS), is purported to result in fewer medical errors and better patient care by streamlining workflow. Little objective research, however, has investigated these assertions. This paper reports on the design of a research methodology to explore the impact of a CCIS on the workflow of Respiratory Therapists, Pediatric Intensivists, Nurses, and Unit Clerks in a Pediatric ICU (PICU) and a General Systems ICU (GSICU) in Northern Canada.
Ley-Chavez, Adriana; Hmar-Lagroun, Tatiana; Douglas-Ntagha, Pamela; Cumbo, Charlotte L
Inefficient facility layouts have been found to be a challenge in health care, with excessive walking adding to the demands of staff and creating delays, which can impact the quality of care. Minimizing unnecessary transportation during care delivery improves efficiency, reduces delays, and frees up resources for use on value-added activities. This article presents a methodology and application of facility design to improve responsiveness and efficiency at a large hospital. The approach described provides the opportunity to improve existing layouts in facilities in which the floor plan is already defined, but there is some flexibility to relocate key areas. The existing physical constraints and work flows are studied and taken into consideration, and the volume of traffic flow throughout the facility guides the decision of where to relocate areas for maximum efficiency. Details on the steps followed and general recommendations to perform the necessary process and data analyses are provided. We achieved a 34.8% reduction in distance walked (4740 miles saved per year) and a 30% reduction in floors traveled in elevators (344 931 floors, which translate to 842 hours spent using elevators) by relocating 4 areas in which frequently used resources are housed.
Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty
Background There are widespread concerns about communication and support for patients and families, especially when they face clinical uncertainty, a situation most marked in intensive care units (ICUs). Therefore, we aimed to develop and evaluate an interventional tool to improve communication and palliative care, using the ICU as an example of where this is difficult. Methods Our design was a phase I-II study following the Medical Research Council Guidance for the Development and Evaluation of Complex Interventions and the (Methods of Researching End-of-life Care (MORECare) statement. In two ICUs, with over 1900 admissions annually, phase I modeled a new intervention comprising implementation training and an assessment tool. We conducted a literature review, qualitative interviews, and focus groups with 40 staff and 13 family members. This resulted in the new tool, the Psychosocial Assessment and Communication Evaluation (PACE). Phase II evaluated the feasibility and effects of PACE, using observation, record audit, and surveys of staff and family members. Qualitative data were analyzed using the framework approach. The statistical tests used on quantitative data were t-tests (for normally distributed characteristics), the χ2 or Fisher’s exact test (for non-normally distributed characteristics) and the Mann–Whitney U-test (for experience assessments) to compare the characteristics and experience for cases with and without PACE recorded. Results PACE provides individualized assessments of all patients entering the ICU. It is completed within 24 to 48 hours of admission, and covers five aspects (key relationships, social details and needs, patient preferences, communication and information status, and other concerns), followed by recording of an ongoing communication evaluation. Implementation is supported by a training program with specialist palliative care. A post-implementation survey of 95 ICU staff found that 89% rated PACE assessment as very or
Teresi, Jeanne A.; Holmes, Douglas; Dichter, Elizabeth; Koren, Mary Jane; Ramirez, Mildred; Fairchild, Susan
Reports on the prevalence of behavior disorders in a sample of residents (N=360) in adult day health care programs. Findings indicate relatively high rates of behavior disorders. Most prevalent were the affective disorders (seeking reassurance, depression, crying) and verbal-vocal agitation. Differences between formal and informal caregivers'…
Benjamin, Kathleen; Edwards, Nancy; Guitard, Paulette; Murray, Mary Ann; Caswell, Wenda; Perrier, Marie Josee
Physical activity has been linked to positive health outcomes for frail seniors. However, our understanding of factors that influence the physical activity of residents in the long-term care (LTC) setting is limited. This article describes our work with focus groups, one component of a multi-component study that examined factors influencing the…
Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman
Purpose: 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. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…
Crosland, Kimberly A.; Cigales, Maricel; Dunlap, Glen; Neff, Bryon; Clark, Hewitt B.; Giddings, Tamela; Blanco, Alfredo
Objective: Use of some restrictive procedures, including physical restraint, has been controversial. For children within the foster care system, who have already suffered various degrees of abuse and neglect, restrictive procedures could add to their emotional and behavioral problems. The current study was conducted to determine whether a…
Conner, Tom; Prokhorov, Artem; Page, Connie; Fang, Yu; Xiao, Yimin; Post, Lori A.
Elder abuse in long-term care has become a very important public health concern. Recent estimates of elder abuse prevalence are in the range of 2% to 10% (Lachs & Pillemer, 2004), and current changes in population structure indicate a potential for an upward trend in prevalence (Malley-Morrison, Nolido, & Chawla, 2006; Post et al., 2006).…
...-determination contract on the condition that such practitioner provide health services to IHS beneficiaries... been extended in contractor health care facilities operated under a self-determination contract on the... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...
...-determination contract on the condition that such practitioner provide health services to IHS beneficiaries... been extended in contractor health care facilities operated under a self-determination contract on the... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...
...-determination contract on the condition that such practitioner provide health services to IHS beneficiaries... been extended in contractor health care facilities operated under a self-determination contract on the... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...
van Hateren, Kornelis J J; Drion, Iefke; Kleefstra, Nanne; Groenier, Klaas H; Houweling, Sebastiaan T; van der Meer, Klaas; Bilo, Henk J G
Objective The Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study was initiated in 1998 to investigate the effects of shared care for patients with type 2 diabetes mellitus (T2DM) in the Netherlands, and to reduce the number of diabetes-related complications. Benchmarking the performance of diabetes care was and is an important aspect of this study. We aimed to investigate trends in diabetes care, within the ZODIAC study for a wide variety of quality indicators during a long follow-up period (1998–2008), with special interest for different age groups. Design Prospective observational cohort study. Setting Primary care, Zwolle, The Netherlands. Participants Patients with T2DM. Methods A dataset of quality measures was collected annually during the patient's visit to the practice nurse or general practitioner. Linear time trends from 1998 to 2008 were estimated using linear mixed models in which we adjusted for age and gender. Age was included in the model as a categorical variable: for each follow-up year all participants were categorised into the categories <60, 60–75 and >75 years. Differences in trends between the age categories were investigated by adding an interaction term to the model. Results The number of patients who were reported to participate increased in the period 1998–2008 from 1622 to 27 438. All quality indicators improved in this study, except for body mass index. The prevalence albuminuria decreased in an 11-year-period from 42% to 21%. No relevant differences between the trends for the three age categories were observed. During all years of follow-up, mean blood pressure and body mass index were the lowest and highest, respectively, in the group of patients <60 years (data not shown). Conclusions Quality of diabetes care within the Dutch ZODIAC study, a shared care project, has considerably improved in the period 1998–2008. There were no relevant differences between trends across various age categories
Kemeny, M. Elizabeth
Using the conceptual model of social structure and personality framework (House, 1981) as a theoretical guide, this cross sectional mixed-method design examined how organizational structure and culture relate to practices for training direct care workers in 328 aging and disability network service provider organizations in Pennsylvania. To…
Angus, Jocelyn; Nay, Rhonda
This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo-reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo-reform period and challenges the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever-changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault.
Karner, T X
Understanding the impact of cohort values is important in trying to project future aging service needs. The cultural characteristics of cohorts yet to reach the age of 65 are compared with those already "old," with specific focus on the Baby Boomers. Aging policies (and available services) reflect the cultural notions of age and aging held as normative during the historical era in which they are enacted. Previous research into lifestyle preferences, consumer practices, and key characteristics is drawn upon to investigate the values of Baby Boomers in light of their projected needs for eldercare services. Cohort research and generational marketing practices offer a promising foundation for exploring how best to develop, target, and deliver aging services that most effectively utilize our social resources.
Spitzer, William J; Davidson, Kay W
Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.
Datta, Hema Sharma; Paramesh, Rangesh
The association between Ayurveda, anti-aging and cosmeceuticals is gaining importance in the beauty, health and wellness sector. Ayurvedic cosmeceuticals date back to the Indus Valley Civilization. Modern research trends mainly revolve around principles of anti-aging activity described in Ayurveda: Vayasthapana (age defying), Varnya (brighten skin-glow), Sandhaniya (cell regeneration), Vranaropana (healing), Tvachya (nurturing), Shothahara (anti-inflammatory), Tvachagnivardhani (strengthening skin metabolism) and Tvagrasayana (retarding aging). Many rasayana plants such as Emblica officinalis (Amla) and Centella asiatica (Gotukola) are extensively used. PMID:21836797
Increasingly, long-term care facilities are using technology to improve safety, reduce costs, and save time. The growing role of high-tech tools in this setting is driven partly by regulations calling for facilities to improve outcomes and streamline costs. One tool that long-term pharmacies and their facilities are turning to is the automated dispensing system. These systems vary in term of type, size, cost, and function; and they are approved for use in long-term care facilities in some but not all states. However, where they can be and are used, they often result in reduced medication management costs and improved safety and accuracy. At the same time, automated dispensing systems may make medication administration easier for nurses. While challenges to their implementation and use remain, automated dispensing systems likely will be a key part of health care's future. This article serves as an introduction to the automated dispensing systems, their use in long-term care, and their potential use as a new era of health care begins.
Ben Natan, Merav; Tabak, Nili
A great deal of research has considered the dynamics of family violence and the way that family violence is processed and handled in the criminal justice system. Very little nursing research has considered the dynamics of older persons' maltreatment in long-term care. Older people living in a residential setting have the right to respectful care based on professional ethics. To fill this void, the current study proposes to identify policy implications for effectively implementing the recently developed Israeli public law designed to protect vulnerable older adults in nursing homes. In addition, this article presents the elder abuse reporting systems and the service delivery systems that have been established to protect older adults at risk of abuse and neglect.
Bigby, C.; Webber, R.; Bowers, B.; McKenzie-Green, B.
Background: Australia's national ageing policy recognises that people ageing with intellectual disability (ID) require particular attention, yet there is no policy framework concerning this population. This study describes the distribution and characteristics of people with ID in residential aged care in Victoria, provides insights into the…
Bauer, Michael; Nay, Rhonda; Tarzia, Laura; Fetherstonhaugh, Deirdre; Wellman, David; Beattie, Elizabeth
This paper reports on a study which explored the views and attitudes of family members towards the sexual expression of residents with dementia in residential aged care facilities in two states in Australia. Recruitment was challenging and only seven family members agreed to an interview on this topic. Data were analysed using a constant comparative method. Family were generally supportive of residents' rights to sexual expression, but only some types of behaviours were approved of. There was an acknowledgement that responding to residents' sexuality was difficult for staff and many families believed that they should be kept informed of their relative's sexual behaviours and moreover be involved in decision making about it. Findings suggest the need for family education and a larger study to better understand the views and motivations of family carers and how these might impact on the sexual expression of the older person with dementia living in residential aged care.
As the healthcare delivery system continues to evolve in the new millennium, initiatives such as the Institute for HealthCare Improvement's 100,000 Lives Campaign include the development of rapid response teams in hospitals. Introduction of rapid response teams provides nurses assistance in difficult clinical situations and provides early clinical intervention to mitigate negative patient outcomes and save lives. Development, implementation strategies, and benefits of rapid response teams are described.
Banach, David B; Zhang, Cen; Factor, Stephanie H; Calfee, David P
Although policies mandating annual influenza vaccination among health care workers (HCWs) are recommended, little is known about which HCWs support mandatory vaccination. We surveyed non-physician, non-nursing HCWs to identify beliefs associated with supporting mandatory HCW vaccination. Although similarities were identified, some beliefs and concerns associated with supporting mandatory vaccination differed among HCW groups. Policy makers should understand these differences and address beliefs and concerns of all HCW groups when attempting to implement a mandatory influenza vaccination policy.
rich mix of medical services that range from simple ambulatory visits to plastic surgery , neuro- surgery , general surgery , bariatric , ophthalmology...CENTER SAN DIEGO NMCSD is a 266-bed tertiary care facility providing patient services ranging from same day surgery to brain surgery . The hospital...orthopedics, cardiology, thoracic surgery , vascular surgery , transient ischemic attack/cerebro vascular accident (TIA/CVA), OB/GYN, urology, non
Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).
Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W
In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record
Ibrahim, Joseph Elias; Bugeja, Lyndal; Ranson, David
The care of older people in residential aged care services could be improved by optimising the use of existing information gathered for medico-legal death investigations. The authors address three myths contributing to underuse of this information: deaths are not preventable; public health gains are too small; and it is someone else's charter or responsibility A significant proportion of deaths are preventable, specifically those occurring prematurely from natural causes or due to injury and trauma. By addressing these preventable deaths, significant public health cost savings and better health outcomes for our growing ageing population can be achieved. Despite substantive monitoring of the provision of aged care, no single entity is explicitly responsible for systematically analysing medico-legal death information. The data and skills for using information from medico-legal death investigations currently exist. Dispelling the myths removes one impediment to investing in this area of public health.
Liu, Tao; Sun, Li
According to the National Bureau of Statistics of China, by 2010 the number of people aged 60 or over had reached 178 million in China or 13% of its population. With the largest elderly population in the world in absolute numbers, China faces a challenge of providing care for the elderly both in the present and the future. Unlike old age pensions and health protection for the elderly, in Chinese society elderly care had never been considered to be a social problem but rather the individual family's responsibility. After the turn of the millennium, as the repercussions of increasingly ageing demographics, the results of the One-Child Policy and drastic changes in traditional family structures gradually became more apparent, this issue of elderly care has increasingly become one of the most pressing concerns for the ageing society. As there is little existing research on this particular topic, this article aims to shed light on elderly care in China, focusing on the care of elderly needing assistance with activities of daily living, since this group of elderly are most in need of care, their numbers having risen to 33 million in 2010. This article argues it is urgent for China to switch from informal family-based elderly care to the state's formal long-term care, illustrates that a model of social insurance (e.g. as in Germany) is advocated by many Chinese scholars and points out the ways in which it is different from both the commercialized models (e.g. as in the USA) and state organized "Beveridge" models (e.g. as in Sweden).
