The primary purpose of this study is to determine whether being a church affiliated nursing home influences performance. Performance is measured based on criterion put in place by the Center for Medicare and Medicaid Services (CMS). The secondary purpose is, regardless of ownership type - religiously affiliated or secular- to investigate if more religiously involved nursing homes perform better than their less religiously involved counterparts. These two purposes are hypothesized with six different hypotheses each of which are tested by utilizing OLS regression analysis. This study extensively discusses the arguments surrounding the Charitable Choice Initiative, which allowed faith-based organizations (FBOs) to compete for federal and state grants and funds without altering their religious beliefs or practices while setting up a partnership with government in delivering social services. The subject has been part of serious debates among policy makers, practitioners and scholars after President George W. Bush's creation of the White House Office of Faith-Based and Community Initiatives in 2001. This study applied self regulation theory, which is originally an individual level theory, to organizations by using metaphors, as many newly developing fields of studies have done. The self regulation theory is tested through analyzing secondary data sets that are provided by CMS and through a religiosity survey data set that this researcher collected from 218 out of 287 CMS certified nursing homes in Virginia. The relationship between religious involvements of nursing homes and their patient outcomes and health inspection outcomes are tested. The statistical analyses supported only one hypothesis out of six. Since most of the hypotheses are not supported by the findings, the theory used to explain the role of religious motivation in performance of organizations requires further testing through additional rigorous studies.

L’obiettivo generale del progetto di ricerca è valutare la percezione della qualità dei servizi offerti in due RSA del Nord Italia e proporre interventi di miglioramento. Nel primo capitolo della tesi sono stati descritti i principali modelli teorici della qualità dei servizi. La letteratura riconosce la mancanza di scale validate che esplorano la percezione della qualità dei servizi nelle RSA Italiane. Per questo motivo, è stato realizzato uno studio di validazione e adattamento della versione italiana della scala SERVQUAL. Nel secondo capitolo della tesi è stato presentato uno studio qualitativo retrospettivo. Partendo dagli eventi critici che si sono verificati nella RSA, sono stati analizzati i principali episodi positivi e negativi ricordati dai famigliari degli anziani. I risultati sono stati utilizzati per ipotizzare nuovi percorsi di intervento e per fornire strategie organizzative per migliorare la gestione degli eventi problematici. La letteratura riconosce l’importanza del coinvolgimento dei famigliari per il benessere degli anziani. Per questo motivo, in questo progetto di ricerca sono state delineate le basi concettuali per l’applicazione di un modello collaborativo di assessment all’interno delle RSA. Nello specifico, il terzo capitolo della tesi ha esplorato l'efficacia dell’Assessment Terapeutico attraverso una meta-analisi multilivello e nell'ultimo capitolo della tesi è stata applicata una componente del modello di Assessment Collaborativo e Terapeutico nelle RSA. / The general aim of the present research project was to broaden the knowledge and understanding of the ways in which elderly’s family members perceive the quality of service and propose interventions to improve services. To lay the ground for discussion about the quality of services offered by nursing homes, Chapter 1 provides a historical overview of the models of the quality of services. Given the lack of validated measures of the quality of services in Italian nursing homes, I presented data regarding the validation and adaptation of the Italian version of the SERVQUAL Scale. Chapter 2 introduced a retrospective qualitative study. Starting from critical events that occurred in nursing homes, I analyzed family members’ observations of the incidents. The results were used to generate new paths for interventions to improve the family members’ evaluation of services and to provide organizational strategies to improve the management of problematic events. Given the effect of family involvement on elder people’s well-being, I presented the conceptual underpinnings and the applicability of a collaborative model of assessment in nursing homes. Chapter 3 explored the effectiveness of the Therapeutic Assessment model through a multilevel meta-analytic study. From these results, a component of the Collaborative and Therapeutic Assessment model was applied in nursing homes, as described in the last chapter.

