This investigation examines the differences in perception of the role of staff-development trainer in organizations, a role identified as an emerging occupation, held by three professional groups. The focus is on sources of stress and strain in the job performance of the trainer. Purposes of the study are (1) to collect data from three coworker groups, administrators, directors of nursing, and trainers relative to the role of the trainer, (2) to examine differences in perception between the groups, (3) to examine the differences as potential sources of stress when viewed from the perspective of role theory, and (4) to delineate the role. This study indicates that knowledge about behavioral sciences and skill at interpersonal communications are important areas in both background and in personal qualities needed. Nurses and trainers widely perceive a lack of commitment to training by administrators. This relates to sources of strain in the role of trainer. There is a generally held expectation in the field that the role will grow in importance and scope.

As the percentage of elderly adults within the U.S. continues to grow, long-term care options will increase. Facing increased competition from other forms of long-term care, many nursing homes are seeking innovative models to enhance management and clinical care practices. The Teaching Nursing Home model, first established in the 1970s, is one in which academic institutions partner with nursing homes to create information exchanges between the nursing home and the school. Currently, nursing schools throughout the country work with nursing homes to create clinical training sites for nursing students. The partnership is also used to encourage research among school faculty and to assist nursing homes in their management of best practices. This study examined the impact of these relationships on nursing home quality. Twenty teaching nursing homes were matched with twenty nursing homes that are not engaged in this practice. Using nursing home quality scores published by the Centers for Medicare and Medicaid Services, mean outcomes for the matched pairs were compared using T-tests. Regression analyses were also performed to test whether quality improves over time within a teaching nursing home. The results from the T-tests performed did not show overall quality differences between the matched pairs. However, when analyzed regionally, some significance was observed for teaching nursing homes in the Upstate NY region (p<0.1). The study discusses some of the differences in design of the teaching nursing homes within that region and the impact that may have on results. Time as a teaching nursing home did not appear to affect quality for nursing homes in this study. Possible explanations for these insignificant results are discussed in the Summary, Discussion and Limitations section of the study. Overall, the findings from this study suggest that the Teaching Nursing Home model can add value to nursing homes by offering them research and professional training opportunities with academic institutions. Within the study, recommendations are made to further explore the impact of these partnerships on nursing home quality and to encourage the development and use of the model through policy changes. / Business Administration

Geographic utilization patterns of nursing homes were examined by comparing patient origin with facility location. The 1985 Patient Origin Study produced by the Virginia Department of Health was used to see if there are predictable geographic patterns of patient migration to nursing homes. A random sample of thirty nursing homes was taken from all facilities in Virginia in the 1985 study. The migration data were used to determine median migration distances, to investigate decreases in utilization with distance from a facility, and to distinguish spatial markets of nursing homes. Comparisons were made between urban and rural facilities to see how factors of limited availability and children-as-decision makers affect the migration patterns. The findings show that there is a distinct pattern of decreasing utilization of nursing homes with distance from the facility. Both urban and rural nursing homes primarily serve the immediate environment in which they are located. Maps of patient origins show that there are service areas for nursing homes which are modified by population distribution and physical geography. General findings show that location is crucial for nursing home utilization. The existence of a facility generates need awareness and utilization throughout the immediate population. On the average, twenty-six percent of the patients at a nursing home come from the same zip code in which the nursing home is located. More than half the patients come from within eight miles of a facility. Eighty-three percent of the patients come from within 26 miles. The ratio of out-of-region migration to urban nursing homes is significantly higher than that for rural nursing homes. The results of this thesis can be used to predict utilization patterns of nursing homes. The findings also have implications for Medicaid budgeting because they show geographic, demographic, and economic factors which affect nursing home utilization rates. / Master of Science

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2006. / Title from first page of PDF document. Includes bibliographical references (p. 104-110).

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The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care. The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners. Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.

This is a study of four nursing care facilities in Portland, Oregon in 1975-1976, which examines the relationship between leadership style and staff satisfaction, leadership style and patient satisfaction,and staff satisfaction and patient satisfaction.

According to the National Patient Safety Foundation, more than 1.5 million Americans are affected by medication errors because of varied factors including miscommunication, bad handwriting, name confusion, poor packaging, and metric or other dosing unit errors. This project addressed medication errors and adverse drug events by developing policy and practice guidelines to support and aid the utilization of health information technology (HIT) systems in addressing medication errors and adverse drug events at a local nursing home in Cincinnati, Ohio. The National Quality Strategy Framework was used by a team of interdisciplinary stakeholders as a guide for the development of policies and practice guidelines. An interdisciplinary project team of institutional stakeholders was led by the DNP student through a review of literature to assess the effectiveness of current policies and guidelines and explore areas for improvement. New policy, practice guidelines, and educational materials were developed, along with plans for implementing and evaluating the policies in the institution. Policy and practice guidelines were shared with 4 scholars possessing expertise in health information technology to validate content of the products. Feedback was used to inform revision and preparation of final policy, practice guidelines, educational materials, and plans for implementation and evaluation. The implementation plan advocates a process that includes multiple stakeholders and institutional preparatory stages. The evaluation plan addresses multiple outcomes related to efficiency and patient safety, and proposes both intermediate and long-term evaluation based on comparisons of pre-post metrics routinely collected by the institution. Following implementation and evaluation, dissemination of results of the project may stimulate positive social change by reducing medication errors in similar health care institutions that adopt related measures.

In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian's category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.

This research used a case study approach to chronicle the process of seeking the American Nurse Credentialing Center's Pathway to Excellence in Long-Term Care designation in one Midwest community. The PTE-LTC practice standards framework guided the implementation of professional nursing practice which focused on a positive practice environment, shared decision-making, accountability for resident care, and the leadership development of nursing staff. These practice standards are outlined in the study and incorporated the major components necessary to implement Professional Nursing Practice and Shared Governance in long-term care. The components of the designation process over a five-year period were documented and compared with other models of shared governance and professional practice supported in the literature. The study included a rich description of the structures and processes in place prior to the designation process and those developed during the process to operationalize the model. The methods which were used to accomplish these organizational changes are identified as well. In addition, the study reports on the effects of the model implementation on organizational, nursing, and resident measures. The implementation of, and support for, a professional nursing practice role and environment in a nursing home was expected to improve both the quality of care and quality of life for older adults who live in the nursing home, as well as staff job satisfaction and retention of nursing staff.