Thesis (M.A.)--Eastern Illinois University, 2009. / Includes bibliographical references (leaves 27-33).

Indiana University-Purdue University Indianapolis (IUPUI) / Between 1 million and 2.2 million nursing home residents are transferred to a hospital emergency department each year. These transfers are costly, have negative health outcomes, and can increase the morbidity and mortality of residents. Few studies, however, have provided in-depth descriptions of transfer experiences. The purpose of this study was to examine the transfer process between the nursing home and the hospital from the perspectives of nursing home residents and nurses, focusing on how decisions were made to transfer residents. Using a qualitative descriptive method, 22 participants (10 residents and 12 nurses) were recruited from four nursing homes located in rural Indiana. Purposive sampling, semi-structured interviews, and conventional content analysis were used to collect and analyze narratives obtained from residents and nurses about their experiences with a recent transfer and to develop four in-depth case descriptions of these transfers. The participants described four aspects of the transfer process: transfer decisions, transport experiences, hospital stays, and returns to the nursing home. The most common reason for transfers was an acute exacerbation of a chronic condition, and the decision to transfer was often made by a nurse. Most participants found aspects of the transfer, including their hospital stay, to be aversive or upsetting. The return to the nursing home was typically welcomed but often challenging due to problems with mobility, medication adjustments, and cognitive changes. Participants also provided several recommendations for avoiding potentially preventable transfers including adding “in-house” diagnostic testing and treatment equipment, improving staff competencies in managing acute exacerbations, increasing staffing, improving communication among staff, and increasing staff familiarity with resident histories and preferences. The findings have several clinical and policy implications for preventing or decreasing the negative effects of hospital transfers.

No description available.

No description available.

Introduction: The number of older adults (≥ 65 years) is increasing in Sweden. At the same time, the elderly care system is being restructured with an increased care burden in nursing homes (NHs). Several studies report a high prevalence of malnutrition among older adults. In recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. However, we lack knowledge regarding how to implement these initiatives to achieve real improvements in practice. Aims: The overall aims of the thesis are to update our knowledge of the nutritional situation in municipal elderly care and to evaluate different implementation strategies (external facilitation and educational outreach visits) for implementing nutritional guidelines in the NH setting. Methods: Residents and staff of altogether eight NH units participated in the studies. The two implementation strategies were external facilitation (EF) and educational outreach visits (EOV). The EF strategy was a one-year, multifaceted intervention that included support, guidance, practice audits and feedback in four NH units. The EOV strategy comprised one three-hour lecture about the nutritional guidelines in four other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Results: In paper I, the prevalence of malnutrition in the NH setting remained high, i.e., 30% were malnourished and 63% at risk of malnutrition, and malnutrition was associated with deterioration in function and cognition and one-year mortality. However, possible improvements in nutritional status among NH residents over time (from 1996 to 2010) were observed. In paper II, the EF strategy improved mealtime ambience compared to the EOV strategy with respect to arranging the table, offering a choice of beverage and more to drink, serving the meal, increasing social interactions between staff and residents, decreasing social interactions among staff and reducing noise from the kitchen. In paper III, the EF strategy may have been related to a delay in cognitive deterioration in a sub-sample of communicative NH residents. In paper IV, the EF strategy improved, on average, the ability and willingness of the staff to implement the guidelines, i.e., the staff experienced a clearer assignment of responsibilities regarding nutritional procedures and that they had more time, tools and support from leadership. Moreover, the staff felt that they experienced less resistance from work colleagues, that their knowledge and experience were valued, that the guidelines worked in practice and that the implementation of guidelines was not labourious.  Conclusions: Malnutrition is prevalent in Swedish nursing homes. Implementation of nutritional guidelines by an external facilitator, as compared to traditional methods, may be more effective on mealtime ambience, provide better preconditions for change among the staff, and may have positive effects on cognition among residents.