The purpose of this randomized control trial (RCT) was to investigate the effects of a story-sharing intervention on older adults transitioning to long-term care (LTC). The specific aims were (1) to determine the effects of story sharing on the health transition outcomes of depression and well-being of adults transitioning to LTC; and (2) to determine if the sociodemographic characteristics (age, gender, ethnicity, marital status, level of education (LOE), months living at LTC facility, choice to move, and health problem(s) that may have resulted in the move) predict depression and/or well-being. Story sharing was defined as the respectful space where one tells and listens to stories of others (Heliker, 2009) while being guided by another (the investigator). Meleis’ middlerange theory of transitions (MMRTT) (Meleis et al., 2000) was used as a guide to understand the transitioning process. A convenience sampling design was used to recruit 100 participants from 11 LTC facilities in Broward County, located in Southeast Florida. The sample included adults, age 65 years and older, who were transitioning to a LTC facility within the past two years. Participants were randomly assigned to the control group (n = 52), who received standard care, or to the intervention group (n = 41), who received story-sharing and standard care. The results indicated there was no significant greater improvement to suggest an Intervention and Time effect for depression and/or well-being. Overall, predictive ability of the sociodemographic variables for depression and well-being were not statistically significant. However, LOE (junior college) did account for a significant portion of unique variance for increased depression, and time, marital status, ethnicity, LOE, and choice to move did account for a significant proportion of unique variance for well-being. Months living in LTC (more months) and marital status (all but divorced) were significant for improved well-being while ethnicity (Hispanic), LOE (high school and junior college), and choice to move (no choice) were significant for reduced well-being. Similar studies using a larger sample size, including non-English speaking participants; lengthier storysharing sessions; and measuring for pain, health, and bereavement may offer additional insights to healthy transition outcomes for this population. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Residents in nursing facilities are more prone to falls than those living in the community. Injuries resulting from falls impact residents, their families, and healthcare costs. The gap in nursing practice was the lack of a comprehensive fall-prevention program in a long-term care facility that had experienced high fall rates among residents. This project addressed whether an educational program using the American Medical Directors Association's clinical practice guideline and the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) toolkit for fall- prevention improved the self-efficacy of direct-care staff in preventing falls among residents in a long-term care facility. The practice-focused question focused on whether education on the use of an integrated multifactorial fall-prevention guideline would increase confidence of long-term care staff in reducing falls in long-term care residents. The evaluation used the 11-item Self-Efficacy for Preventing Falls-Nurse scale for 5 licensed nursing staff and the 8-item Self-Efficacy for Preventing Falls-Assistant scale for 21 nursing assistants. The positive change in self-efficacy scores of nurses and nursing assistants after the education program was greatest for face-to-face team communication regarding fall risk and individual resident prevention plans. The use of best-practice guidelines that improve fall risk-assessment and use of fall precautions to decrease the number of falls and falls with injury has the potential to bring about positive social change by improving the nursing care of nursing home residents, resulting in improved resident safety and quality of life.

