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.

The following study assessed the effectiveness of two simple and inexpensive performance feedback conditions in improving the job performance of institutional staff. Participants were care staff employed at a large center for the developmenta1ly disabled. During two 3 week sessions participants from two separate treatment units received publicly posted feedback graphs with either their own personal names or self-chosen anonymous codes to designate whose graphs were whose. These graphs were posted in each unit's training room and depicted participant performance (use of rewards and prompts) during behavioral training sessions with developmentally disabled clients. These two conditions were investigated to determine whether designation by proper name is important in the effectiveness of public feedback. It was hypothesized that the use of personal names would have a greater effect than anonymously coded feedback. Results indicated that only one participant's performance improved during the personal name condition. For the same participant there was a decrease in performance during the subsequent anonymous code condition. For the other 5 participants, neither of the two feedback conditions were successful in improving their performance.

The first purpose was to develop and validate a quantitative selection tool, the weighted application blank, tailored to the nursing home industry. The second purpose of this study was to determine whether data scaling and increased statistical rigor can reduce the frequency of type I and type II errors in the weighted application.

An evidence-based clinical practice guideline was developed to prevent and manage constipation in the long-term care (LTC) resident. Constipation is a prevalent condition in the LTC resident. Guidelines do not address this vulnerable population. Constipation may result in poor nutritional status, quality of life along with increased health care costs and hospitalizations. A literature review was completed and evidence was evaluated and included into the initial draft recommendations. The guideline was reviewed for content validity using a Delphi Committee of clinical experts in gastroenterology, geriatrics, and pharmacy. The updated guidelines were presented to an interdisciplinary team of long-term care residents. Participants were asked to review and complete a survey regarding clinical applicability of the guideline. Thirty-one interdisciplinary members participated in the education session and 30 surveys were received. Overall, the interdisciplinary team members agreed or strongly agreed the guideline was clinically applicable. Finally, the guideline was evaluated by a group of doctoral prepared practicing nurse practitioners using the AGREE II instrument. The scores were >80% in every domain, with an overall score of 91%, indicating the guideline is high in quality. Development of this guideline signifies an initial step in the management and prevention of constipation in the LTC resident.

Bakgrund: Demens är en sjukdom där den kognitiva funktionen ochminnesfunktionen sätts ned och försämras med tiden. Personer meddemenssjukdom utvecklar ofta beteendemässiga och psykiska problem när derasbehov inte blir tillfredsställda. Det uttrycker sig som aggressivitet, oro, ångest ochirritabilitet samt försämrad minnes- och orienteringsförmåga. För de personerna ärdet viktigt att befinna sig en miljö som är anpassad för dem och som minskarrisken för uppkomsten av symptomen. Hälften av de som diagnostiserats meddemenssjukdom flyttar till särskilt boende inom 2,5-3 år. I nuläget är detvårdinrättningar som är traditionellt storskaliga som är dominerande. Den fysiskavårdmiljön kan bli en resurs i omvårdnaden om den är rätt utformad och det börjarbli mer och mer vedertaget med en sådan design. Det är den legitimeradesjuksköterskans ansvar att planera och genomföra så att de behov som finnsuppfylls och att vårdtagaren får den omvårdnad som behövs för att få en godlivskvalitet. Syfte: Syftet är att belysa vårdgivarens uppfattning om hur den fysiska vårdmiljönpåverkar måendet hos personer med demenssjukdom. Metod: Litteraturstudien grundar sig i tio vetenskapliga artiklar av kvalitativstudiedesign och innefattar 222 vårdpersonal, inkluderat sjuksköterskor. SBU’small (2013) användes för kvalitetsgranskning. Sex av artiklarna ansågs vara avmedelhög kvalitet och fyra av artiklarna erhöll hög kvalitet. Resultat: Tre teman med fem tillhörande underteman skapades: Utemiljö,Orientering och lokalisering inne och ute, hinder och möjligheter vårdmiljönskapar avseende vårdleveransen.Konklusion: Ett småskaligt vårdboende som har tillgång till utomhusmiljö och äranpassat efter vårdtagarens behov minskar beteendemässiga psykiatriskasymptom och ökar livskvaliteten hos personer med demenssjukdom. / Background: Dementia is a disease in which cognitive function and memoryfunction are reduced and deteriorate over time. People with dementia oftendevelop behavioral and psychological symptoms when their needs are not met. Itmanifests itself as aggression, anxiety, worry and irritability along with loss ofmemory and orientation capability. For these people, it is important to find anenvironment that is suitable for them and that reduces their symptoms. Half ofthose diagnosed with dementia move to special housing within 2.5-3 years. Atpresent, it is traditionally large-scale care facilities that are dominant. Thephysical care environment can become a resource in nursing if it is properlydesigned and this is starting to become more and more accepted. It is the licensednurse's responsibility to plan and implement that these needs are met and that thecare recipient receives the care needed to have a good quality of life. Aim: The aim is to shed light on the caregiver's perception of how the physicalcare environment is affected by people with dementia. Method: The literature study is based on ten scientific articles of qualitative studydesign and includes 222 nursing staff, including nurses. SBU's template (2013)was used for quality review. Six of the articles were considered to be of mediumquality and four of the articles received high quality. Results: Three themes with five associated sub-themes were created: Access tothe outdoor environment, orientation/location inside and out, obstacles andopportunities the care environment creates regarding care delivery.