Teachy, Cindy L.; And Others
This workshop section includes four essays: (1) "Building Lifelong Relationships: School Age Programs at Work" (Cindy L. Teachey); (2) "Building Friendships in School Age Programs" (Joan M. Bergstrom); (3) "On the Rocky Road to Friendship: Emerging Peer Relationships" (Kay Albrecht); (4) "Helping Teachers Understand Their Role in Supporting Peer…
SCHRÖDER-BUTTERFILL, ELISABETH; FITHRY, TENGKU SYAWILA
The provision of physical care is a sensitive matter in all cultures and is circumscribed by moral injunctions and personal preferences. Research on Western cultures has shown care networks to be narrow subsets of people’s wider networks and revealed dependence to be deeply undermining of full personhood. In non-Western societies these issues have received little attention, although it is sometimes assumed that care provision and dependence are much less problematic. This paper uses longitudinal ethnographic data from two ethnic groups in rural Indonesia to compare care preferences and practices in old age and to examine the implications of care dependence. The groups manifest varying degrees of daughter preference in care and differ in the extent to which notions of shame and avoidance prohibit cross-gender intimate care and care by ‘non-blood’ relatives. Demographic and social constraints often necessitate compromises in actual care arrangements (e.g. dependence on in-laws, neighbours or paid carers), not all of which are compatible with quality care and a valued identity. We argue that by probing the norms and practices surrounding care provision in different socio-cultural settings, it becomes possible to arrive at a deeper understanding of kinship, personhood and sociality. These insights are not only of sociological interest but have implications for people’s vulnerability to poor quality care in old age. PMID:24518962
Ramklass, Serela S.; Butau, Anne; Ntinga, Nomusa; Cele, Nozipho
In view of South African policy developments related to the care of older persons, it was necessary to examine the nature of the geriatrics content within physiotherapy curricula. A survey was conducted amongst final-year student physiotherapists at South African universities, together with content analysis of physiotherapy curricula. Very little…
At its heart "Every Child Matters: change for children" endeavours to engender an ethic of "care for" the client group. However, although its raison d'etre might well espouse such orientations, it has a certain level of internal ambiguity which if not considered might lead education to position subsequent operationalization in…
Hinkley, Nancy E.
With increasing emphasis on treating the whole person, on the maintenance of an individual's former life style, and on patients' rights, long-term care personnel need to become aware that many nursing home residents experience needs related to their sexuality. A model two-day workshop is presented wlth a focus on the following topics: (1) a broad…
Analysis of research on the Australian elder care industry used the categories of gender equity, gender differences, and gender deconstruction. Findings revealed the gender segregation of the industry, devaluing of women's work, and persistence of body/mind, male/female dualism. (Contains 16 references.) (SK)
Pfaff, A B
The current type of distribution of tasks between the generations leads to a system of income maintenance programs for the aged, which is based on their own past (largely statutory) provision for their old age income via public institutions. On the whole, the aged are to a very limited degree in the labor force. Most of them receive public transfer payments. On the average, the diverse income maintenance systems dependent on own past performance provide a fairly substantial income level when compared with wages and salaries. The transfer level is largely dependent on the type of old age security institution, on the extent of past labor force participation or contribution and past income; consequently it is quite diverse. Sex largely correlates with income differentials. While some groups end up with retirement incomes higher than their last wage income, others are definitely needy. Especially women constitute a substantial part of the poor. Besides low income, the danger of becoming a nursing case makes the aged dependent on other persons' or institutions' aid. The forthcoming reform of the public pension system shows little hope of eliminating the pockets of poverty among the aged by assuring a redistribution also among the aged.
Background Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. Methods The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. Results All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were
Reusswig, James, Ed.; Ponzio, Richard, Ed.
Eight essays are presented which reflect current problems, issues, and practices related to the development of teacher and administrator expertise. The authors are school district and public school administrators, faculty of schools of education, and a director of staff development in a state department of education. The topics treated are: (1)…
Annear, Michael; Walker, Kim; Lucas, Peter; Lo, Amanda; Robinson, Andrew
This article examines the reflective discourses of medical, nursing, and paramedic students participating in interprofessional education (IPE) activities in the context of aged-care clinical placements. The intent of the research is to explore how students engage with their interprofessional colleagues in an IPE assessment and care planning activity and elucidate how students configure their role as learners within the context of a non-traditional aged-care training environment. Research participants included cohorts of volunteer medical (n = 61), nursing (n = 46), and paramedic (n = 20) students who were on clinical placements at two large teaching aged-care facilities in Tasmania, Australia, over a period of 18 months. A total of 39 facilitated focus group discussions were undertaken with cohorts of undergraduate student volunteers from three health professions between February 2013 and October 2014. Thematic analysis of focus group transcripts was assisted by NVIVO software and verified through secondary coding and member checking procedures. With an acceptable level of agreement across two independent coders, four themes were identified from student focus group transcripts that described the IPE relations and perceptions of the aged-care environment. Emergent themes included reinforcement of professional hierarchies, IPE in aged care perceived as mundane and extraneous, opportunities for reciprocal teaching and learning, and understanding interprofessional roles. While not all students can be engaged with IPE activities in aged care, our evidence suggests that within 1 week of clinical placements there is a possibility to develop reciprocal professional relations, affirm a positive identity within a collaborative healthcare team, and support the health of vulnerable older adults with complex care needs. These important clinical learnings support aged-care-based IPE as a potentially powerful context for undergraduate learning in the 21st Century.
Salas, C; Raftery, J P
A recent study by Zweifel et al. (Zweifel P, Felder S, Meiers M. Ageing of the population and health care expenditure: a red herring? Health Economics 1999; 8: 485-496) suggests that age is not related to health care expenditure among the elderly once 'closeness to death' is controlled for. If correct, this finding has major policy implications, but flaws in the econometric analysis undermine its credibility. We highlight two in particular, and propose methods to deal with them.
In this article, the author presents two emerging state-level public policy trends in the United States, one toward universalizing pre-school services, and one toward systems for delivering early education and care. At this point, it is not clear whether the effect of the two trends will be to unite or divide the field of early education and care.…
Blank, Helen; Behr, Andrea; Schulman, Karen
This report provides highlights and updates regarding state actions on child care and early education issues during 2000. The information in the report was collected by means of written and telephone surveys with advocates or state child care administrators in each state. The final draft was reviewed for verification by advocates or a state child…
Crossen, Brian; Yerkes, Rita
Recruiting of camp staff is challenged by economic and workplace restructuring, including business downsizing, part-time and temporary employment patterns, and generational attitude changes. Strategies for hiring and retaining staff include knowing what college-age workers want, marketing benefits, adopting new business strategies, and empowering…
Herron, Rachel V; Skinner, Mark W
Qualitative research offers important insights into the subjectivity, complexity, and relationality of care. In this article, we examine the particular processes and relationships involved in doing qualitative research about care with older people in rural places. We draw on our experience completing two related qualitative studies of rural care in Canada to extend discussions about responsible research practice in relation to participant recruitment, interviews, and focus groups. By applying Hankivsky's principles of care ethics in our reflection on research practices, we make explicit the role of emotions in connecting with research participants, collecting and participating in narrative-based research, and negotiating identity. We conclude with a discussion of the distinct ways in which applying care ethics throughout the research process can augment reflexive practice and enhance the integrity and theoretical contributions of qualitative health research while developing more inclusive understandings of vulnerability in older rural populations.
Background Evidence-based care should improve acute stroke outcomes with the same magnitude of effect for stroke patients of all ages. However, there is evidence to suggest that, in some instances, older stroke patients may receive poorer quality care than younger patients. Our aim was to systematically review evidence of the quality of care provided to patients with acute stroke related to their age. Quality of care was determined by compliance with recommended care processes. Methods We systematically searched MEDLINE, CINAHL, ISI Web of Knowledge, Ageline and the Cochrane Library databases to identify publications (1995-2009) that reported data on acute stroke care process indicators by patient age. Data extracted included patient demographics and process indicator compliance. Included publications were critically appraised by two independent reviewers using the Critical Appraisal Skills Programme tool, and a comparison was made of the risk of bias according to studies' findings. The evidence base for reported process indicators was determined, and meta-analysis was undertaken for studies with sufficient similarity. Results Nine from 163 potential studies met the inclusion criteria. Of the 56 process indicators reported, eleven indicators were evidence-based. Seven of these indicators (64%) showed significantly poorer care for older patients compared to younger ones, while younger patients received comparatively inferior care for only antihypertensive therapy at discharge. Our findings are limited by the variable methodological quality of included studies. Conclusion Patients' age may be a factor in the care they receive after an acute stroke. However, the possible influence of patients' age on clinicians' decision-making must be considered in terms of the many complex issues that surround the provision of optimal care for older patients with acute stroke. PMID:21729329
Ilhamto, Nila; Anciado, Katrina; Keller, Heather H; Duizer, Lisa M
Texture modification of foods to a pureed consistency is a common management approach for older adults with dysphagia. Long-term care (LTC) facilities commonly produce some pureed food in-house. This study investigated challenges and preferred practices associated with the production of pureed food in LTC facilities. Nutrition Managers (n = 27) and cooks (n = 26) from 25 Ontario LTC facilities were recruited for one-on-one, semistructured interviews. Interviews were digitally recorded, transcribed, and analyzed using inductive thematic analysis. Four themes arose from the data to exemplify challenges in production, including (a) difficulty in using standardized recipes, (b) varied interpretation of governmental guidelines, (c) lack of consistency in terminology and texture, and (d) wanting to improve the visual appeal. These challenges were reported to reduce the quality of in-house produced pureed food. Preferred practices to overcome these challenges were also provided by participants, such as involving cooks in pureed recipe improvements and tailoring to the specific needs of residents. Incorporation of these practices into pureed food production may help to shape and improve future practice and pureed food products.
McKeown, Mick; Ridley, Julie; Newbigging, Karen; Machin, Karen; Poursanidou, Konstantina; Cruse, Kaaren
Drawing on a national study of independent mental health advocacy, we explored the social relations of independent advocacy. The study was commissioned by the Department of Health (England), and involved a case study design covering eight different geographies and service configurations, and interviews or focus groups with a total of 289 stakeholders across two phases of inquiry. This paper focused on the analysis of qualitative data relevant to the relationship between mental health-care services and independent advocacy services, drawn from interviews with 214 participants in phase two of the study. Discussion of these particular findings affords insights into the working relations of independent advocacy within mental health services beset by reorganizational change and funding cuts, and increasing levels of legally-sanctioned compulsion and coercion. We offer a matrix, which accounts for the different types of working relationships that can arise, and how these are associated with various levels of understanding of independent advocacy and appreciation for the value of advocacy. The discussion is framed by the wider literature on advocacy and the claims by practitioners, such as nurses, for an advocacy role as part of their professional repertoire.
Lee, S M; LoGiudice, D
Aged care health professionals in Australia are increasingly referred patients whose standard of cleanliness and self-care has deteriorated to levels resulting in public health concern. This paper describes three illustrative case studies of people referred to an Australian Aged Care Assessment Service who present with 'Diogenes Syndrome'. The diversity and complexity of these cases reflect variable underlying diagnoses. Symptoms of self-neglect, hoarding and domestic squalor and combinations thereof may provide a more useful classification system of the older person who presents in such circumstances than the frequently used term Diogenes syndrome. Practical guidelines are required for appropriate assessment and management of these conditions.
Tariq, Amina; Douglas, Heather E; Smith, Cheryl; Georgiou, Andrew; Osmond, Tracey; Armour, Pauline; Westbrook, Johanna I
Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care.
Clark, Shannon J; Parker, Rhian M; Davey, Rachel
Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner-Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: "The right care," "in the right place," and "at the right time." In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program's applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding.
Avery, Rosemary J.; Freundlich, Madelyn
This article considers the repercussions of discharging youth from foster care at age 18 based on recent research demonstrating that youth at this age are not developmentally prepared to live independently and have a continued need for strong social scaffolding during emerging adulthood. Drawing upon recent research findings, we make…
McKenzie, Ellen L.; Brown, Patricia M.