Cette recherche porte sur la mise en évidence des spécificités des organisations non lucratives à travers l'analyse des modalités de la coexistence de celles-ci aux côtés d'organisations lucratives et publiques. Cette étude s'ouvre sur un examen critique de la littérature des théories économiques des organisations non lucratives sur base de la grille d'analyse proposée par Favereau (1989). Il apparaît que ces théories, qui reposent pour la plupart sur un paradigme de rationalité substantielle, s'avèrent inadéquates pour expliquer les raisons de la coexistence d'organisations non lucratives, lucratives et publiques dans un même secteur d'activités. Pour arriver à une explication satisfaisante, nous avons dès lors choisi de nous situer dans une perspective conventionnaliste, au sens de la théorie des conventions (Lewis, 1961; Orléan, 1994), basée sur une conception procédurale de la rationalité. L'étude s'est construite plus particulièrement sur le modèle des "Économies de la grandeur" (Boltanski et Thévenot, 1987) qui explique comment et pourquoi différents principes de justification peuvent être invoqués par des individus et des groupes afin d'exprimer leurs divergences dans les modes de coordination, ainsi que pour justifier leurs actions. Cette théorie nous a par ailleurs permis d'appréhender et d'opérationaliser, dans ses multiples facettes, le concept de qualité des services offerts par un secteur d'activités. Le secteur d'activités retenu pour appliquer le modèle développé est celui des maisons de repos pour personnes âgées (MRPA). Les différentes logiques de qualité des services au sein des MRPA ont été identifiées au travers d'études de cas qui ont permis d'analyser les tensions qui s'y manifestent et les compromis qui y sont réalisés, ainsi que le rôle tenu par le statut juridique. L'hypothèse de base du travail était en effet qu'à chaque statut juridique correspond un compromis spécifique entre les différents "mondes" de justification. / This research has been dedicated to the specificities of nonprofit organizations (NPO) when competing with for-profit (FPO) and governmental (GO) organizations in the same industry. The first part of this study consists of a review of the literature on economic theories of NPO's (Hansmann, 1987) along with a critical study based on the analytic scheme proposed by Olivier Favereau (1989). The economic literature is rich in theories explaining the existence of NPO's. Nevertheless, these theories are unable to explain the reasons for their coexistence with FPO's and GO's. As a matter of fact, most of these theories are founded on a classical paradigm based on a concept of substantive rationality, which can only explain the predominance of a type of organization in a specific sector. Therefore, in order to reach a satisfactory explanation of the coexistence of various organizational forms, our study has been rooted in a new paradigm, named the Theory of conventions (Lewis, 1961; Orléan, 1994), based on a procedural concept of rationality. More specifically, our study has been grounded on the approach elaborated by Boltanski and Thévenot (1987, 1991). The so-called model of the “Economics of Worth” (“les Economies de la Grandeur”), explaining how and why various principles of justification (e.g., domestic, civic, industrial, or merchant) may be invoked by individuals and groups in order to express their divergences in some process requiring coordination, as well as to justify the course of actions they have been adopting. This approach is centered on "conventions" as a way of understanding the interaction of social actors, be they individuals or organizations. This theory allows us to apprehend and operationalize in a multifaceted or multidimensional way the concept of the quality of service provided by a sector of activity. The second part of our research consists in the implementation of the developed model in a chosen sector, the nursing home industry, through selective case studies. Our empirical study firstly consists of the identification of the different "logics of quality" of services present or absent in several nursing homes with different legal statuses (NPO, FPO or GO). It then analyzes the specific tensions and compromises achieved within each nursing home under study as well as the role played by their statuses, keeping in mind that our basic hypothesis is that every legal status will induce a specific compromise between various "worlds" of justification.

Las caídas representan un importante problema de salud para los ancianos, principalmente cuando viven en centros residenciales. Con el objetivo de identificar la incidencia, los factores de riesgo y las principales consecuencias de las caídas en ancianos institucionalizados de la Región de Murcia, se evaluó una cohorte representativa (n=275) de ancianos y se registraron las caídas durante 8,4 meses (media). La densidad de incidencia de caídas es 67,5 por 100 personas-año. Los factores de riesgo son incontinencia urinaria, consumo de antidepresivos o psicoanalépticos y déficit de equilibrio. La actividad física diaria es un factor de protección. Las principales consecuencias físicas son dolor, herida superficial o contusión (43,8% de las caídas), y fractura (7%). La alta incidencia de caídas en los centros de Murcia y el conocimiento de los factores asociados deben orientar las intervenciones preventivas. / Falls represent a major health problem for the elderly, especially when living in residential centers like nursing homes.To identify the incidence, risk factors and the main consequences of falls in institutionalized elderly of Murcia, was assessed a representative cohort (n = 275) for the elderly and the falls were recorded during a follow up of 8.4 months (average). The density of incidence of falls was 67.5 per 100 person-years. Risk factors are urinary incontinence, use of antidepressants or psicoanaleptics and deficits of equilibrium. Daily physical activity is a protective factor. The main physical consequences are pain, superficial wound or contusion (43.8% of falls) and fracture (7%).The high incidence of falls in the nursing homes of Murcia and knowledge of associated factors should guide preventive interventions.