The abuse of older people is a largely unrecognised and under acknowledged social problem in Australia. My major objective in undertaking the work, which is represented by the original published articles that comprise the thesis, was to make a scholarly and practical contribution toward the minimisation of 'elder abuse. This objective was achieved with the development and implementation of a series of studies that articulated and ameliorated elder abuse in Australia.The thesis provides an erudite synthesis of these studies, which fall into four themes that illustrate the nature and scope of my theoretical and professional work in elder abuse. Much of the work was guided by a conceptual framework of ways of knowing in nursing, and was underpinned by the principles and practice of community development and participatory community-based action processes.The outcomes of these studies include work with three stakeholder groups: professionals who deal with elder abuse, older people who are victims or potential victims of abuse, and those who perpetrate abuse on an older person. The work, illustrated in the four themes, includesthe articulation of elder abuse issues with West Australian aged care workersthe development of elder abuse protocols, policy guidelines and ethical principles, to guide professional practice in abuse prevention and interventionthe design and implementation of participative community programs to empower older people, and their carers, to resist being abused or abusing and to assist perpetrators stop their abusethe amelioration of abuse of nursing home residents by staff.The thesis situates my conceptual and clinical effort within the wider corpus of Australian knowledge and practice on elder abuse and contributes to addressing the social problem of elder abuse within the context of Australian aged care.

PURPOSE-Administrators of nursing homes are turning over at very high rates in the present industry. With the growth of older populations needing skilled nursing care, this presents a risk to the needs of the elderly. Satisfaction and turnover have been correlated in the literature. The purpose of this qualitative study was to explore dimensions of satisfaction and dissatisfaction among nursing home administrators in order to ascertain constructs potentially contributing to dissatisfaction in the industry. METHODS-Informational letters were mailed to all licensed administrators in the state (N=143) who were then randomized to receive follow-up invitational phone calls to join the study. Those interested in participating were asked a few short screening questions about their tenures in the industry and overall perceptions of satisfaction. Interested participants were then divided into 3 different strata based on their tenures. Purposive sampling informed the choices of participants and selected 10 from each of the shortest, longest, and most dynamic tenures. Interviews occurred on nursing home sites around Oregon. Grounded theory was used in a priori analysis by means of a coding paradigm in order to allow emergent data to reveal substantive categories in a theoretically directed pattern of coding, contrasting, verifying, and eventually grounding new theory in data. FINDINGS-Allowing the data to emerge in analysis of satisfaction and dissatisfaction revealed two corresponding core categories, Constraints to the Job and Meaningful Work. Constraints to the Job included 4 categories: Bureaucratic Constraints, Budgetary Constraints, Personnel Constraints, and Ethical Constraints. Meaningful Work included Working Conditions and Meaningful Interiors. As dissatisfaction and satisfaction were further compared and verified, theory grounded in data emerged and revealed that constraints to the job obstruct an administrator's autonomy, which in turn impedes the ability to engage in meaningful work and contributes to dissatisfaction. CONCLUSIONS-While constructs of dissatisfaction emerged, administrators on the whole revealed high satisfaction with their positions. Future studies should concentrate on the bureaucratic constraints to the job as these constraints were perceived as extremely dissatisfying and hold political implications for state and corporate policies. / Graduation date: 2005

Background The demand of long-term care facilities has increased because of the geriatric population growing up rapidly. How to reduce the frequency of the nursing home residents¡¦ being hospitalized is one of the most important indicators for the quality of long-term care. Objective To understand the characteristics of facilities and nursing home residents. To test the effect of the characteristics on the probability of hospitalization of nursing home residents and to analyze the predictors of readmission in order to improve the quality of nursing care and the life quality of their residents. Methods We collected 329 residents of a hospital-based nursing home in southern Taiwan before March 31, 2011 and who stayed more than 90 days at the facility. The medical records were reviewed retrospectively. Data were analyzed using descriptive statistics (correlation and one way ANOVA) to test the effect of the resident¡¦s and facility¡¦s characteristics on the probability of hospitalization. Multiple linear regression was used to study the risk factors and the predictors of readmission frequency. Results Of the 29 residents, 141(42.9%) were male. The average age was 78.06. 33.7% of the residents died in the facility. The total individual admissions were from 0 to 18. The hospitalized frequency was 0.42 in each 90-day period. Infectious disease was the majority diagnosis of admission. The three leading causes of admission were pneumonia(45.5%), urinary tract infection (20.0%) and upper gastrointestinal bleeding(10.3%). Correlation analysis showed the age had a positive correlation with the frequency of readmission. The hemoglobin level, serum albumin level, serum cholesterol level, body mass index, mini-nutritional assessment score and mini-mental status evaluation score disclosed a negative correlation with the frequency of readmission. Multiple linear regression showed the male gender, age, lung diseases, complete bed-ridden and mini-nutritional assessment score were significant predictors of readmission frequency. Conclusion The evaluation of the risk factors and predictors might help to identify the nursing home residents who are likely to be readmitted. It is hoped that the hospitalizations from nursing home may be prevented and the results of this study might contribute to the quality of long-term care facilities.

