Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 156-167). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

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Patient safety culture (PSC) is a critical factor in creating high reliability healthcare organizations. However, few studies to date have correlated PSC measures with actual safety outcomes. In particular, nursing home studies have only recently appeared in the literature. Nursing homes differ from hospitals in that the vast majority of direct care is provided by certified nursing assistants (CNAs), not licensed nurses. Thus nursing home PSC could differ in important ways from PSC in acute care institutions. This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate. In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample. Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population. This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.

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According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.3 million U.S. residents are residing in nursing homes. CMS enforced regulations in the Nursing Home Reform Act. Training in the use of restraints in nursing homes is monitored through the CMS standards. The purpose of this study was to determine whether there was a correlation between training standards of health care practitioners and their use of restraints in nursing homes based on the patterns of citations by RNs and CNAs. Data were collected from Kansas, Louisiana, and Ohio within the CMS Nursing Home Data Compendium. The key research question examined differences in standard training requirements, policies, and citations regarding restraint use in the selected states. The theoretical framework for this study was the social influence theory. The results of the analysis of variance indicated that between 2008 and 2012, there were significant differences in policy and standards requirements for the training of registered nurses and certified nursing assistants regarding restraint use; there was also a relationship between the training of staff and the number of citations of restraint use in Kansas, Louisiana, and Ohio. There were significant (p < .02) variations throughout the 3 states regarding the policies, procedures, and training expectations. The positive social change that could result from these findings is the standardization of training that may help decrease restraint use and become the foundation of more respectful and caring practices in nursing homes.

This two-part study evaluates a government sponsored Long Term Care Aide/ESL Program taken by a group of immigrant women. The purpose of the first part of the study was to assess how effective a B.C. government sponsored Long Term Care Aide/ESL program was in preparing a group of immigrant women for the workplace. A questionnaire was used to determine demographics and employment status. Also, it obtained perceptions on the strengths and weaknesses of the program. The purpose of the second part of this study was to hear the women's personal insights and voices about their experiences while taking the program and after the program. Semi-structured interviews were used to obtain these stories. Results from the quantitative questionnaire indicated that 94% of the immigrant women who had taken this course were employed as care aides. Three years after the completion this program, the women felt that the course had provided them with both a vocational skill and more English language skills. Results from the qualitative portion of this paper focused on how the women felt about their experiences in this Long Term Care Aide/ESL program in their own words. The data were analyzed and put into themes. Theme 1 was "The pain of renewal". It presented their collective stories of being an immigrant and struggling to begin again. Theme 2 was "The costs and the benefits". This theme presented the women's insights on working as care aides. Most of the women liked their jobs but found trying to secure a full time job difficult. Theme 3 was "The need to learn the language of care". All the women interviewed wanted to have more "caring" language, the "everyday" language to relate to their clients. Theme 4 was "Advice to other immigrant women". This theme revealed how some women felt about the work they did. The last theme, Theme 5, was "Hopes and dreams". Half of the women interviewed had aspirations to continue their education and these women were already enrolled in other health care courses. The results of the study are discussed and implications are drawn for research and pedagogy.

This two-part study evaluates a government sponsored Long Term Care Aide/ESL Program taken by a group of immigrant women. The purpose of the first part of the study was to assess how effective a B.C. government sponsored Long Term Care Aide/ESL program was in preparing a group of immigrant women for the workplace. A questionnaire was used to determine demographics and employment status. Also, it obtained perceptions on the strengths and weaknesses of the program. The purpose of the second part of this study was to hear the women's personal insights and voices about their experiences while taking the program and after the program. Semi-structured interviews were used to obtain these stories. Results from the quantitative questionnaire indicated that 94% of the immigrant women who had taken this course were employed as care aides. Three years after the completion this program, the women felt that the course had provided them with both a vocational skill and more English language skills. Results from the qualitative portion of this paper focused on how the women felt about their experiences in this Long Term Care Aide/ESL program in their own words. The data were analyzed and put into themes. Theme 1 was "The pain of renewal". It presented their collective stories of being an immigrant and struggling to begin again. Theme 2 was "The costs and the benefits". This theme presented the women's insights on working as care aides. Most of the women liked their jobs but found trying to secure a full time job difficult. Theme 3 was "The need to learn the language of care". All the women interviewed wanted to have more "caring" language, the "everyday" language to relate to their clients. Theme 4 was "Advice to other immigrant women". This theme revealed how some women felt about the work they did. The last theme, Theme 5, was "Hopes and dreams". Half of the women interviewed had aspirations to continue their education and these women were already enrolled in other health care courses. The results of the study are discussed and implications are drawn for research and pedagogy. / Education, Faculty of / Language and Literacy Education (LLED), Department of / Graduate

The role of social capital in forming organizational commitment is the focus of this research. Organizational social capital is the idea that social relationships have value in the organization. The theoretical framework is based on Kanter's (1993) structure of organizational commitment. This research views the structure within organizations based on global empowerment, job satisfaction, organizational commitment, and social capital. In addition, the role that race, income, and education affect the organizational structure is also taken into account. The organizational configuration was assembled using a structural equation model with latent variables employing a sample of 235 certified nurse aides. The sample was collected from 10 nursing homes in the Dallas-Ft.Worth metropolitan area. It was expected that Kanter's general format is reestablished within the sample. In fact, the study found that empowerment significantly influences job satisfaction. In turn, job satisfaction does foster organizational commitment. Although Kanter's original thesis was supported in this analysis, it was also determined that social capital plays a significant mediating role in creating organizational commitment. Furthermore, this research indicates that social capital alone can create organizational commitment. Thus, in conclusion, this research builds on Kanter's original idea and argues that organizational commitment is based on job satisfaction, global empowerment, and social capital.

The purpose of this study was to examine a select set of organizational variables and determine their relationship to nursing assistants' intentions to quit in state-owned veterans' long-term care facilities located across the United States. America's long-term care industry (e.g., nursing homes, assisted living facilities) is a multibillion dollar industry. Because the U.S. government is projecting a 250% increase in the elderly population, staffing these nursing homes and related facilities is a critical concern. A vitally important but often overlooked factor of the long-term care industry is employee turnover. Of the staff in long-term care facilities, the nursing assistant (NA) position is particularly susceptible to turnover. Approximately 80% of NAs who enter the workforce leave within the 1st year and many leave within the first 3 months of employment. Some facilities report that they are unable to accept new residents because of a lack of qualified NAs. While many studies have researched this issue, staff turnover in long-term care facilities remains a serious and widespread problem. This study provides a foundation for future research related to the perceptions of intentions to quit of nursing assistants (NAs) working in state-owned veterans long-term care facilities by providing primary data regarding NAs intentions to quit. Results of this study indicate that NA intentions to quit might be reduced provided that pay and rewards are increased, workplace violence is addressed, and better access to patient care plans is provided. This research is useful to state-owned and operated long-term care facilities by giving them additional insights into nursing assistants' intentions to quit perhaps resulting in lower rates of turnover. It is suggested that future research be performed using populations of individuals from other segments of the long-term care industry, mainly, for-profit institutional care nursing homes, and federally owned veterans long-term care facilities.