Given a projected threefold increase in people living with dementia globally by 2050 (World Health Organization, 2012), attracting nurses to work in this area will be critical to meet demand. This study examined the role of age, positive ageism, negative ageism, and aged-care placement completion in predicting nursing students' intentions to work…
Hsiao, Peng-Ching; Chu, Chi-Ming; Sung, Pei-Yi; Perng, Wann-Cherng; Wang, Kwua-Yun
Background Because Taiwan has the fastest aging rate among developed countries, care for the elderly is becoming more prominent in the country. Primary family caregivers play an important role in patient health and health promotion behavior. Chronic obstructive pulmonary disease (COPD), an age-related disease, is a major public health problem with high morbidity and mortality and can be a long-term burden for family members; however, little attention has been given to the differences in COPD care between elder caregivers and other caregivers. This study aimed to investigate the differences between elder family caregivers and non-elder family caregivers caring for COPD patients in Taiwan, including caring behavior, caregiver response, and caring knowledge. Methods This cross-sectional study was conducted between March 2007 and January 2008; 406 primary family caregivers of COPD patients from the thoracic outpatient departments of 6 hospitals in north-central Taiwan were recruited to answer questionnaires measuring COPD characteristics, care behavior, caregiver response, and COPD knowledge. All questionnaires, which addressed caregiver knowledge, care behaviors, and care reactions, were shown to have acceptable validity and reliability, and the data were analyzed using univariate and generalized linear model techniques. Results The elder caregivers group had 79 participants, and the non-elder caregivers comprised 327 participants. The COPD-related knowledge scale results were positively correlated with the family caregiver caring behavior scale, suggesting that better COPD-related knowledge among family caregivers may result in improved caring behavior. After adjusting for all possible confounding factors, the elder caregivers had significantly lower COPD-related knowledge than the non-elder caregivers (P<0.001). However, there were no significant differences in the family caregiver caring behavior scale or the caregiver reaction assessment scale between the two
Berkowitz, Eric N; Schewe, Charles D
The health care landscape is ever changing. Medical groups are experiencing challenges in recruiting staff, dealing with managing effective clinical teams, and tempering the growing tensions among partnerships and medical groups. Additionally, all clinicians report many patients are now approaching them differently than in the past. They come armed with medical information from the Internet and a more questioning attitude toward the clinician's directive for care. What accounts for these behavioral changes and management challenges within health care organizations? These issues may be best understood and addressed through generational cohort analysis.
Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings. PMID:21385446
Lawlis, Tanya; Wicks, Alison; Jamieson, Maggie; Haughey, Amy; Grealish, Laurie
Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.
Shen, Sijun; Neyens, David M
There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.
Neuman, P H; Rice, D P; Hussey, P S
The aging of the U.S. population presents challenges in financing care and meeting the health and long-term care needs of older Americans. Women, who constitute a majority of the older adult population and a disproportionate share of those with low incomes, chronic conditions and long-term care needs, have much at stake in the future direction of health programs for aging Americans. This paper examines the status of older women in 12 industrialized nations to assess how the U.S. compares to other countries in terms of its aging female population. We find that women across the 12 industrialized countries have a longer life expectancy than men at ages 65 and 80, underscoring the universality of aging as a "women's issue". With respect to age composition, the U.S. lags behind many industrialized nations in the share of its elderly female population; by 2030, the proportion of women aged 65 and older, and 80 and older, will be lower in the U.S. than in any of the industrialized nations compared in this paper. Against this backdrop, the paper examines the characteristics of older adult women in the U.S., considers the role of Medicare in meeting the needs of aging women, and identifies gaps in coverage, primarily prescription drug and long-term care, that disproportionately affect older women. The paper concludes by considering how other nations provide and finance prescription drug and long-term care services for older adults, suggesting useful models for the U.S. to consider as it struggles to meet the demands of its aging population.
Jacomet, Christine; Berland, Pauline; Guiguet, Marguerite; Simon, Anne; Rey, David; Arvieux, Cédric; Pugliese, Pascal; Gerbaud, Laurent
The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older.
Xiao, Lily D; Kelton, Moira; Paterson, Jan
The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas' communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year-levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities.
Conedera, F; Schoessler, M
Hospice nursing is unique because of the philosophy and issues surrounding hospice care. Program planning for hospice staff follows basic principles. The real challenge in developing programs for orientation, continuing, and inservice education is using a format that will truly enable staff to meet the objectives. A lecture, programmed instruction, or video/slide format works well for the "nuts and bolts," but more creativity is needed for the other issues facing the hospice nurse--death, grief, symptom control, stress, team roles, and helping patients with options. Incorporating into the program some of the methods suggested will offer staff the opportunity to become involved in learning and make that learning more meaningful.
Bartlett, H P; Phillips, D R
"Although the U.K.'s population is not predicted to grow very much in the future, the population structure is changing and there is a shift towards a much older age distribution. The characteristics of demographic aging in the U.K. include a marked reduction in fertility rates, increasing rates of life expectation at birth..., increasing dependency ratios and variations in mortality and social class in old age. The U.K.'s demographic context has important implications for aged care policy and planning. This paper documents the demographic trends, reviews recent major policy changes and their impact on care provision, and discusses some of the emerging implementation issues that challenge the potential of such policies to meet the needs of an aging population."
Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Steinberg, Laurence; Vandergrift, Nathan
Relations between nonrelative child care (birth to 4(1/2) years) and functioning at age 15 were examined (N = 1,364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with escalating positive effects at higher levels of quality. The association between quality and achievement was mediated, in part, by earlier child-care effects on achievement. High-quality early child care also predicted youth reports of less externalizing behavior. More hours of nonrelative care predicted greater risk taking and impulsivity at age 15, relations that were partially mediated by earlier child-care effects on externalizing behaviors.
Torr, Jane; Pham, Lien
Little is known about the quality and characteristics of the language used by childcare staff when interacting with infants in non-parental group care settings. This qualitative study analysed the manner in which staff used language when interacting with ten children aged between 9 and 20 months in four different long day care centres in Sydney,…
McKinnon, Cole; Capone, Martha
Woburn Nursing Center (WNC), a private nursing home owned and operated by Salter Healthcare Services (SHS), developed an integrated, comprehensive staff development program and handbook. A literature review focused on staff needs, responsible agent, and handbook development. The following activities were undertaken: a review of ERIC documents,…
... The attending doctor has completed fellowship training in neonatology and residency training in pediatrics. Each fellowship most ... other specialists to help with your baby's care. NEONATOLOGY FELLOW A neonatology fellow is a doctor who ...
Casado Marín, D
Over the last 30 years, the elderly population of developed countries has shown an unprecedented increase. This process has raised alarm about the future affordability of health care systems. In this context, we consider the effects of population aging on health care expenditure within a process involving several elements: the increasing number of elderly persons, variations in the health status of the elderly and the evolution of the cost of medical treatment. The main conclusion is that only a small part of the increase in expenditure is due to population aging. Furthermore, because the average health status of the elderly has improved with greater longevity, we suggest that most of the increase in health care expenditure can be attributed to the evolution of non-demographic factors. Such as health services utilization, treatment cost and the development of new medical technology. Unlike populations aging, these factors can be subjected to future regulation and consequently, can to a large extent be controlled.
Cylus, Jonathan; Hartman, Micah; Washington, Benjamin; Andrews, Kimberly; Catlin, Aaron
This paper examines differences in national health care spending by gender and age. Our research found significant variations in per person spending by gender across age groups, health services, and types of payers. For example, in 2004 per capita health care spending for females was 32 percent more than for males. Per capita differences were most pronounced among the working-age population, largely because of spending for maternity care. Except for children, total spending for and by females was greater than that for and by males, for most services and payers. The gender difference in total spending was most pronounced in the elderly, as a result of the longer life expectancy of women.
Zweifel, P; Felder, S; Meier, M
Salas and Raftery allege that in our paper, (1) remaining life expectancy is an endogenous explanatory variable of health care expenditure and (2) the parameter designed to correct for sample selection bias in fact represents a hidden relationship between health care expenditure and age. We argue that claim (1) is not supported by the available empirical evidence, while claim (2) seems to derive from a too cursory reading of our paper.
Martin, Ruth S; Hayes, Barbara J; Hutchinson, Anastasia; Yates, Paul; Lim, Wen Kwang
Introduction Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. Methods and analysis This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. Dissemination The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. Trial registration number ACTRN12615000298516, Results. PMID:28283490
Chin, Lee; Quine, Susan
A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.
Verschuur, Rianne; Huskens, Bibi; Verhoeven, Ludo; Didden, Robert
Deficits in question-asking are common in children with autism spectrum disorder (ASD). Furthermore, their opportunities to self-initiate questions are often hindered by directive behavior of their conversation partners. This study assessed the effectiveness of staff training in pivotal response treatment (PRT) on staff member-created…
Sakti, G M; Boldy, D P
This study assessed the usefulness and relevance of the information, which had been provided by the Ministry of Health for use in community health centers. Furthermore, this identified the needs of health professionals in terms of relevant information for providing health care to the elderly in the community health centers. A total of 105 questionnaires were administered to 35 doctors and 70 health care workers. The overall response rate of the 105 questionnaires sent out was 80%. Findings revealed that the overall opinion expressed by the health professionals was that the information leaflets, in general, were good. However, some gaps existed between the information provided by the Ministry of Health and the information needs perceived by health professionals working in community health centers for providing health care to the elderly. The majority commented that pertinent information on health problems related to hypertension, arthritis, and heart disease needed to be added. Furthermore, effective pre-testing of the prepared information materials with the target groups before their production and distribution may lessen such gaps or deficiencies. Recommendations to ensure appropriate information are also given and presented in this article.
Shibano, Jun-Ichi; Tadano, Shigeru; Kaneko, Hirotaka
A wide variety of home care equipment has been developed to support the independent lifestyle and care taking of elderly persons. Almost all of the equipment has an alarm designed to alert a care person or to sound a warning in case of an emergency. Due to the fact that aging human beings' senses physiologically, weaken and deteriorate, each alarm's sound must be designed to account for the full range of elderly person's hearing loss. Since the alarms are usually heard indoors, it is also necessary to evaluate the relationship between the basic characteristics of the sounds and living area's layout. In this study, we investigated the sounds of various alarms of the home care equipment based on both the age-related hearing characteristics of elderly persons and the propagation property of the sounds indoors. As a result, it was determined that the hearing characteristics of elderly persons are attuned to sounds which have a frequency from 700Hz to 1kHz, and it was learned that the indoor absorption ratio of sound is smallest when the frequency is 1kHz. Therefore, a frequency of 1kHz is good for the alarm sound of home care equipment. A flow chart to design the alarm sound of home care equipment was proposed, taking into account the extent of age-related auditory sense deterioration.
Ohara, Hiroo; Okabe, Hiromi; Tsuchiya, Kumiko; Kikuchi, Kana
When a patient receives home care, an important factor is how the family accepts the patient's death. In this study, we observed that the number of long-term in-home terminal care cases increased, as well as the number of short-term in-home care cases. Moreover, the number of cancer cases among the young population is also increasing. Consequently, how to acceptance of a patient's death varies among their family. When tending to patients, suitable support from the medical staff is required. Additionally, various options need to be provided for terminal care.
The article considers the quality of specialized hospital care of early age children based on the materials of 568 records of hospital patients in the Republican children hospital of Makhachkala. The important imperfections are detected. About 30% of patients suffered from untimely and insufficient treatment. The untimely consultations took place in case of 15.6% of patients. About 22% of patients didn't receive a whole course of treatment needed. The comprehensive treatment of children was not applied in fullness at the discharge from the hospital in 14% of patients. The guidelines to enhance the quality of specialized hospital care of early age children are developed.
Hughes, Mark; Kentlyn, Sujay
While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people's experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate "coming out" in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace.
Katz, Lilian G.; Allison, Jeanette; Clark, Marty; Bergman, Roberta; Gainer, Sue
Presents four articles on the benefits of multi-age child care settings as being similar to a natural family setting. The workshop titles are: "The Benefits of the Mix" (Katz); "Dealing with Staff and Parent Concerns" (Allison); "Multi-Age at Riverfield Country Day School" (Clark); and "Making Multi-Age Groups Work" (Bergman and Gainer). (LBT)
Mullan, Fitzhugh; Frehywot, Seble; Jolley, Laura J
A combination of "environmental factors" in the U.S. has led to an increased demand for health care professionals. However, there has been a significant decrease in the number of U.S. medical graduates selecting careers in family medicine and general internal medicine, thus driving demand for international medical graduates. At the heart of our national workforce policy needs to be good domestic and foreign policies, such as self-sufficiency approaches that include strategies to incentivize rural and underserved practice for U.S. medical graduates.
Schor, Edward L., Ed.
The middle years of childhood are challenging for both children and their parents, as children master skills and develop behaviors that will strongly influence their later health and well-being. This parenting manual offers up-to-date information and guidelines on key emotional, physical, and behavioral issues that parents of school-age children…
Pattaranit, Rumpan; Chantachum, Vasana; Lekboonyasin, Orathai; Pradubwong, Suteera
The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.
Street, Maryann; Ottmann, Goetz; Johnstone, Megan-Jane; Considine, Julie; Livingston, Patricia M
The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.
Su, Chuan-Jun; Chiang, Chang-Yu
As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients’ needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet. PMID:24225647
Su, Chuan-Jun; Chiang, Chang-Yu
As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients' needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.
Stewart, Michael J.; Georgiou, Andrew; Westbrook, Johanna I.
Background Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including increased access, promoting greater efficiency, and improving care outcomes. There is little research, however, investigating how integrated aged care can be successfully achieved. The PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy) project, from Quebec, Canada, is one of the most systematic and sustained bodies of research investigating the translation and outcomes of an integrated care policy into practice. The PRISMA research program has run since 1988, yet there has been no independent systematic review of this work to draw out the lessons learnt. Methods Narrative review of all literature emanating from the PRISMA project between 1988 and 2012. Researchers accessed an online list of all published papers from the program website. The reference lists of papers were hand searched to identify additional literature. Finally, Medline, Pubmed, EMBASE and Google Scholar indexing databases were searched using key terms and author names. Results were extracted into specially designed spread sheets for analysis. Results Forty-five journal articles and two books authored or co-authored by the PRISMA team were identified. Research was primarily concerned with: the design, development and validation of screening and assessment tools; and results generated from their application. Both quasi-experimental and cross sectional analytic designs were used extensively. Contextually appropriate expert opinion was obtained using variations on the Delphi Method. Literature analysis revealed the structures, processes and outcomes which underpinned the implementation. PRISMA provides evidence that integrating care for older persons is beneficial to individuals through reducing incidence of functional decline and
Haines, Christine; Brand, Jennie Bickmore
The implementation and effectiveness of the inclusion of literacy and numeracy in industry training packages was examined in case studies of three programs in Western Australia. Two were certificate programs in cooking and food and beverage as specified in the hospitality training package, and the third was an aged care program based on the…
Fink, Dale B.