Despite the benefits of physical activity for older adults, many residents living in long-term care homes (LTC) are relatively inactive. Previous research has revealed barriers to physical activity at the resident-level, organizational, and environmental level. However, little attention has been paid to other factors influencing physical activity within the broader institutional complex. The goal of this study was to uncover how the work of personal support workers (PSWs) related to the promotion of physical activity was socially organized. Institutional Ethnography (IE), developed by Dorothy Smith, guided this study. Smith proposed that peoples’ everyday experiences in local settings are organized, often unknowingly, by the actions of people located outside of the local setting and that this organization is textually-mediated. Two LTC homes in Ontario participated in this study. I began data collection by observing PSWs as they went about their work. Next, I interviewed PSWs and other people located inside (e.g. nurses, managers) and outside the LTC homes (e.g. representatives from the Ministry of Health and Long-Term Care (MOHLTC). Lastly, I collected texts that organized the PSWs’ work, such as Ministry standards. The findings revealed that although the MOHLTC standards were viewed as producing something “good” for the residents, some of the standards disrupted the PSWs’ work, which made it challenging for them to support daily physical activity. The promotion of physical activity was seen as an additional program that happened a few times per week and it was parceled out as a professional activity that was socially organized “out” of the PSW role. The findings suggest that local solutions are needed. A good starting point would be to go and talk to PSWs and residents to determine what type of assignments would permit the incorporation of physical activity into daily care. To embed the promotion of physical activity into daily care, a major rethink and reorganization of PSWs work will be needed, including a greater investment in human and material supports for PSWs.

Bakgrund: Då den äldre befolkningen successivt ökar i antal väntas fler personer drabbas av demenssjukdom. I många fall med denna progressiva sjukdom kan personen tillslut inte bo kvar i hemmet utan behöver flytta till ett särskilt boende. I dessa situationer kan de närstående bli de som för den sjukes talan och ser till att kvaliteten på vården upprätthålls. Syfte: Att beskriva upplevelsen av att ha en närstående med demenssjukdom som vårdas på ett särskilt boende. Metod: En deskriptiv litteraturstudie som omfattade tretton vetenskapliga artiklar med kvalitativ ansats. Databasen Medline via PubMed användes för att finna artiklarna. Huvudresultat: De närstående upplevde både positiva och negativa känslor kring den situation de befann sig i. De upplevde att personalbrist och bristande engagemang hos personalen kunde påverka kvaliteten på vården och bemötandet av de sjuka. Det uppstod känslor som frustration och misstro när personalen inte strävade efter personcentrerad vård. De närstående beskrev att de antog sig olika roller, när de sjukas tillstånd försämrades tog de en mer aktiv roll. Slutsats: Det primära för de närstående var de demenssjukas välmående. De närstående var nöjda om de involverades i vården. De upplevde missnöje vid bristande engagemang hos personalen samt organisationella brister. Sjuksköterskans medvetenhet om de närståendes betydelse för personcentrerad vård ökar förutsättningarna att bedriva så god vård som möjligt. / Background: As the elderly population gradually increases in number, more people are expected to suffer from dementia. In many cases with this progressive disease, the person is eventually unable to live in their own home and needs to move to a nursing home. In these situations, the relatives can become the spokesperson who ensures that the quality of care is maintained. Aim: To describe the experience of having a close relative with dementia who is cared for in a nursing home. Method: A descriptive literature review that included thirteen scientific articles with a qualitative approach. The articles were found through the database Medline via PubMed. Result: The relatives experienced both positive and negative feelings about the situation they were in. They experienced that staff shortages and lack of commitment from the staff could affect the quality of care and treatment of the patients. Emotions such as frustration and mistrust arose when staff did not strive for person-centered care. The relatives described that they took on different roles, when the condition of the patients deteriorated, they took on a more active role. Conclusion: The main concern for the relatives was the well-being of the dementia patients. The relatives were satisfied if they could be involved in the care. They experienced dissatisfaction with the lack of commitment from staff and organizational shortcomings. The nurse's awareness of the relatives' importance for person-centered care increases the chances of providing the best possible care.

