Originally, the focus of this project was to be a policy analysis and survey of the new procedures and regulations established by the state of Oregon for the protection and management of nursing home residents' Personal Incidental Funds (PIF). The analysis was to be divided into four phases, according to a pre-planned timetable. The last phase was to be a field survey of the policy's impact upon nursing homes and adult service workers. The timetable was synchronized with that of the Congregate Care Consultant from the Public Welfare Division's (PWD) Adult Services Unit, whose responsibility it was to develop and write a new policy for the state. Although the PIF is a miniscule segment of the total policy which the state of Oregon has developed for nursing facilities, it is submitted here as representative of public policy formulation in that area.

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No description available.

This qualitative phenomenological study examined central Florida's nursing home administrators' knowledge and perception of cultural competence and how they perceive that their knowledge and perceptions impact residents, families, and healthcare. The theoretical framework for this study was explained through Campinha-Bacote's interdisciplinary model of The Process of Cultural Competence in the Delivery of Healthcare Services. The theoretical framework was used to guide research questions, and individual interview questions to obtain nursing home administrator's knowledge and perception of cultural competence. The study explored the level of cultural competence reported by nursing home administrators, their individual perception of cultural competence, their degree of confidence in cultural competence, and how nursing home administrators describe their proficiencies and skills in cultural competence. Interviews with six nursing home administrators included licensed nursing home administrators (NHA) and assistant nursing home administrators, and the director of nursing (DON). The findings identified and analyzed the diverse levels of nursing home administrator's knowledge and perception of cultural competence. Some participants demonstrated difficulty expressing their knowledge and perception of cultural competence. Findings indicate that various factors influenced participants' overall degree of confidence in their knowledge and perception of cultural competence. Nursing home administrators also had a difficult time articulating particular skills that demonstrate their ability to adapt to the diverse residents in their facilities, and how they promote cultural competence in their nursing home facilities. This study identified the need for additional research and continuing education about cultural competence in healthcare.

Bakgrund: Demenssjukdomar drabbar miljontals människor världen över. Det som präglar en demenssjukdom är att kognitiva förmågor börjar försämras. Både behandlingar och förståelser för sjukdomen är under konstant utveckling. Innan vård- och omsorgsboende blir aktuellt är anhöriga oftast den första omvårdaren. Syfte: Syftet avser att beskriva upplevelser av att vara anhörig till en person med demenssjukdom på vård- och omsorgsboende. Metod: Metoden utgår från en litteraturöversikt enligt Friberg, där tio artiklar är framtagna från databaserna CINAHL Complete och PubMed. Artiklarna analyserades efter Fribergs femstegsmodell vilket utgör en litteraturöversikt. Den teoretiska referensramen bygger på Janice Morses omvårdnadsteori om lidande. Resultat: Litteraturöversiktens resultat av anhörigas upplevelser delas upp i tre teman. En ny relation, förväntningar på vården och en meningsfylld vardag. Resultatet påvisar att förflytten till vård- och omsorgsboende var en omfattande upplevelse för anhöriga. Resultatets underteman påvisar att även delaktighet, förtroende, normalitet och tillit är viktigt i vården som anhörig. Sammanfattning: Anhöriga har upplevt en förändrad vardag samt tillvaro sedan personen med demenssjukdom flyttat in på vård- och omsorgsboende. Vardagen speglas av kontakt som anhöriga upplever olika beroende på bemötandet av vårdpersonalen. / Background: Dementia is a widespread diagnosis that affects millions of people. What characterizes dementia is that cognitive abilities begin to deteriorate. Treatments and understandings for the disease are under development. Those most affected by the disease are the relatives who usually become the first caregiver of dementia patients, before nursing homes begin to become more relevant. Aim: The aim of this study is to describe experiences of being relative to a person with dementia in nursing homes. Method: The method used is a literature review according to Friberg, where ten articles are produced from the databases CINAHL Complete and PubMed. Selected articles were analyzed according to Friberg's five-step model for a literature review. Janice Morse's nursing theory of suffering was used as a theoretical frame of reference. Results: The results of relatives' experiences were divided into three main themes; a new relationship, expectations of care and a meaningful everyday life. It turned out that the move to care and nursing homes was a comprehensive experience for relatives and everyday life did not look good for close relatives as it were stressful. The sub-themes of the results also show that confidence, involvement, maintain same old routines and trust in the care as a relative was important as well. Conclusion: Relatives have experienced a change in their daily routines and even a different life since their dementia patient moved into nursing homes. The change is reflected on the relative’s daily life and causes the development of new habits as they now experience life differently depending on how the treatment at the care and nursing home goes.

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities.

Some social and organizational behavior scientists measure resiliency through anecdotal qualitative research, i.e. personality analyses and stories of life experience. Empirical evidence remains limited for identifying measurable indicators of resiliency. Therefore, a testable contingency model was needed to clarify resiliency factors pertinent to organizational performance. Two essential resiliency factors were: 1) a written plan and 2) affiliation with a disaster network. This contingency study demonstrated a quantifiable, correlational effect between organizational complexity, disaster plan adequacy and organizational resiliency. The unit of analysis, the skilled nursing facility proved vulnerable, therefore justifying the need for a written emergency management plan and affiliation with a disaster network. The main purpose of this research was to verify the significance of emergency management plans within a contingency framework of complexity theory, resource dependency, systems theory, and network theory. Distinct sample moments quantified causal relationships between organizational complexity (A), plan adequacy (B) and resiliency (C). Primary and secondary research data were collected from within the context of public health and emergency management sectors within the State of Florida.