This background briefing paper synthesizes current thinking and practice on the issue of latchkey children and school-age child care (SACC). The paper defines the problem of latchkey children; reviews related literature and programmatic responses to the problem; reports responses of four southern states; and points out implications for policy…
Kane, Robert; Kane, Rosalie
The tendency in the United States to view the nursing home as an all-purpose solution to the health problems of the elderly has created a set of self-made problems: increased dependency, depression and social isolation among the aged. In the United States, unlike in many European nations, institutional care of the elderly is conceived of and…
Garrett, Douglas D.; Tuokko, Holly; Stajduhar, Kelli I.; Lindsay, Joan; Buehler, Sharon
Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants…
Wray, Natalie; McCall, Louise
The research reported in this article explored the impact of the undergraduate placement experience on medical, nursing, and allied health students' perceptions of careers in aged care. Data were collected from undergraduate students (48) and graduates (26) via individual (46) and group (7) interviews; data were thematically analyzed.…
Cullen, Jennifer C.; Hammer, Leslie B.; Neal, Margaret B.; Sinclair, Robert R.
Using a national sample of 267 couples, the authors identify distinct profiles of dual-earner couples in the sandwiched generation (i.e., those caring for children and aging parents) using cluster analysis and then assess the relationship between these profiles and work-family conflict. The profiles are defined by characteristics of couples' child…
Ko, Yi-An; Song, Peter X. K.; Clark, Noreen M.
Rationale: Asthma is a variable condition with an apparent tendency for a natural decline in asthma symptoms and health care use occurring as children age. As a result, asthma interventions using a pre-post design may overestimate the intervention effect when no proper control group is available. Objectives: Investigate patterns of natural decline…
Mack, Robert D.
Foster children experience multiple barriers and challenges that, amongst other issues, prevent them from achieving academically. At the age of 18, foster youth are forced out of the Department of Children and Families care, leading many of them to become homeless or to return to the homes from which they were displaced. Scholarly literature and…
Lee, Yeon-Shim; Chaudhuri, Anoshua; Yoo, Grace J
With the growth in engineering/technology industries, the United States has seen an increase in the arrival of highly skilled temporary migrant workers on H1B visas from various Asian countries. Limited research exists on how these groups maintain family ties from afar including caring for aging parents. This study explores the experiences and challenges that Asian H1B workers face when providing care from a distance. A total of 21 Chinese/Taiwanese, Korean, and Indian H1B workers participated in in-depth qualitative interviews. Key findings indicate that despite distance, caring relationships still continue through regular communications, financial remittances, and return visits, at the same time creating emotional, psychological, and financial challenges for the workers. Findings highlight the need for further research in understanding how the decline of aging parent's health impacts the migrants' adjustment and health in the United States.
Belderok, J J
The situation in homes for the elderly and nursing homes is for the residents both alarming and tragic. Recent Dutch legislation supports the movement towards more self-determination and autonomy for the residents. The staff are dedicated to making the living situation as good as possible for the residents. Nevertheless many publications describe how the dependence and helplessness of the residents stil continue. In this paper this helplessness is placed within the broader framework of modern society by application of Habermas' theory of communicative action and Giddens' structuration theory. Both theories show that the key to improve dependent making structures should be sought principally in the behaviour of both staff and residents. Habermas offers a perspective to more equivalent communicative action between residents and staff. Giddens draws attention to the knowledgeability of residents, with which they should be able to interact on an equal basis with professionals. This presupposes much dedication of both staff and residents.
Background Frailty in the elderly increases their vulnerability and leads to a greater risk of adverse events. According to various studies, the prevalence of the frailty syndrome in persons age 65 and over ranges between 3% and 37%, depending on age and sex. Walking speed in itself is considered a simple indicator of health status and of survival in older persons. Detecting frailty in primary care consultations can help improve care of the elderly, and walking speed may be an indicator that could facilitate the early diagnosis of frailty in primary care. The objective of this work was to estimate frailty-syndrome prevalence and walking speed in an urban population aged 65 years and over, and to analyze the relationship between the two indicators from the perspective of early diagnosis of frailty in the primary care setting. Methods Population cohort of persons age 65 and over from two urban neighborhoods in northern Madrid (Spain). Cross-sectional analysis. Bivariate and multivariate analysis with binary logistic regression to study the variables associated with frailty. Different cut-off points between 0.4 and 1.4 m/s were used to study walking speed in this population. The relationship between frailty and walking speed was analyzed using likelihood ratios. Results The study sample comprised 1,327 individuals age 65 and older with mean age 75.41 ± 7.41 years; 53.4% were women. Estimated frailty in the study population was 10.5% [95% CI: 8.9-12.3]. Frailty increased with age (OR = 1.14; 95% CI: 1.10-1.19) and was associated with poor self-rated health (OR = 2.52; 95% CI: 1.43-4.44), number of drugs prescribed (OR = 1.17; 95% CI: 1.08-1.26) and disability (OR = 6.58; 95% CI: 3.92-11.05). Walking speed less than 0.8 m/s was found in 42.6% of cases and in 56.4% of persons age 75 and over. Walking speed greater than 0.9 m/s ruled out frailty in the study sample. Persons age 75 and older with walking speed <0.8 m/s are at particularly high
Ryan, Rob; Garlick, Robyn; Happell, Brenda
There is currently considerable discussion about the impact of the aging population on the demand for health care services, however there is considerably less attention paid to the impact of mental health issues on the needs of the aged population. Nurses comprise the largest professional group within the mental health workforce in Australia. The availability of a high quality mental health nursing workforce will therefore be crucial to meeting the health needs of aging clients in the future, accompanied by an increased pressure to increase the proportion of care delivered in the community. There is however, a paucity of literature on the role and contribution of community mental health nurses specialising in the aged care field. The aim of this paper is to present the findings of a project designed to examine the role of mental health nursing within aged persons' community mental health teams in Victoria, Australia, with particular emphasis on the biopsychosocial interventions used. Fifteen participants from three community mental health services in Victoria participated in a focus group interview to share their insights and experiences. Data analysis revealed two main themes, the role of the nurse, and the specific functions of the nurse. This data is presented as a beginning contribution to the paucity of literature currently available in this important area.
Happo, Iiris; Maatta, Kaarina; Uusiautti, Satu
Every preschool age child in Finland has the right to child care. Well-educated staff consists of all-round experts who work in versatile contexts with various children in a multi-professional collaboration. This staff is one of the strengths of the Finnish child care system. The aim of this article is to clarify the expertise of those early…
Park, Jungsun; Park, Jong-Tae; Kim, Soo Geun; Yoo, Cheol-In; Son, Junseok; Yim, Jun; Kim, Dae-Seong; Rhee, Kyung Young; Kim, Yangho
The rapid aging trend in South Korea will cause a growing shortage of labor and decreasing quality of the labor force. The purpose of this commentary is to recommend a health care strategy to maintain and promote the work ability of employees in an aging Korea. Strategies to promote the work ability require the collaboration of governmental agencies at the central and local levels. First, the common goal should be the reinforcement of follow-up measure in general medical examinations and the promotion of healthy lifestyles for workers. Second, collaborating activities should be performed among the Worker's Health Center, the Health Promotion Center, and community health centers. In conclusion, health care strategies for ensuring the work ability in an aging Korea require the collaboration of governmental agencies at the central and local levels.
Perlman, Michal; Falenchuk, Olesya; Fletcher, Brooke; McMullen, Evelyn; Beyene, Joseph; Shah, Prakesh S
The quality of staff/child interactions as measured by the Classroom Assessment Scoring System (CLASS) in Early Childhood Education and Care (ECEC) programs is thought to be important for children's outcomes. The CLASS is made of three domains that assess Emotional Support, Classroom Organization and Instructional Support. It is a relatively new measure that is being used increasingly for research, quality monitoring/accountability and other applied purposes. Our objective was to evaluate the association between the CLASS and child outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Studies that measured association between the CLASS and child outcomes for preschool-aged children who attended ECEC programs were included after screening by two independent reviewers. Searches and data extraction were conducted by two independent reviewers. Thirty-five studies were systematically reviewed of which 19 provided data for meta-analyses. Most studies had moderate to high risk of bias. Of the 14 meta-analyses we conducted, associations between Classroom Organization and Pencil Tapping and between Instructional Support and SSRS Social Skills were significant with pooled correlations of .06 and .09 respectively. All associations were in the expected direction. In the systematic review, significant correlations were reported mainly from one large dataset. Substantial heterogeneity in use of the CLASS, its dimensions, child outcomes and statistical measures was identified. Greater consistency in study methodology is urgently needed. Given the multitude of factors that impact child development it is encouraging that our analyses revealed some, although small, associations between the CLASS and children's outcomes.
Perlman, Michal; Falenchuk, Olesya; Fletcher, Brooke; McMullen, Evelyn; Beyene, Joseph; Shah, Prakesh S.
The quality of staff/child interactions as measured by the Classroom Assessment Scoring System (CLASS) in Early Childhood Education and Care (ECEC) programs is thought to be important for children’s outcomes. The CLASS is made of three domains that assess Emotional Support, Classroom Organization and Instructional Support. It is a relatively new measure that is being used increasingly for research, quality monitoring/accountability and other applied purposes. Our objective was to evaluate the association between the CLASS and child outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Studies that measured association between the CLASS and child outcomes for preschool-aged children who attended ECEC programs were included after screening by two independent reviewers. Searches and data extraction were conducted by two independent reviewers. Thirty-five studies were systematically reviewed of which 19 provided data for meta-analyses. Most studies had moderate to high risk of bias. Of the 14 meta-analyses we conducted, associations between Classroom Organization and Pencil Tapping and between Instructional Support and SSRS Social Skills were significant with pooled correlations of .06 and .09 respectively. All associations were in the expected direction. In the systematic review, significant correlations were reported mainly from one large dataset. Substantial heterogeneity in use of the CLASS, its dimensions, child outcomes and statistical measures was identified. Greater consistency in study methodology is urgently needed. Given the multitude of factors that impact child development it is encouraging that our analyses revealed some, although small, associations between the CLASS and children’s outcomes. PMID:28036333
The combination of an ageing population and increasing numbers of prisoners means delivering end of life care in prisons is inevitable. To this end the National End of Life Programme has published a practical guide, aimed at health and social care workers, and prison staff. The guide outlines the six steps of the end of life care pathway in detail, from initiating discussions to care after death. It also includes case studies highlighting best practice. To read the guide, visit http://tinyurl.com/ndoflifeinprison.
Howe, Anna L; King, Debra S; Ellis, Julie M; Wells, Yvonne D; Wei, Zhang; Teshuva, Karen A
Concerns about the capacity of the aged care industry to attract and retain a workforce with the skills required to deliver high quality care are widespread, but poor conceptualisation of the problem can result in strategies to address turnover being poorly targeted. A census of residential and community aged care services conducted by the National Institute of Labour Studies (NILS) in 2007 provided a comprehensive empirical account of the workforce, and estimated turnover on the basis of retention: that is, the proportion of the workforce who had been in their job for 1 year or less. This paper adds the dimension of intention: that is, workers' expectations as to whether in 1 year's time, they would still be working in the same aged care service. The dual driver model that takes both retention and intention into account was applied in further analysis of the 2007 NILS data. Investigation of relationships between workforce instability and 13 variables covering worker attributes, organisational attributes and structural attributes of the industry demonstrated the usefulness of the dual driver model for reconceptualising and analysing stability and, in turn, refining strategies to address turnover.
Horsfall, Debbie; Blignault, Ilse; Perry, Astrid; Antonopoulos, Penny
This article documents the findings of a short-term longitudinal study that explored the caring journeys of aged Greek carers providing in-home care for their spouse. Through a deeper understanding of carers' decisions and decision-making and insights from service providers and community leaders, we aimed to inform policy makers, service managers and providers about how to develop and promote culturally appropriate support services, and negotiate them with carers and care recipients in a timely way. Initially, we conducted three focus groups and one follow-up forum with service providers and Greek community leaders. Then, over a 6-month period, we conducted two in-home interviews and two telephone interviews with 12 older Greek carers. We sought to understand factors influencing carers' decision-making regarding service uptake, and we provided information about services as required. Through our thematic analysis, we found that most carers wanted to remain as independent as possible and to avoid forced separation from the one they loved, through institutionalisation. They placed great value on their caring role which, while a struggle at times, gave them a sense of meaning, purpose and belonging. We also found that carers had great resourcefulness, strength and competence. They were all in long-term relationships, had negotiated coming to a foreign country and establishing themselves and were now in the process of negotiating old age and increasing frailty while at the same time providing care and support to family and friends. Our findings suggest that services need to be communicated in ways which support what carers value, not on outdated assumptions about cultural groups, otherwise providers will perpetuate exclusion. We propose an outreach in-home service model with an emphasis on ageing well and staying at home. This model of service provision is a model of care which emphasises relationships and community, and seeks to build social and cultural capital.
Advocating development for all continuing education staff, the author asserts that staff who understand adult education theory, the goals and visions of the organization, the environmental context of continuing education, and the roles of other staff members will be more effective. Also essential are support mechanisms that facilitate change. (SK)
Julian, Megan M
One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.
Julian, Megan M.