Bakgrund: Djur som använts i vårdande syfte är ett historiskt tillvägagångssätt för att främja hälsa hos människan. De vanligaste orsakerna till att vårdhundar används inom sjukvård är att öka motivation och välbefinnande, lindra depression samt att öka lust till fysisk aktivitet och träning. Då ensamhet och psykisk ohälsa är vanligt förekommande bland äldre på särskilda boenden så är det av vikt att sjuksköterskan kan lära sig mer om alternativa metoder för att hjälpa de äldre att kunna skapa en meningsfull vardag med hjälp av alternativa metoder såsom användning av vårdhund. Syfte: Syftet var att undersöka hur individer på särskilda boenden för äldre påverkas av vårdhund. Metod: En litteraturöversikt genomfördes. Tretton artiklar identifierades som lämpliga relaterat till syftet. Artiklarna hämtades från databaserna CINAHL complete, PubMed och Ageline med hjälp av relevanta sökord. Artiklarna sammanfattades i en matris samt analyserades och presenterades under fyra rubriker och en underrubrik. Resultat: Resultaten framställde fyra teman; Det första var social påverkan, där vårdhundens påverkan på deltagares sociala liv, kommunikation, upplevd ensamhet samt engagemang undersöktes. Det andra temat, psykiskt hälsa, granskade huruvida vårdhund hade någon påverkan på den psykiska hälsan hos deltagare. Exempelvis depression, ångest och apati. Livskvalitet, tema tre, där belyses huruvida vårdhunden har någon verkan på deltagares livskvalitet, under samt efter avslutad intervention. Det fjärde och sista temat, uppvisat humör och beteende, hanterar deltagares allmänna beteende och humör i anknytning till kontakt med vårdhund. Slutsats: Resultaten visade goda förutsättningar kring hur vårdhunden påverkar äldre på särskilda boenden. I alla resultatteman visade vårdhunden ha en positiv påverkan på deltagare, vilket är väsentligt då de olika teman belyser olika ämnen och problem som äldre upplever. Däremot uppmärksammas även vikten av fortsatt forskning och förbättrad terminologi för vetenskaplig evidens. Därutöver är det viktigt att beakta de problematiska aspekter som vårdhunden kan betinga, exempelvis separation mellan vårdtagare och hund.

This is a study of twenty-six patients aged sixty years and over residing in a nursing care facility in Portland, Oregon in the fall of 1973, which explores the relationship of their morale and selected environmental and social factors. There are three major aims of the study. The first is to measure variances in morale states as experienced and reported by the respondents. The second aim is to determine how a given set of factors correlate with the self-reported morale of each of the respondents. Selected for consideration are 1) attitudes: expectations upon entering the home and choice, comparison of one’s self-assessed age and health status with that of others, feelings of financial and physical security, feelings of happiness vis a vis their life’s course; 2) activities: enjoyment of solitary activities, i.e. reading, writing, television, and radio, participation in group activities such as games, crafts, movies, and discussion groups, and visits outside the home; and 3) interpersonal relationships: interaction with peers, the presence or absence of friendships, the frequency of visitors, satisfaction with family relationships, and anticipation of events and contacts with others. The third aim of the study is to identify from the above information, points and strategies for social work intervention.

Early in the fall of 1973, the Oregon Chapter of the National Association of Social Workers (NASW) decided to sponsor a statewide training project in cooperation with seven chapters in other Department of Health, Education and Welfare (DHEW) regions across the United States. These workshops were to comprise Stage I of a two-stage plan; they were to serve as demonstration projects. Their planning, implementation and evaluation were to be seriously reviewed and studied afterword in an attempt to devise a model, or models, for Stage II, when a great number of such workshops would be held across the nation. The training plan ensued as part of a contract between NASW and the Health Resource Administration of DHEW, and was entitled Project Provide. The purpose of the contract was to train social work designees and consultants who are employed in Long Term Care Facilities (LTCF). The objective of the training was to initiate and/or improve appropriate social services to reduce the unmet social and human needs of residents and their families.