The purpose of this research is to study the relationship between both the characteristic of the residents and the nursing home and the changes of the ADLs of the residents. Descriptive study was designed. 35 nursing homes and theirs residents in Kaoshiung City were be the sample and 34 questionnaires of the nursing home were returned. Residents¡¦ questionnaire were interviewed by trained personnel twice (pre and post), on June and December 2001 respectively. 310 residents including 141 male, 169 female, average age 72.94 were interviewed. Structural questionnaire was used as the tool, organization¡¦s questionnaire consists of the type of organization, size, admission rate , resignation rate. Resident¡¦s questionnaire including demographic data, Katz Index of ADLs, health status, pressure sore etc. Data analysis including descriptive analysis, T-test, Anova, Pearson relation analysis and linear regression analysis. The result shown that 86.2% of the residents¡¦ ADLs severely dependent on others help. T-Test shown that male has better ADLs than female, widow has better ADLs than couple ¡]P¡Õ0.05¡^. but shown no significant of changes of ADLs. Age, sickness and ADLs and changes of ADLs shown no significant results. On the other hand, the relationship between the characteristic the nursing home and the changes of the ADLs of the residents shown the government aided and ¤½¥ßor°]¹Îªk¤Hnursing home has better changes of ADLs¡]P¡Õ0.01¡^. The greater the size of the organization the better of the ADLs changes, private sector and affliated nursing home shown no significant results of the ADLs changes. Pressure sore is the important index of the quality care of the long term care organization, research sectors always take it as the routine surveillance. This study consisted of 31 cases of pressure sore (10%),¤½¥ßor°]¹Îªk¤Hnursing home has a low incidence of pressure sore, the higher the bed using rate, the worse of the ADLs changes, the higher of the high incidence of the pressure sore, but there is no difference between the resignation rate and the incidence of the pressure sore. The results of this study may help the clinical care-taker to design different care targets in order to help to recover and to improve the ability of ADLs by the characteristic of the residents. Moreover, study of the characteristic of nursing home and effects of the changes of the ADLs of the residents may act as suggestion to the manager and the administrator who may take the different characteristic of the organization into consideration when making policy to improve or to further investment and expansion of the organization.

This research is mainly aimed at the spirit issue for the residents of the nursing home to investigate the correlation of satisfaction between the physical condition, psychologic condition and spirit condition. The subjects are the residents of three nursing homes in Kaohsiung city. The measure of structural questionnaire is selected and adopted by this research. Two hundred and seventy questionnaires are issued, and two hundred and fifty-two questionnaires are valid. The valid questionnaires are analyzed by descriptive statistical measurement, one-way ANOVE, Independent-Samples T test, and examined the differences with the control by Bonferroni. The results of this research are listed as follows: 1. The correlation of satisfaction in regard to the residents¡¦ basic conditions: The older residents are more satisfied with the nursing home. The residents¡¦ satisfaction for the nursing home is less and less when they stay there longer and longer. Single residents are more content than married, divorced, widowed, and widowered residents. There is no difference in the correlation of satisfaction between the residents with different religions and education levels. The residents with independent economic ability are more contented with the nursing home. 2. The correlation of satisfaction in regard to the residents¡¦ physical conditions: There is difference in the self-image between the residents with normal hearing and without hearing. The residents who can communicate with others by oral language have better relationship and they are more content. The residents with normal sightare more satisfied. The residents who have to rely on others in their daily lives are most unsatified. 3. The correlation of satisfaction in regard to the residents¡¦ psychologic conditions: There is no difference in the correlation of satisfaction between the residents with different sentiments. The residents with good behavior are more satisfied. The residents who have good relationships with others and join the activities actively are more content. According to the results of this research, we would like to make some suggestions.The government institutions, educationists, nursing home¡¦s superintendents and clinical staffs should provide the fine and practical services, including of physical, psychology and spirit care. These fine services should reach the target of practical nursing and moreover, spirit care should be the responsibility of all nursing staffs.