Bakgrund: Den äldre populationen ökar och många av de äldre lider av flera olika sjukdomar. Därmed ökar behovet av professionell och god omvårdnad. Den äldre människan som ofta lider av flera sjukdomar bor vanligtvis sista tiden av sitt liv på vård- och omsorgsboende. Äldre människor vårdas inte utifrån ett palliativt perspektiv trots att behov föreligger. Palliativ vård kopplas ofta ihop med människor som är under 65 år och har en obotlig sjukdom exempelvis cancer. Syfte: Att belysa hur den äldre människan vårdas i livets slut på vård- och omsorgsboende, ur de äldres, de närståendes och vårdpersonalens perspektiv. Metod: En litteraturstudie inspirerad av Friberg (2006). Tio kvalitativa artiklar och en kvantitativ artikel har analyserats och strukturerats utifrån den teoretiska referensramen. Teoretisk referensram: Den palliativa vårdens fyra hörnstenar; Symtomkontroll, teamarbete, kommunikation/delaktighet och närståendestöd. Resultat: Samtliga områden visade på stora brister i omvårdnaden om den äldre personen. Sjuksköterskan var ofta ensam i beslutet angående symtomlindring. De äldre kände sig i vägen och till besvär. Vårdpersonalen önskade mer handledning av sjuksköterskan. Närstående saknade information och delaktighet i beslut som rörde livsuppehållande åtgärder. Diskussion: Kunskap, information och kommunikationsbrist har visat sig leda till bristande omvårdnad kring den äldre personen på vård- och omsorgsboenden. Tydligare riktlinjer, samtal och en sammanhållen arbetsgrupp behövs för att kunna möta den äldre personens individuella behov. / Background: The population of elderly people is increasing and many of those suffer from multiple illnesses, thereby the need for professional and high quality care increases. The elderly suffering from multiple illnesses usually live their final years in nursing homes, and are not cared for throw a palliative approach, despite the need for it. Palliative care is often associated with people younger than 65 years and with an incurable disease, such as cancer.  Aim: To illustrate how elderly people are cared for during end- of- life in nursing homes, from the elderly, next of kin and nursing staff perspective. Method: A literature review inspired by Friberg (2006). Ten qualitative articles and one quantitative article have been analyzed and structured using the theoretical framework. Theoretical framework: The corner stones of palliative care; symptom control, teamwork, communication / involvement and support to next of kin. Result: All areas were lacking in the care of the elderly. The nurse was often alone in the decision making process regarding symptom relief for the elderly. The elderly felt that they were in nuisance and in the way for the staff. The caring staff wanted more guidance from the registered nurse. Next of kin were missing information and participation in decision making process concerning life prolonging measures. Discussion: Lack of knowledge, information and communication are shown and was leading to inadequate caring for the elderly in nursing homes. Clearer guidelines, dialogue, and a good teamwork are needed to meet the older person's individual needs.

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Title from first page of PDF document. Includes bibliographical references (p. 20-21).

Nous avons peu d’informations sur les interactions sociales des personnes démentes en institution et sur les effets des interventions psychosociales sur leurs interactions sociales, qui sont favorables à une bonne qualité de vie et à un bon fonctionnement cognitif. 56 résidents d’une maison de retraite vivant avec une démence ont été observés par vidéo, afin d’analyser leurs comportements sociaux et de valider une grille d’observation des interactions sociales : le Social Observation Residents Index (SOBRI). 36 résidents ont bénéficié d’une séance de stimulation psychosociale. Leurs scores au SOBRI ont été comparés à ceux d’un groupe contrôle. La validation du SOBRI met en évidence deux profils de comportements : interactions sociales avec les résidents et avec les soignants. Une séance de stimulation psychosociale favorise significativement les interactions sociales avec les soignants. Des tendances positives sont observées dans les deux groupes sur les interactions sociales entre les résidents. Les résidents vivant avec une démence interagissent spontanément entre eux et avec les soignants. La stimulation psychosociale favorise les interactions avec les soignants. Une stimulation, quelle que soit son intensité, stimule les interactions entre les résidents. Ces résultats doivent être confirmés dans l'objectif de développer des programmes favorisant l’inclusion sociale en institution. / We have little information about the nature of social interactions of people with dementia living in nursing homes and about effectiveness of psychosocial intervention on social interactions. We know that social interactions promote a good quality of life and a good cognitive functioning. 56 residents with dementia living in a nursing home were observed by video to analyse their social behaviours and to validate an observation grid of social interactions, the Social Observation Residents Index (SOBRI). 36 residents received a session of psychosocial stimulation. Their scores on the SOBRI were compared to those of a control group. The validation of the SOBRI highlighted two profiles of behaviours: social interactions with other residents and with care staff. One session of psychosocial stimulation promotes significantly social interactions with care staff. Positives trends are observed in both groups in terms of increase of social interactions with other residents. Residents with dementia interact spontaneously with other residents and with care staff. Psychosocial stimulation promotes social interactions with care staff. A stimulation, regardless its intensity, seems to stimulate social interactions between residents. Future studies are needed to confirm these trends and to develop programs promoting social inclusion in nursing homes.