One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered. PMID:23576122
Rykkje, Linda L R; Eriksson, Katie; Raholm, Maj-Britt
Spirituality is an important part of caring for the whole human being. However, there is lack of consensus about the concept parameter, and there is an ongoing discussion in nursing regarding the relation between religion and spirituality. Spirituality and religion is found to support health and well-being in old age, and this article portrays how older Norwegians understand religion and religious support as part of spirituality and caring. The theoretical framework in this study is Eriksson's caritative caring theory, and the research aim is to broaden the understanding of spirituality from a caring science perspective. The methodology is hermeneutical according to Gadamer. The study is based upon qualitative content analysis of 30 interviews with 17 participants above 74 years, six men and 11 women. The findings portray connectedness with a Higher power, including how Christianity has influenced upon the philosophy of life of the participants, wonders about the end of life/afterlife, and the meaning of religious symbols and rituals. The study also portrays how religious support may foster dignity, especially near the end of life, and experiences and opinions regarding support from nursing personnel. The study concludes that religiousness cannot be separated from spirituality, and that nurses should be able to provide spiritual care to a certain extent. Spiritual care including religious support according to patients' desires may foster health and preserve human dignity.
Karam, S E; Nies, D M
A partnership between a nursing home and a school of nursing provides both staff and students with creative opportunities for solving clinical problems. Through collaborative efforts of senior baccalaureate students and the staff administration of a long-term care facility in eastern Virginia, a successful bowel management program was developed and implemented.
Polaro, Sandra Helena Isse; Gonçalves, Lucia Hisako Takase; Nassar, Silvia Modesto; Lopes, Márcia Maria Bragança; Ferreira, Viviane Ferraz; Monteiro, Hellen Karinna
This study aimed to determine the pattern of family functioning on everyday care relationships of adults in the fourth age. This is a study of diagnostic-evaluative nature of adults with 80 or more years old who depend on care, and of their relatives as caregivers. The participants were selected among the registered patients of a Family Health Unit in a district in the suburbs of Belém-PA, Brazil. They were evaluated according to the dynamics of their family, and quality of life related health lifestyle. Most of the elderly rated their families with good functionality. However, data on the elderly and caregivers' quality of life and caregivers' life style only reached the median level, showing some difficulty in the family functioning system. It was concluded that the multiple results obtained through the assessments indicate some practical implications of care to the family unity and confirm the need for multidimensional assessment about the family intervention.
Ground, Anita; Jones, Josette; Flatley-Brennan, Patricia
Persistent questions remain regarding computer use by elders, particularly those recovering from a major surgical procedure. Fifty-three participants of the HeartCare project were provided home-accessible WWW-based recovery support post-coronary artery bypass graft (CABG) surgery and used it to access tailored educational web pages, communicate via email, and join a discussion group. We employed use data to evaluate the impact of age on use for the first 30 days after discharge and determined that the age of the participants did not significantly influence use of the system in this study.
Gabrielli, Joy; Jackson, Yo; Brown, Shaquanna
The Behavioral Assessment System for Children-2 (BASC-2) is used to assess behavioral and emotional outcomes for youth. Research providing evidence for use of the BASC-2 parent-report form historically has included biological parents reporting on their children (Reynolds and Kamphaus 2004). For youth residing in out-of-home placements through enrollment in foster care, caregivers reporting on their functioning may include foster parents or residential staff. Given the significant adverse mental health outcomes for youth in foster care and the need to adequately assess adjustment in foster care, the purpose of the study was to evaluate the measurement properties of caregivers' report on the parent report form (PRS) of the BASC-2 in foster care youth. Using 479 respondents, a measurement model was fit to the data demonstrating adequate fit across Internalizing Problems, Externalizing Problems, and Adaptive Skills. Further, a comparison of measurement properties across child and adolescent groups and groups of youth residing in residential facilities versus foster homes was conducted. Factorial invariance and latent means also were assessed. The BASC-2 PRS was found to be an adequate assessment of psychological outcomes for youth in foster care when completed by foster parents or residential facility staff.
Lesauskaite, Vita; Macijauskiene, Jurate; Rader, Erin
The aim of this paper is to present the Lithuanian experience in creating a geriatric care system with the hope that it can be of some use to other countries undergoing similar transitions and changes. The Lithuanian population is old with 20% of the population being 60 years and older, and 15% being 65 years and older, with the trend toward a rapidly aging society. In 1990, Soviet rule in Lithuania ceased and the country regained its independence. With its recent acceptance into the European Union, the nation has set goals to meet the recommended requirements for the care of the elderly. The changes began with specialist training in gerontology and geriatrics, and were an essential first step to bridge the gap between the real and the future needs. Later, the Geriatric Care System Development Program was approved by the Ministry of Health. Despite its difficult past, Lithuania is confronting the challenges of health and social care of the aging population. It is embracing the opportunities to initiate policies and related measures to meet these challenges, and is potentially setting an example of good practice as a new European community.
Devine, Elizabeth C.; And Others
A three-hour, two-stage workshop for staff nurses on providing education and psychological support to 148 patients who had abdominal surgery. After the workshop the patients used fewer sedatives or antiemetics, fewer hypnotics, and were discharged from the hospital on the average half a day sooner. (Author/BJV)
Modanlou, Houchang D
During the Sassanid Empire in Persia (226-652 AD), there was a renaissance of humanistic sciences, including medicine, in the city of Gondi-Shapur. When the Islamic center of power moved to Baghdad in about 750 AD, physicians of Gondi-Shapur, including the dean of the medical school (a Nestorian Christian), gradually moved to Baghdad constructing hospitals and medical schools. Aided by the Persian and Nestorian Christians, the Islamic civilization ushered in what is considered to be the Golden Age of Islam from the 8th to 13th century AD. During this period, there were remarkable achievements in humanistic sciences including medicine by many physicians/authors whose medical textbooks were used for centuries in burgeoning medical schools in Europe. The medical texts written during the Golden Age of Islamic Medicine contain sections and chapters about the clinical conditions, diseases and medical care of children. It was during this era that the first treatise was written on the diseases of children and their care. This essay will describe, in brief, the writings about the conditions and diseases of children and their medical care, by three prominent Persian physicians of the Golden Age of Islamic Medicine: 1) Abubakr Muhammad Ibn Zakaria Razi, Rhazes (865-925 AD); 2) Ali ibn-al-Abbas al-Majusi or Haly Abbas (949-994 AD); and 3) Abu Ali al-Husayn ibn Abd Allah ibn Sina or Avicenna (980-1037 AD).
There is a growing body of literature about the potential for early childhood settings to serve as community hubs to develop relationships with families. However, there is limited information about the ways in which families and early childhood staff interface in defining what constitutes "quality" within settings. Researchers have…
Iacono, T.; Bigby, C.; Carling-Jenkins, R.; Torr, J.
Background: Disability staff are being increasingly required to support adults with Down syndrome who develop Alzheimer's disease. They have little understanding of the nature of care required, and may lack input from aged care and dementia services, which lack knowledge of intellectual disability. The aim of this study was to report on the…
Ko, Yi-An; Clark, Noreen M.
Rationale: Asthma is a variable condition with an apparent tendency for a natural decline in asthma symptoms and health care use occurring as children age. As a result, asthma interventions using a pre-post design may overestimate the intervention effect when no proper control group is available. Objectives: Investigate patterns of natural decline over time with increasing age in asthma symptoms and health care use of children. Develop a statistical procedure that enables adjustment that accounts for expected declines in these outcomes and is useable when intervention evaluations must rely solely on pre-post data. Methods: Mixed-effects models with mixture distributions were used to describe the pattern of symptoms and health care use in 3,021 children aged 2 to 15 years in a combined sample from three controlled trials. An adaptive least squares estimation was used to account for overestimation of intervention effects and make adjustments for pre-post only data. Termed “Adjustment for Natural Declines in Asthma Outcomes (ANDAO),” the adjustment method uses bootstrap sampling to create control cohorts comparable to subjects in the intervention study from existing control subjects. ANDAO accounts for expected declines in outcomes and is beneficial when intervention evaluations must rely solely on pre-post data. Measurements and Main Results: Children under 10 years of age experienced 18% (95% confidence interval, 15–21%) fewer symptom days and 28% (95% confidence interval, 24–32%) fewer symptom nights with each additional year of age. The decline was less than 10% after age 10 years, depending on baseline asthma severity. Emergency department visits declined regardless of baseline symptom frequency (P = 0.02). The adjustment method corrected estimates to within 2.4% of true effects through simulations using control cohorts. Conclusions: Because of the declines in symptoms and health care use expected with increasing age of children with asthma, pre
DeMarco, Rosanna F; Brennan-Ing, Mark; Sprague, Courtenay; Brown, Shelley M
Ageism, in the form of prejudice, stereotyping, and discrimination targeting older adults, represents a barrier to addressing the graying of the HIV epidemic. There is widespread misperception on the part of older adults themselves, as well as service providers and society in general that HIV risk is low as one ages. In addition, internalized ageism may play a role in poorer physical and mental health outcomes, as the negative stereotypes associated with aging become a self-fulfilling prophecy. A number of steps can be taken to address HIV and aging in the context of ageism with regard to: prevention, education, and outreach; treatment guidelines for older adults with HIV; funding to address the aging of the epidemic; engagement of communities, health and social service organizations, and other providers around mental health and social support, and addressing the needs of special populations. Caring for an aging population with HIV represents a challenge, which is exacerbated in low and/or middle-income countries that typically lack the infrastructure of high resource settings. How we address the aging-related issues of the HIV epidemic across regions and settings could serve as a model in dealing with aging in our society in general regardless of HIV status.
Wright, Olivia R. L.; Connelly, Luke B.; Capra, Sandra; Hendrikz, Joan
Abstract Background Poor satisfaction with institutional food is a significant moderator of food intake in geriatrics/rehabilitation and residential aged care. Purpose To quantify the relationship between foodservice satisfaction, foodservice characteristics, demographic and contextual variables in geriatrics/rehabilitation and residential aged care. Methods The Resident Foodservice Satisfaction Questionnaire was administered to 103 patients of 2 geriatrics/rehabilitation units and 210 residents of nine residential aged care facilities in Brisbane, Australia. Ordered probit regression analysis measured the association of age, gender, ethnicity and appetite, timing and amount of meal choice, menu selectivity, menu cycle, production system, meal delivery system and therapeutic diets with foodservice satisfaction. Results Patient and resident appetite (P < 0.01), the amount and timing of meal choice (P < 0.01), self‐rated health (P < 0.01), accommodation style (P < 0.05) and age (P < 0.10) significantly moderated foodservice satisfaction. High protein/high energy therapeutic diets (P < 0.01), foodservice production (P < 0.01) and delivery systems (P > 0.01) were significant moderators for those with ‘fair’ self‐rated health. Conclusions Patient and resident characteristics and structural and systems‐related foodservice variables were more important for influencing foodservice satisfaction than characteristics of food quality. The results suggest modifications to current menu planning and foodservice delivery methods: reducing the time‐lapse between meal choice and consumption, augmenting the number of meals at which choice is offered, and revising food production and delivery systems.It is important that residents in poorer health who are a high risk of under‐nutrition are provided with sufficient high protein/high energy therapeutic diets. Diets that restrict macro‐ and micro‐nutrients should be
Vukicevic, M; Heraghty, J; Cummins, R; Gopinath, B; Mitchell, P
Purpose Caregivers of older persons with eye disease, namely age-related macular degeneration (AMD), have been reported to have a higher than expected distress. Very few studies have explored caregiver perceptions as to what is important when providing care. The aim of this study was to explore the perceptions of caregivers of persons with neovascular AMD in relation to the most important aspects of caring, as described in extended answers to self-administered survey questions. Methods A cross-sectional, self-administered survey of 643 caregivers of people with neovascular AMD, comprising 27 closed-response questions and 2 open ended questions. The latter were analysed as part of this study utilising and ‘inductive' Grounded Theory approach. Results Six-hundred and forty-three caregiver responses to 2 open ended questions were analysed using an inductive approach and sorted into thematic networks. Three discrete categories arose: The Impact of Caring; Injections and Information and Activities of Daily Living. Conclusions Most caregivers were family caregivers and were found to be compassionate and self-sacrificing. They accepted additional responsibility whilst providing an encouraging environment for their care recipient. As a result, they experience distress and consider their own needs as secondary. Very few seek or receive respite and this added burden can have a negative impact upon the relationship between caregiver and care recipient. PMID:26611848
The notion of a separate "women's health" component within the U.S. health care system emerged in the 1980s as many health care organizations recognized the opportunities offered by this market. While originally addressed traditional women's needs such as OB services, the 1990s witnessed as expansion of the scope of women's services as baby-boom women became a driving force for consumerism. For health care marketers, the female market is in many THE market for health care for the future and health care organizations have responded to this opportunity in a variety of ways. Demographic, social, and economic trends will only serve to increase the importance of women as health care consumers. For both providers of care and marketers, the women's market is clearly a force to be reckoned with as health care enters the 21st century.
Retarded Infants Services, Inc., New York, NY.
A 12-WEEK TRAINING PROGRAM WAS DEVELOPED TO PREPARE NONPROFESSIONAL PERSONNEL TO SERVE MENTAL RETARDATES IN THE AREAS OF HOMEMAKING AND CHILD CARE, PHYSICAL MEDICINE AND NURSING CARE, SPEECH THERAPY, PLAY ACTIVITY, AND AUXILIARY MATERNAL CARE. RECRUITMENT WAS THROUGH NEWSPAPER ANNOUNCEMENT, THE RETARDED INFANTS SERVICE REFERRAL AGENCIES, POVERTY…
Lay-Yee, Roy; Pearson, Janet; Davis, Peter; von Randow, Martin; Kerse, Ngaire; Brown, Laurie
The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65 years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community-based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual-level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community-based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people.
Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn
To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (body mass index ≥ 85th percentile) 6-12-year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies and feasibility of specific dietary strategies. Focus groups were recorded, transcribed and analysed using margin coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American and 23%, white. Parents' recommendations on the primary-care provider's role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up and using discretion during weight discussions. Weight-management components identified as key included emphasising healthy lifestyles and enjoyment, small changes to routines and parental role modelling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasising servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement and deemphasising specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximise parental acceptance.
Soheilipour, Saeed; Soheilipour, Fatemeh; Derakhshandeh, Fatemeh; Hashemi, Hedieh; Memarzadeh, Mehrdad; Salehiniya, Hamid; Soheilipour, Fahimeh
Background: Due to numerous difficulties in patients suffering from varieties of cleft lip and palate, their therapeutic management involves interdisciplinary teamwork. This study was conducted to compare the age of commencing treatments such as speech therapy, secondary palate and alveolar bone grafting and orthodontics between those who sought treatment early and late. Materials and Methods: In this retrospective study, 260 files of patients with cleft lip and palate based on their age at the time of admission to a cleft care team were divided into two groups: The early admission and late admission. Both groups compared based on four variables including the mean age of beginning speech therapy, palatal secondary surgery, alveolar bone grafting, and receiving orthodontics using t-test. Results: Based on the results, among 134 patients admitted for speech therapy, the mean age of initiating speech therapy in early clients was 3.3 years, and in the late ones was 9 years. Among 47 patients with secondary surgery, the mean age in early clients was 3.88 years, and in the late clients was 15.7 years. Among 17 patients with alveolar bone grafting, the mean age in the first group was 9 years, and in the other was 16.69 years. Among 24 patients receiving orthodontic services, the mean age in early clients was 7.66 years, and in the second group was 17.05 years. Conclusion: There was a significant difference between the age of performing secondary surgery and alveolar bone grafting and the age of beginning speech therapy and receiving orthodontic services in early references and late references to the team. PMID:27274350
Seaman, Karla; Saunders, Rosemary; Williams, Elly; Harrup-Gregory, Jane; Loffler, Helen; Lake, Fiona
It is essential that health professionals are trained to provide optimal care for our ageing population. Key to this is a positive attitude to older adults along with the ability to work in teams and provide interprofessional care. There is limited evidence on the impact an interprofessional education (IPE) placement in a residential aged care facility (RACF) has on students. In 2015 in Western Australia, 51 students (30% male, median age 23 years), from seven professions, undertook a placement between 2 and 13 weeks in length at 1 RACF. Pre- and post-placement measurements of attitudes to the elderly were collected using the Ageing Semantic Differential (ASD) questionnaire and level of readiness for interprofessional learning with the Readiness for Interprofessional Learning Scale (RIPLS). A total of 47 students completed matched ASD and RIPLS surveys. The mean total score on the ASD survey decreased significantly from pre- to post-placement from 116.0 to 108.9 (p = 0.033), indicating attitudes became increasingly positive towards older adults. Significant differences post-placement were seen indicating better readiness for interprofessional learning, for two out of four subscales on the RIPLS, namely "teamwork & collaboration" (42.1-44.0; (p = 0.000)) and "positive professional identity" (18.2-19.3 (p = 0.001)). The degree of change is similar to findings from other settings. The results support IPE-focussed student placements within RACF positively influence student's attitudes towards the older adult as well as increase student's readiness for interprofessional learning, confirming RACF are valuable places for training health professionals.
An alternate technique of care to prevent, arrest and manage root caries using aqueous silver fluoride followed by stannous fluoride (AgF+SnF2) in aged care is demonstrated by three case studies. With increasing age, the inability to maintain ones own oral care from dementia, illness or frailty and polypharmacy induced salivary gland hypofunction will result in dental caries becoming a progessively greater burden for the elderly. Future generations of elders will live longer and need to maintain many more teeth longer than earlier generations. Both silver diamine fluoride (SDF)and AgF+SnF2 arrest and prevent caries and are easy to use in residential aged care facilities. Clinical differences between SDF and AgF+SnF2 are discussed. However, in aged care, AgF+SnF2 may offer advantages over SDF. AgF+SnF2 used to arrest and prevent caries in children can be modified to provide effective but minimally invasive care for an ageing and frail population. These techniques are rapid, inexpensive and nonthreatening suited to treat frail elders, dementia patients exhibiting challenging behaviours and patients with multiple rapidly progressing decay. Silver fluoride, applied before placing glass-ionomer cement (GIC) restorations is an important adjunct to the atraumatic restorative technique and may retard caries reactivation more than GIC used alone.
Changes in the healthcare industry have created great challenges for leaders of acute-care organizations. One of the greatest challenges is ensuring a competent nursing staff to care for patients within this changing environment (Boylan & Westra, 1998). Patients are more acutely ill and have shorter lengths of stay, placing greater demands on nurses who must demonstrate competency in caring for increasingly complex patients in a continually changing healthcare environment. Competency is defined as "the knowledge, skills, ability and behaviors that a person possesses in order to perform tasks correctly and skillfully" (O'Shea, 2002, p. 175). Competency assessment involves more than a checklist and a test. Hospitals are required to assess, maintain, demonstrate, track, and improve the competence of the staff. Competency assessment is an ongoing process of initial development, maintenance of knowledge and skills, educational consultation, remediation, and redevelopment. Methods to assess competencies include competency fairs, Performance Based Development System and online programs. Certain key people should be involved in the development of competencies. The department managers can give input related to department-specific competencies. Experienced staff members can provide valuable insight into the competencies that need to be assessed. Educators should be involved for providing the input for the methods used to validate competencies. Competencies are an important part of the work world. They are a part of a continual process to help ensure that the organization provides a high-quality care to its customers and patients.
Pammolli, Fabio; Riccaboni, Massimo; Magazzini, Laura
During the last 30 years, health care expenditure (HCE) has been growing much more rapidly than GDP in OECD countries. In this paper, we review the determinants of HCE dynamics in Europe, taking into account the role of income, aging population, technological progress, female labor participation and public budgetary variables. We show that HCE is a multifaceted phenomenon where demographic, social, economic, technological and institutional factors all play an important role. The comparison of total, public and private HCE reveals an imbalance of European welfare toward the care of the elderly. European Governments should increasingly rely on pluralistic systems to balance sustainability and access and equilibrate the distribution of resources across the functions of the public welfare system.
Weakley, Alyssa; Tam, Joyce W; Van Son, Catherine; Schmitter-Edgecombe, Maureen
Health care professionals (HCPs) are a critical source of recommendations for older adults. Aging services technologies (ASTs), which include devices to support the health-care needs of older adults, are underutilized despite evidence for improving functional outcomes and safety and reducing caregiver burden and health costs. This study evaluated a video-based educational program aimed at improving HCP awareness of ASTs. Sixty-five HCPs viewed AST videos related to medication management, daily living, and memory. Following the program, participants' objective and perceived AST knowledge improved, as did self-efficacy and anticipated AST engagement. About 95% of participants stated they were more likely to recommend ASTs post-program. Participants benefitted equally regardless of years of experience or previous AST familiarity. Furthermore, change in self-efficacy and perceived knowledge were significant predictors of engagement change. Overall, the educational program was effective in improving HCPs' awareness of ASTs and appeared to benefit all participants regardless of experience and prior knowledge.
Lists 36 tangible ways that child care directors can motivate staff through showing them respect and appreciation. Included are suggestions related to publicly acknowledging staff expertise and training, organizing events for team bonding, recognizing and using staff members' talents, and providing space for organization and planning. (KB)
Herbert, Patrick C.; Lohrmann, David K.
Health promotion programs for school staff are an overlooked and underused resource that can reduce overweight and obesity among teachers and other staff members. They can also reduce staff absenteeism, increase productivity, reduce costs associated with health care and disability, and foster a climate that promotes good health schoolwide. An…
Henderson, Karla A.; Bialeschki, M. Deborah
The 1981 study ascertained whether the self-concept of 66 camp staff from 2 Wisconsin camps changed more than a control group of 18 college students attending summer school; if differences in self-concept were based on a particular characteristic (age, gender, staff position, years at camp); and in what ways, if any, self-concept of camp staff…
Age-related macular degeneration (AMD) is the predominant cause of legal blindness in the population over 50 years of age. The disorder shows exponentially increasing prevalence with age, and the late forms with their vision threatening evolution are found in approximately one third of cases. The late AMD may be purely atrophic and so far untreatable. Or it may be neovascular and exudative, for which medical treatment is available, consisting of repetitive intravitreous injections of Anti-VEGF molecules. The treatment is highly effective in blocking the growth of the pathological vessels and allowing resolution of the accompanying edema. Visual improvement is variable but often very meaningful for the patients. However, the final visual level depends mostly on early intervention. Thus, screening for the first signs of neovascular AMD is crucial for the endresult. However, the repetitive intraocular injections are an important burden for the patients. Due to the high patient numbers, the chronic care management with steadily adding new patients is a major challenge for treating institutions. Limited resources may put patients at risk of undertreatment with resulting visual loss. Various strategies have been developed to cope with the burden. In addition, the financial cost is high for the health care system. On the other hand, timely and ongoing treatment is the best investment to achieve meaningful visual improvement, which is extremely important for the quality of life and autonomy of the patients. Side effects of the treatment are limited and mostly procedure related. Systemic side effects are possible but despite the large studies not conclusive. However, care must be taken in cases of high cardiovascular risk, as thromboembolic risk increase may rarely happen. So far unsolved problems include the long term visual results, the degree of reversibility of neovascularization, and the missing treatment options of atrophic AMD. Basic and clinical research on various
Sugimoto, Kaoru; Ishikawa, Mariko; Kouketsu, Nobuko; Ozaki, Mitsuyo; Tomita, Ikue; Hong, Youngjae; Miura, Hisayuki; Nishikawa, Mitsunori; Yokoe, Yuriko; Nakashima, Kazumitsu
The National Center for Geriatrics and Gerontology in Japan implemented a home medical care support system for aged patients in April 2009. In this study, we report a case of terminal care system where a medical care intervention was carried out by a close coordination of visiting nurses and other staffs with a "at-home terminal care" brochure on hand, and we discussed how this system was brought forward satisfactory and how it affected this culture.
Jerome, Jared; Kaplan, Howard; Sturmey, Peter
Three residential staff aged 22-38 years participated in this study which measured the accuracy of their data collection, following instruction, in-service, and in-service plus feedback. The experimenter trained them to collect data on targeted maladaptive behavior of one consumer at one time of the day. Following the in-service and the in-service plus feedback trainings, the experimenters assessed whether data collection accuracy increased for that consumer at that time and whether these improved data collection skills generalized to the other consumers and different times. The experimenter used a multiple-baseline-across-participants design to demonstrate experimental control. All three staff improved their data-collection-accuracy from instruction to in-service, and then from in-service to in-service plus feedback. Additionally, improved data collection generalized to two different consumers and two separate time periods. Future research should extend these findings of this study to measuring the effects of more accurate data collection on other functional dependent variables such as accuracy of staff implementation of behavior plans, frequency of maladaptive behavior and amount of prescribed psychotropic medications.
Campbell-Hall, Vicky; Petersen, Inge; Bhana, Arvin; Mjadu, Sithembile; Hosegood, Victoria; Flisher, Alan J
The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.
Congress of the U.S., Washington, DC. Senate Committee on Finance.
Legislation has been proposed by the Administration to revise the Aid to Families with Dependent Children (AFDC) foster care program. This committee print provides background information on the AFDC foster care program under Title IV-A (from 1962-1980); discusses the changes made in the program since the passage of the Adoption Assistance and…
Frampton, Kristen L.; Perlman, Michal; Jenkins, Jennifer M.
Use of metacognitive language by child care center staff in classrooms that serve preschool-aged children was examined. Staff's use of mental-state talk, perspective-taking talk, and activity-relevant questioning with children were coded in a series of 20-s snapshots taken over the course of one full morning per classroom. A total of 3401…
Mohanty, Pranoti S.
This practicum project sought to improve nutrition in a day care program serving children ages 2 through 14 years by increasing staff, student, and parent knowledge about nutrition. The primary goal was to increase knowledge and interest in nutrition and its relation to wellness of students, staff, and parents. The second goal was to provide…
Romano, Elisa; Kohen, Dafna; Findlay, Leanne C.
Canadian data based on maternal reports for a nationally representative sample of 4,521 4-5-year-olds were used to examine associations among child care, family factors, and behaviors in preschool-aged children. Linear regressions testing for direct and moderated associations indicated that regulated home-based care was associated with less…
Hurley, Kristin Duppong; Shaw, Tanya; Thompson, Ron; Griffith, Annette; Farmer, Elizabeth M.; Tierney, Jeff
This study describes the development of the Staff Implementation Observation Form, an instrument to assess staff competence delivering an intervention to youth in group home care with behavioral or emotional disorders. This instrument assesses staff skill at implementing the key treatment components, including building relationships with youth,…
Keane, Barry; Bellamy, Gary; Gott, Merryn
With the future focus on palliative and end-of-life care provision in the community, the role of the general practice team and their relationship with specialist palliative care providers is key to responding effectively to the projected increase in palliative care need. Studies have highlighted the potential to improve co-ordination and minimise fragmentation of care for people living with palliative care need through a partnership between generalist services and specialist palliative care. However, to date, the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. The aim of this study was to explore how general practice and specialist palliative care team (SPCT) members view their relationship in terms of partnership working. Five focus group discussions with general practices and SPCT members (n = 35) were conducted in 2012 in two different regions of New Zealand and analysed using a general inductive approach. The findings indicate that participants' understanding of partnership working was informed by their identity as a generalist or specialist, their existing rules of engagement and the approach they took towards sustaining the partnership. Considerable commitment to partnership working was shown by all participating teams. However, their working relationship was based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. Tensions between the cultures of 'generalism' and 'specialism' also provided challenges for those endeavouring to meet palliative care need collaboratively in the community. Further research is required to better understand the factors associated with successful partnership working between general practices and specialist palliative care in order to develop robust strategies to support a more sustainable model of community palliative care.
