An original AIDS Attitude Scale was distributed to registered nurses employed in intensive care, medical, medical-surgical, and surgical units of four western Massachusetts hospitals. 439 completed questionnaires, representing a 64.6% response rate, were returned by mail. Results of data analysis indicated that nurses would be more cautious than necessary in using precautions while handling body secretions of or doing nursing procedures with patients with AIDS. Nurses form a small community hospital and those with less experience in caring for AIDS patients would be more cautious than those from a teaching medical center and those who had cared for six or more AIDS patients. Two-thirds of the nurses would feel a great deal of stress in caring for seriously ill adult AIDS patients. Significant differences in mean stress scores for caring for patients with five diagnoses indicate that AIDS patients evoke the most amount of stress, and those with extensive burns, multiple trauma, metastatic cancer, or hepatitis B evoke decreasing amounts of stress, in that order. More than one-half of the respondents indicated that more than one-half of their family members/significant others had expressed concern about their becoming infected with HIV as a result of caring for AIDS patients. Teaching hospital respondents reported a significantly greater percent of concerned persons than did those from community hospitals. Multiple regression analysis of the twelve Likert items indicated that having a family member/personal friend with AIDS, having a greater percent of concerned persons, being male, or being employed in a small community hospital were associated with a less favorable attitude about caring for AIDS patients. The coefficient alpha (Cronbach's alpha) for the Likert scale was.72. Factor analysis of the Likert scale identified five subconcepts: stigma; pregnancy concern; mortality/prognosis stress; resource utilization; and HIV-status knowledge. Study results are limited to the respondents. Implications of the results for health services managers include implementation of a multi-faceted educational and support program for nurses caring for AIDS patients. Suggestions for further research include replication of the study with nurses in different clinical specialties, settings, and geographic regions.

<p> Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care. </p><p> Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education. </p><p> A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology. </p>

<p> This research used a Delphi methodology to solicit challenges that significantly impact the operational success of pediatric long-term care facilities. Further, this study sought to understand the ability of pediatrics administrators to impact, affect, overcome, or resolve these challenges. Round 1 accomplished the desired goal of eliciting a substantial amount of new qualitative information regarding administrative challenges in pediatric long-term care, which previously had been extant in the literature. In Round 2, data were distilled into categories and unique exemplars which in turn were validated by participants. In Round 3, administrators ranked and rated categories and individual challenges in terms of significance and impact. </p><p> Findings revealed that the most important challenges for administrators are those of working with an inadequate model that is designed for a geriatric population, inadequate Medicaid funding, and the lack of clinical and administrative indicators in pediatric long-term care. The most important challenges that could be affected by the administrators are related to inadequate model, clinical practice, and the need for diversification. Administrators believe they can strongly impact the rules, regulations, and protocols that are currently geriatric focused, develop pediatric long-term care indicators and evidence-based research, and impact their financial security by diversification. </p><p> The Delphi research accomplishes the desired goal of eliciting a substantial amount of new information regarding administrative challenges in pediatric long- term care and contributes to the broader body of knowledge in health services administration. The significant research findings suggest the need for changes in the regulatory and financial models in pediatric long-term care and the need for enhanced clinical practice though evidence-based practice and outcomes.</p>

The purpose of this study was to identify, through a needs analysis, the skills required of the clinical supervisory role in certified home health agencies as described in the literature and as perceived by clinical supervisors and agency administrators. The identified skills were then used to propose elements for a training curriculum. The general problem guiding this research is the lack of a systematic approach to supervisory training and development in certified home health agencies in Massachusetts that may result in supervisory employees being inadequately prepared to assume the responsibility of that role. A descriptive survey design was utilized. A questionnaire was mailed to first-line clinical supervisors and their administrators to assess the skill requirements of the supervisory role as perceived by these respective groups. The sample survey, which consisted of 125 certified home health agencies, was obtained from the Massachusetts Department of Public Health. The response rate was 63% for the administrators and 65% for the supervisors. A modified version of the conceptual framework of the needs identification process as presented by Watson (1979) was utilized in conducting the analysis, and the skills were categorized using Katz's model (1974) of conceptual, technical, and human competencies. The findings of the analyses showed that the administrative respondents perceived a greater need for the skill development of their supervisors in all three areas of conceptual, technical, and human skills than the supervisors perceived for themselves. In addition, supervisory respondents with 6-10 years of professional experience and those with over 21 years of supervisory experience reported the greatest need in all three areas. The findings also showed that the majority of incumbent supervisors in certified home health agencies were technically at an entry-level stage of management, and that the combined responses of both the administrative and supervisory respondents supported the need for additional training in the technical and human skill areas. As a result, the concluding recommendations for curricula development for training programs for incumbent and future clinical supervisors were focused on those skills specific to the technical and human competency areas as described in the study.