The prevalence of mental health disorders among the nursing home population is well recognized. However, providing adequate mental health services for nursing home residents who need them remains a challenging endeavor. The social support of family has long been recognized as a key resource for older adults with a mental health history and older adults residing in nursing homes. The purpose of this study is to examine the quality of mental health care provided for nursing home residents with a mental health history and to determine if family support influences the quality of their mental health care accounting for other facility resident and facility organizational characteristics. The study utilized a retrospective, cross-sectional design with 2003 national Online Survey Certification and Reporting (OSCAR) facility data merged with the resident-level Minimum Data Set (MDS) resulting in N=2,499 nursing homes. Guided by the convoy model of social support and socioemotional selectivity theory, descriptive statistics and exploratory factor analysis were used to create a profile of facility level data of nursing home residents with a mental health history, explore the role of family support, and determine if items within the OSCAR and MDS databases could respectively be used to measure mental health care quality and family support. Overall, it was found that families have a positive relationship with their relatives and are involved in their lives. Additionally, items within the OSCAR and MDS databases could be used to measure mental health care quality and family support. Finally, facility organizational characteristics explained more variation in the quality of mental health care than did facility resident, family support, or market characteristics. In sum, to enhance the quality of mental health care in nursing homes, partnering with families may be an important tool to meet resident needs.

Bakgrund Sömnkvalitet är betydande för livskvalitet. Sömnbrist leder till att kroppen inte fungerar optimalt. Äldre personer som bor på särskilt boende riskerar att utsättas för försämrad sömnkvalitet. Ofta behandlas sömnsvårigheter med sömnläkemedel, vilket kan skapa negativa biverkningar. Omvårdnadens centrala mål är hälsa, välbefinnande och livskvalitet. Sjuksköterskan ansvar för bedömning av omvårdnadsåtgärder. Att identifiera samt utveckla individuella och förebyggande icke- farmakologiska omvårdnadsåtgärder är viktigt för att skapa förutsättningar att förbättra sömnkvaliteten hos äldre. Syfte Syftet med litteraturöversikten är att beskriva omvårdnadsåtgärder som främjar sömnkvalitet hos äldre på särskilt boende. Metod Denna litteraturöversikt utfördes med inslag av den metodologi som används vid systematiska litteraturstudier baserat på 15 vetenskapliga originalartiklar från databaserna CINAHL och PubMed.  Resultat Litteraturöversiktens resultat visar att främjande omvårdnadsåtgärder som fysisk aktivitet, socialt samspel, minskade depressiva symtom samt sensorisk stimuli har positiva effekter på äldres sömnkvalitet. Sjuksköterskan är viktig när det gäller att ge handledning och stöd i det sömnfrämjande arbetet. Slutsats Omvårdnadsåtgärder som identifierades och som visade sig kunna förbättra sömnkvalitet är fysisk aktivitet, socialt samspel, sensorisk stimuli samt åtgärder för att minska depressiva symtom. Sjuksköterskan har ett ansvar att handleda i team samt ge stöd utifrån ett personcentrerat förhållningssätt. / Background Quality of sleep is significant for quality of life. With lack of sleep, the body does not function optimally. Older people living in nursing homes are exposed to impaired sleepquality. Often, insomnia is treated with sleep medications, which can contribute to negative side effects. The central goals of nursing are health, well-being, and quality of life. The nurse is responsible for the assessment of nursing interventions. To identify and develop individual and preventive non pharmacological nursing interventions to create conditions to improve the quality of sleep in the elderly are important. Aim The aim of the literature review was to describe nursing interventions that promote sleepquality in elderly people living in nursing homes. Method This literature reviews were conducted with elements of the methodology used in systematic literature reviews based on 15 original scientific articles from the databases CINAHL and PubMed. Results The results of this literature review show that promoting nursing interventions such as physical activity, social interaction, reduced depressive symptoms and sensory stimuli have positive effects on the sleep quality of the elderly. The nurse is important when it comes to providing guidance and support in the sleep promotion work. Conclusions Nursing interventions that were identified and that were shown to improve sleep qualityare physical activity, social interaction, sensory stimuli as well as measures to reduce depressive symptoms. The nurse has a responsibility to supervise in teams and provide support based on a person-centered approach.

Background: There is significant concern about nurse burnout in nursing homes. There has been little research to investigate whether training in person-centred care and supervision can reduce nursing home nurses’ burnout. Aims: To adapt training to be suitable for nursing home nurses and evaluate the impact of training and supervision on burnout and related outcomes. Study Design: Focus groups with nursing home nurses were used to inform adaptation of the training. Mixed methods were used to evaluate the impact of training and supervision employing a convergent parallel design, including a Randomised Controlled Trial with quantitative measures (primary outcome measure: the Maslach Burnout Inventory) to assess effectiveness and exploration of subjective experience using qualitative interviews. The findings of the RCT and qualitative interviews were then compared to determine the convergences and divergences. Findings: The training was adapted to include content on leadership and stress management. Hypotheses that the interventions would reduce burnout and impact on other quantitative outcomes were not supported. Qualitative interviews with nursing home nurses about training indicated that the nurses reported reduced burnout, enhanced self-efficacy, reduced isolation, better team working, more informed person centred dementia care and enhanced leadership. Nurses’ views on the impact of supervision included a range of benefits. There was convergence between quantitative measurement and subjective experience indicting significant levels of burnout, but divergence in terms of the impact of training in person-centred care and supervision. Conclusions: My study demonstrates that burnout is a significant issue for nursing home nurses in the UK. There was divergence in my findings in terms of the impact of training in person-centred care and supervision. The hypotheses about training and supervision having positive impact on burn-out were rejected. However, the qualitative findings suggest that nursing home nurses experienced positive benefits from the person-centred training and supervision, in particular on their sense of burnout, their approach to care and leadership skills. Recommendations are made regarding research, training and policy to address burnout in nursing home nurses. / Burdett Charitable Trust of Nursing