Freda, M C
Of the many social trends that will have an impact on the ethical debates surrounding women's health in the 21st century, three are discussed: the shifting demographics of age and race in the United States; the fundamental change in the health care system to a community-based, preventive model; and the equal voice of women in the government. Using these trends as a framework, this article hypothesizes the ethical debates that will occur in the 21st century concerning such issues as fetal viability, abortion, contraception, infertility, genetic engineering, aggressive versus nonaggressive treatment of aging women, scarce resources, menopause, organ transplants, sexism in biomedical research, fertility in postmenopausal women, birthing centers, fetal surgery, and fetal therapy.
Hughes, Anne K; Lewinson, Terri D W
Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers.
Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process
Viotti, Sara; Gilardi, Silvia; Guglielmetti, Chiara; Converso, Daniela
Among nursing staff, the risk of experiencing violence, especially verbal aggression, is particularly relevant. The present study, developed in the theoretical framework of the Job Demands-Resources model (JD-R), has two main aims: (a) to examine the association between verbal aggression and job burnout in both nurses and nurse's aides and (b) to assess whether job content, social resources, and organizational resources lessen the negative impact of verbal aggression on burnout in the two professional groups. The cross-sectional study uses a dataset that consists of 630 workers (522 nurses and 108 nurse's aides) employed in emergency and medical units. High associations were found between verbal aggression and job burnout in both professional groups. Moderated hierarchical regressions showed that, among nurses, only the job content level resources moderated the effects of the verbal aggression on job burnout. Among nurse's aides, the opposite was found. Some resources on the social and organizational levels but none of the job content level resources buffered the effects of verbal aggression on workers burnout. The study highlights the crucial role of different types of resources in protecting nursing staff from the detrimental effects of verbal aggression on job burnout. PMID:26568956
Public Health Service (DHEW), Rockville, MD.
USING DATA COLLECTED IN A SAMPLE SURVEY OF RESIDENT INSTITUTIONS WHICH PROVIDE NURSING OR PERSONAL CARE TO THE AGED OR CHRONICALLY ILL, EMPLOYEES WERE DESCRIBED IN TERMS OF AGE AND SEX, JOB CATEGORIES, HOURS WORKED PER WEEK, FULL-TIME EQUIVALENT STAFF, AND RATIO OF RESIDENTS TO EMPLOYEES. SOME FINDINGS WERE--(1) NURSING AND PERSONAL CARE HOMES…
Bodak, Marie; Barlas, Joanna; Harwood, June; Pether, Mary
Robots, including robotic seals, have been used as an alternative to therapies such as animal assisted therapy in the promotion of health and social wellbeing of older people in aged care facilities. There is limited research available that evaluates the effectiveness of robot therapies in these settings. The aim of this study was to identify, explore, and describe the impact of the use of Paro robotic seals in an aged care facility in a regional Australian city. A qualitative, descriptive, exploratory design was employed. Data were gathered through interviews with the three recreational therapists employed at the facility who were also asked to maintain logs of their interactions with the Paro and residents. Data were transcribed and thematically analysed. Three major themes were identified from the analyses of these data: “a therapeutic tool that's not for everybody,” “every interaction is powerful,” and “keeping the momentum.” Findings support the use of Paro as a therapeutic tool, revealing improvement in emotional state, reduction of challenging behaviours, and improvement in social interactions of residents. The potential benefits justify the investment in Paro, with clear evidence that these tools can have a positive impact that warrants further exploration. PMID:27990301
Huitink, C.; Embregts, P. J. C. M.; Veerman, J. W.; Verhoeven, L.
The purpose of the present study was to examine psychometric properties of the Staff Behavior toward Clients questionnaire (SBC), a self-report measure for care staff working with children and adolescents with mild to borderline intellectual disabilities in residential care. Ninety-nine care staff completed the SBC and the Strengths and…
Hajek, André; Lehnert, Thomas; Wegener, Annemarie; Riedel-Heller, Steffi G; König, Hans-Helmut
The need for long-term care is expected to increase markedly in the next decades as a result of demographic ageing. Consequently, it is important to know the long-term care preferences. This study investigated the long-term care preferences among older individuals in Germany. Based on a systematic review and expert interviews, a questionnaire was designed to assess long-term care preferences. Data were gathered from a representative telephone survey of the German population (n=1,006; 65 years and above) in 2015. The mean age was 75.2 years (±6.6 years, ranging from 65 to 96 years). While nearly 90% of the individuals preferred home care, other care settings such as nursing care abroad were mostly undesired. In case of home care, most of the individuals preferred care provided by friends/family or formal caregivers, whereas the idea of all-day care services (such as employed private caregivers) was less popular. With respect to home care, additional services such as household assistance, transportation services, and emergency call systems were highly valued by the study participants, whereas continual supervision throughout the day was seen as less important. In case of inpatient care, more than 90% of the individuals preferred a private room, with the inpatient facility located near home or close to relatives' homes. A wide range of activities was appreciated. Given these preferences, it is assumed that there is a gap between expectations (preferences) and reality (utilization) regarding long-term care in Germany. Interventions aimed at minimizing this gap are urgently needed. For example, strategies to raise the awareness of private long-term care provision might be fruitful.
Midorikawa, Yasuhiko; Suzushino, Seiko; Tamotsu, Kiyokazu
We conducted home care and home palliative care from the department of home care. We provided home care services to 190 patients(105 men, 85 women)in October 2013. Their average age was 78.7(range: 32-102)years old, and home care had been underway from 1 day to 8 years, 10 months. Among all participants, 168(88.4%)suffered from malignant diseases, 168 patients had died, and over half of deceased patients(88 out of 168)had died at home. We used opioids for control of cancer pain, carried out home parenteral nutrition(HPN), home enteral nutrition(HEN), percutaneous endoscopic gastrostomy( PEG), and removed pleural effusion and ascites during home care. In order to facilitate the practice of palliative care by the palliative care team, which consists of various medical staff in the hospital, we are giving high priority to education and enlightenment in the hospital. To provide enlightenment, education, and cooperation between regional home care and home palliative care, we are also conducting educational lectures in the regional party of the Iwaki city medical associate, and providing combined educational-medical training for home care and home palliative care by various medical staff.
Brew, Angela, Ed.
This collection of readings is intended to provide a source book on best practices in staff development in higher education within a British context. The 13 papers are grouped into three parts: part 1 presents the educational development tradition which has focused on development of staff as teachers; part 2 considers development of staff in…
Retief, F P; Cilliers, L
Since time immemorial the snake has been venerated as an enigmatic creature with supernatural powers. As a snake and staff symbol it is also traditionally associated with the healing arts, either as the single-snake emblem of Asklepios, or as the double-snake emblem (caduceus) of Hermes. The mythological basis for this symbolism is reviewed. The Asklepian emblem has been associated with health care since the 5th century BC, when Asklepios became accepted by the Greeks as the god of healing. Whether he was also an historical figure as healer in earlier ages is less certain. The origin of the double-snake emblem is shrouded in the mists of antiquity. In classical times it became the herald's wand of Hermes, messenger of the gods who guided departed souls to the underworld, and was seen as protector of travellers, shepherds and merchants. In the latter capacity Hermes also conveyed a negative connotation as protector of thieves. During the Middle Ages the caduceus became a symbol of the healing sciences (pharmacy and alchemy in particular), and today, although mythologically incorrect, it is in common usage in the health care field.
Wildeman, Christopher; Emanuel, Natalia
Foster care placement is among the most tragic events a child can experience because it more often than not implies that a child has experienced or is at very high risk of experiencing abuse or neglect serious enough to warrant state intervention. Yet it is unclear how many children will experience foster care placement at some point between birth and age 18. Using synthetic cohort life tables and data from the Adoption and Foster Care Analysis and Reporting System (AFCARS), we estimated how many U.S. children were placed in foster care between birth and age 18, finding support for three conclusions. First, up to 5.91% of all U.S. children were ever placed in foster care between their birth and age 18. Second, Native American (up to 15.44%) and Black (up to 11.53%) children were at far higher risk of placement. Foster care is thus quite common in the U.S., especially for historically disadvantaged racial/ethnic groups. Third, differences in foster care placement were minimal between the sexes, indicating that the high risks of foster care placement are shared almost equally by boys and girls.
Ellison, Caroline; White, Amy; Chapman, Libby
Background: Most people with a disability want to remain living in their own home as they age. Without additional support, people with a disability may not be able to avoid moving into residential aged care, attending day programs, or becoming isolated from participation in the wider community. This study examined whether participants perceived…
Lundberg, David; Marshallsay, Zariah
Older workers' perspectives are examined in a national survey of the finance sector and case studies of aged care and construction workers. The majority of older workers intend to work beyond retirement age, to achieve a better lifestyle. With training, older workers could mentor younger workers. This support document includes a national survey of…
Kang-Yi, Christina D; Adams, Danielle R
This systematic review aimed to (1) identify and summarize empirical studies on youth with behavioral health disorders aging out of foster care and (2) address implications for behavioral health policy, research, and practice. We identified previous studies by searching PubMed, PsycINFO, EBSCO, and ISI Citation Indexes and obtaining references from key experts in the child welfare field. A total of 28 full articles published between 1991 and 2014 were reviewed and summarized into the key areas including systems of care, disability type, transition practice area, study methods, study sample, transition outcome measures, study analysis, and study findings. Considering how fast youth who have behavioral health disorders fall through the crack as they exit foster care, one cannot understate the importance of incorporating timely and appropriate transition planning and care coordination for youth who have behavioral health disorders aging out of foster care into the usual case management performed by behavioral health systems and service providers.
Aims Examine the associations of depression and self-esteem on self-care activities and care received among Mexicans with diabetes. Methods Using data from the Mexican Nutrition and Health Survey 2012, logistic regression models were fit to test the associations between each self-care activity and diabetes care, and self-esteem and depression. Results People with low self-esteem were less likely to follow a diet, but no other associations were found. Contrary to what was expected, there were no relationships between depression and quality of care received or self-care behaviors. Conclusion Current findings support the importance of looking at mental health and emotional state among older adults with diabetes. Future studies should explore the relationship between different psychological barriers to proper diabetes management. PMID:24846446
Chan, Paul S.; Cram, Peter
Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by > 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required. PMID:21051386
Gantz, Nancy Rollins; Sorenson, Lisa; Howard, Randy L
By 2004, only organizations whose institutional operating strategies are built on a continual state of readiness and include performance improvement practices throughout the organization are going to successfully meet Joint Commission on Accreditation of Healthcare Organizations standards. As stewards of patient care, nurses maintain a unique role in identifying and guiding the intervention processes central to quality care, which prepares them to become key players/designers of a paradigm that demonstrates commitment to establishing and maintaining quality care. However, without recognition and support from organization leadership and physicians, the opportunity to effectively use the capabilities of nursing may be lost. The collaborative perspectives offered here attest to the fact that mutual belief and vision, coupled with creativity, strategic planning, and implementation, can effectively mobilize resources to establish priority measures and achieve quality patient/safety outcomes within the organization. Shifting the paradigm from just meeting the standards to continual readiness and performance improvement throughout the organization then becomes mission and mantra.
Munn, Jean C.; Dobbs, Debra; Meier, Andrea; Williams, Christianna S.; Biola, Holly; Zimmerman, Sheryl
Purpose: We designed this study to examine the end-of-life (EOL) experience in long-term care (LTC) based on input from key stakeholders. Design and Methods: The study consisted of 10 homogeneous focus groups drawn from a purposive sample of LTC residents (2 groups; total n = 11), family caregivers (2 groups; total n = 19), paraprofessional staff…
Hamre, Bridget; Grove, Rebecca; Louie, Justin
This progress report highlights findings from the first year of a 3-year evaluation of the Matching Funds for Retention program, a child-care retention incentive (CRI) program. It includes initial rates of professional development, training, and retention of 677 program participants in four California counties (Napa, San Luis Obispo, Siskiyou, and…
Keogh, Justin W L; Power, Nicola; Wooller, Leslie; Lucas, Patricia; Whatman, Chris
This mixed-methods, quasi-experimental pilot study examined whether the Nintendo Wii Sports (NWS) active video game (exergame) system could significantly improve the functional ability, physical activity levels, and quality of life of 34 older adults (4 men and 30 women, 83 ± 8 yr) living in 2 residential aged-care (RAC) centers. Change score analyses indicated the intervention group had significantly greater increases in bicep curl muscular endurance, physical activity levels, and psychological quality of life than the control group (p < .05). Analysis of the quotes underlying the 3 themes (feeling silly, feeling good; having fun; and something to look forward to) suggested that intervention group participants developed a sense of empowerment and achievement after some initial reluctance and anxiousness. They felt that the games were fun and provided an avenue for greater socialization. These results add some further support to the utilization of NWS exergames in the RAC context.
Population aging is a key public health issue facing many nations, and is particularly pronounced in many Asian countries. At the same time, attitudes toward filial obligation are also rapidly changing, with a decreasing sense that children are responsible for caring for elderly parents. This investigation blends the family versus nonfamily mode of social organization framework with a life course perspective to provide insight into the processes of ideational change regarding filial responsibility, highlighting the influence of education and international travel. Using data from a longitudinal study in Nepal—the Chitwan Valley Family Study—results demonstrate that education and international travel are associated with a decrease in attitudes toward filial obligation. However, findings further reveal that the impact of education and international travel vary both across the life course and by gender. PMID:25866415
Dies, Kira A; Bodell, Adria; Hisama, Fuki M; Guo, Chao-Yu; Barry, Brenda; Chang, Bernard S; Barkovich, A James; Walsh, Christopher A
Schizencephaly is a rare malformation of cortical development characterized by congenital clefts extending from the pial surface to the lateral ventricle that are lined by heterotopic gray matter. The clinical presentation is variable and can include motor or cognitive impairment and epilepsy. The causes of schizencephaly are heterogeneous and can include teratogens, prenatal infection, or maternal trauma. Reported genetic causes include chromosomal aneuploidy, EMX2 mutations, and possible autosomal recessive familial cases based on recurrence in siblings. In an effort to identify risk factors for schizencephaly, we conducted a survey of 48 parents or primary caretakers of patients with schizencephaly born between 1983 and 2004. We discovered that young maternal age, lack of prenatal care, and alcohol use were all significantly associated with risk of schizencephaly. Our results suggest that there are important nongenetic, intrauterine events that predispose to schizencephaly.
Halpin, Sean N.
Several interventions aimed at increasing positive attitudes towards older adults among health-care professionals have been introduced. These interventions tend to focus on a small subset of clinical employees, ignoring other clinical and nonclinical hospital staff. The objective of this study was to evaluate the efficacy of a short aging…
Greer, Joseph A.; El-Jawahri, Areej; Traeger, Lara; Gallagher, Emily R.; Park, Elyse R.; Jackson, Vicki A.; Pirl, William F.; Temel, Jennifer S.
Background. Studies demonstrate that early palliative care (EPC) improves advanced cancer patients’ quality of life (QOL) and mood. However, it remains unclear whether the role of palliative care differs based upon patients’ demographic characteristics. We explored whether age and gender moderate the improvements in QOL and mood seen with EPC. Methods. We performed a secondary analysis of data from a randomized controlled trial of patients with metastatic non-small cell lung cancer. Patients received either EPC integrated with oncology care or oncology care alone. We assessed the degree to which QOL (Trial Outcome Index [TOI]) and mood (Hospital Anxiety and Depression Scale [HADS] and Patient Health Questionnaire 9 [PHQ-9]) outcomes at week 12 varied by patient age (<65) and gender. The week 12 data of 107 patients are included in this analysis. Results. At 12 weeks, younger patients receiving EPC reported better QOL (TOI mean = 62.04 vs. 49.43, p = .001) and lower rates of depression (HADS–Depression = 4.0% vs. 52.4%, p < .001; PHQ-9 = 0.0% vs. 28.6%, p = .006) than younger patients receiving oncology care alone. Males receiving EPC reported better QOL (TOI mean = 58.81 vs. 48.30, p = .001) and lower rates of depression (HADS–Depression = 18.5% vs. 60.9%, p = .002; PHQ-9 = 3.8% vs. 34.8%, p = .008) than males receiving oncology care alone. At 12 weeks, QOL and mood did not differ between study groups for females and older patients. Conclusion. Males and younger patients who received EPC had better QOL and mood than those who received oncology care alone. However, these outcomes did not differ significantly between treatment groups for females or older patients. Implications for Practice: This study found that early palliative care improves patients’ quality of life and mood differentially based on their age and gender. Specifically, males and younger patients receiving early palliative care experienced better quality of life and mood than those receiving
Jiang, Tao; Yu, Ping; Hailey, David; Ma, Jun; Yang, Jie
To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in
Congress of the U.S., Washington, DC. House Select Committee on Aging.
This document contains testimony and prepared statements from the Congressional hearing examining the impact on the elderly of the federal health care cost containment measure. Correspondence between the Select Committee on Aging and the Department of Health and Human Services, concerning the government restrictions' harmful effects on the…
Lakin, Brittany L.; Leon, Scott C.; Miller, Steven A.
This study explored burnout among frontline staff within a children's residential treatment center (RTC) population. Data were collected from 375 full-time, frontline, children's RTC staff employed at 21 RTCs in Illinois. Using hierarchical linear modeling (HLM), results indicated that frontline staff age, training, empathic concern, communicative…
Savard, N.; Levallois, P.; Rivest, LP.; Gingras, S.
Abstract Background: In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight < 10th percentile on the Canadian scale). Methods: In this ecological study, births were identified from Quebec’s registry of demographic events between 2006 and 2008 (n = 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs) were adjusted for mother’s age, marital status, parity, program coverage and mean income in the area. Results: Mothers eligible for the programs remain at a higher odds of SGA than non-eligible mothers (OR = 1.40; 95% confidence interval [CI]: 1.30–1.51). Further, areas that provide more visits to eligible mothers (4–6 food supplementation visits) seem more successful at reducing the frequency of SGA birth than those that provide 1–2 or 3 visits (OR = 0.86; 95% CI: 0.75–0.99). Conclusions: Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done. PMID:27409987
Hahn, Joan Earle; FitzGerald, Leah; Markham, Young Kee; Glassman, Paul; Guenther, Nancy
Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP) students. Phase 2 includes evaluation of GNP students' perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3. PMID:22619708
Kiss, Szilárd; Chandwani, Hitesh S; Cole, Ashley L; Patel, Vaishali D; Lunacsek, Orsolya E; Dugel, Pravin U
Purpose To examine the comorbidity profile and update estimates of health care resource utilization for commercially insured, working-age adults with diabetic macular edema (DME) relative to a matched comparison group of diabetic adults without DME. Additional comparisons were made in the subgroup of pseudophakic patients. Patients and methods A retrospective matched-cohort study of commercially insured diabetic adults aged 18–63 years was conducted using medical and outpatient pharmacy claims (July 1, 2008–June 30, 2013). Outcomes included diabetes-related and ocular comorbidities and health care resource utilization (any health care visit days, outpatient visit days, inpatient visit days, emergency room visits, eye care-related visit days, unique medications) in the 12-month post-index period. Results All diabetes-related and ocular comorbidities were significantly more prevalent in DME cases versus non-DME controls (P<0.05). A significantly greater proportion of DME cases utilized eye care-related visits compared with non-DME controls (P<0.001). DME cases had almost twice the mean number of total health care visit days compared to non-DME controls (28.6 vs 16.9 days, P<0.001), with a minority of visit days being eye care-related (mean 5.1 vs 1.5 days, P<0.001). Similar trends were observed in pseudophakic cohorts. Conclusion This working-age DME population experienced a mean of 29 health care visit days per year. Eye care-related visit days were a minority of the overall visit burden (mean 5 days) emphasizing the trade-offs DME patients face between managing DME and their overall diabetic disease. Insights into the complex comorbidity profile and health care needs of diabetic patients with DME will better inform treatment decisions and help optimize disease management. PMID:27994438
Murphy, Catriona M; Whelan, Brendan J; Normand, Charles
The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%-9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7-5.3), older age (Adj OR 3.4, 95% CI 2.4-4.8) and living alone (Adj OR 2.6, 95% CI 1.9-3.8). Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.
Healthcare systems in aging societies need to find new solutions in the provision of care and treatment of older people. Gerotechnologies play a crucial role in the "aging-in-place" process. This article offers a critical overview of gerotechnological studies and will suggest a new approach in the study of the relationship between aging and technologies. Some trajectories of analysis and theoretical models are presented to underline the different perspectives in the discipline. Critical positions highlight the lack of theoretical analysis, mainly in relation to the complex social phenomenon of aging related to technology. Conclusions outline a relational approach to gerotechnologies: an analysis of the interactions between technological artifacts, users, and the context in which technologies are used. This approach expands the view from the technical potential of the technology to the way elderly people use technology, and suggests innovative care and cure strategies for aging.
Duque, Gustavo; Close, Jacqueline J; de Jager, Julien P; Ebeling, Peter R; Inderjeeth, Charles; Lord, Stephen; McLachlan, Andrew J; Reid, Ian R; Troen, Bruce R; Sambrook, Philip N
Older people living in residential aged care facilities (RACFs) are at considerably higher risk of suffering fractures than older people living in the community. When admitted to RACFs, patients should be assessed for fracture risk to ensure early implementation of effective fracture prevention measures. Routine or regular determination of calcium and phosphate serum levels in institutionalised older people is not indicated. Opinion is divided about the value of routine measurements of serum concentrations of 25-hydroxyvitamin D, parathyroid hormone and bone turnover markers. The non-pharmacological approach to fracture prevention includes multifactorial programs of falls prevention and the use of hip protectors. Vitamin D supplementation is recommended for all patients in RACFs. Dietary calcium intake should be optimised (1200-1500 mg per day is recommended) and supplementation offered to those with inadequate intake. The decision to prescribe calcium supplements should be guided by patients' tolerance, whether or not they have a history of kidney stones, and emerging data about its cardiovascular safety. Bisphosphonates are the first-choice pharmacological agents for fracture prevention in older persons at high risk. Intravenous administration is as efficient as oral and has the significant advantage of better adherence. Use of strontium ranelate has not been tested on people in RACFs, but evidence in the "old-old" (those aged 75 years and older) suggests it could be a therapeutic option for fracture prevention in this setting. In general, teriparatide should not be considered as a first-line treatment for fracture prevention, particularly for people in RACFs.
Tiholova, Mayda; Gopala, Kusuma; Berberova, Magda; Strokova-Stoilova, Margarita; Tafalla, Monica
Background Rotavirus (RV) causes a high proportion of acute gastroenteritis (AGE) cases, especially among children under the age of five years old. This surveillance study was undertaken to study the incidence and severity of rotavirus gastroenteritis (RVGE) in primary care settings in Bulgaria over a one-year period. Methods In this prospective, observational study of AGE cases in children under five years of age presenting in the primary care setting over a one year period, stool samples were collected and tested for RV using a rapid visual immunochromatographic test kit. After the first visit, parents monitored their child for about two weeks and reported the symptoms experienced by the child during the follow-up period to the physician in a follow-up phone call. The percentage of RVGE cases among AGE was calculated and the severity of AGE (according to the 20-point Vesikari scale) was assessed by the physician based on the symptoms reported by the parents. The seasonality of RVGE was also studied. Results The proportion of RVGE among the 624 AGE cases examined was 25.5%. Severe AGE was experienced by 81.8% RV-positive and 54.6% RV-negative children (p-value <0.001) and a third of all severe AGE cases occurred in RV-positive patients. A multivariate logistic regression analysis of the determinants of hospitalization indicated that severity of disease and RV-positivity were the statistically significant variables explaining hospitalization of AGE cases; even controlling for severity, RV-positive patients were more often hospitalized than RV-negative ones. RVGE cases occurred throughout the year, with peaks during August and September. Conclusion Our study emphasizes that RV is an important cause of AGE in children under five presenting in primary care settings in Bulgaria and a disproportionately high proportion of severe AGE cases may be attributed to RV infections. Trial registration number NCT01733849 PMID:27622162
Maglo, Koffi N
This article addresses the philosophical and moral foundations of group-based and individualized therapy in connection with population care equality. The U.S. Food and Drug Administration (FDA) recently modified its public health policy by seeking to enhance the efficacy and equality of care through the approval of group-specific prescriptions and doses for some drugs. In the age of genomics, when individualization of care increasingly has become a major concern, investigating the relationship between population health, stratified medicine, and personalized therapy can improve our understanding of the ethical and biomedical implications of genomic medicine. I suggest that the need to optimize population health through population substructure-sensitive research and the need to individualize care through genetically targeted therapies are not necessarily incompatible. Accordingly, the article reconceptualizes a unified goal for modern scientific medicine in terms of individualized equal care.
Kanaskie, Mary Louise
Staff retention presents a common challenge for hospitals nationwide. Mentorship programs have been explored as one method of creating environments that promote staff retention. Successful achievement of nurse competencies identified in the Synergy Model for Patient Care can best be achieved in an environment that encourages and facilitates mentoring. Mentoring relationships in critical care provide the ongoing interactions, coaching, teaching, and role modeling to facilitate nurses' progression along this continuum. Mentoring relationships offer support and professional development for nurses at all levels within an organization as well as an optimistic outlook for the nursing profession.
Keijser, W; de Manuel-Keenoy, E; d'Angelantonio, M; Stafylas, P; Hobson, P; Apuzzo, G; Hurtado, M; Oates, J; Bousquet, J; Senn, A
Information and communication technologies (ICT) are promising for the long-term care of older and frequently frail people. These innovations can improve health outcomes, quality of life and efficiency of care processes, while supporting independent living. However, they may be disruptive innovations. As all European member states are facing an increasing complexity of health and social care, good practices in ICT should be identified and evaluated. Three projects funded by DG CNECT are related to Active and Healthy Ageing (AHA) and frailty: (i) BeyondSilos, dealing with independent living and integrated services, (ii) CareWell, providing integrated care coordination, patient empowerment and home support and (iii) SmartCare, proposing a common set of standard functional specifications for an ICT platform enabling the delivery of integrated care to older patients. The three projects described in this paper provide a unique pan-European research field to further study implementation efforts and outcomes of new technologies. Below, based on a description of the projects, the authors display four domains that are in their views fundamental for in-depth exploration of heterogeneity in the European context: 1. Definition of easily transferable, high level pathways with solid evidence-base; 2. Change management in implementing ICT enabled integrated care; 3. Evaluation and data collection methodologies based on existing experience with MAST and MEDAL methodologies; and 4. Construction of new models for delivery of health and social care. Understanding complementarity, synergies and differences between the three unique projects can help to identify a more effective roll out of best practices within a varying European context.
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