Safety of residents has gained increased popularity in recent years following a report from the Institute of Medicine attributing 98,000 hospital deaths each year to errors by staff. As a result, regulatory agencies, advocates, and health care providers have shifted their focus to understanding patient safety and developing a culture that promotes safety. However, nursing homes lag behind other health care providers in their adoption of a patient safety culture and understanding what factors affect safety in resident care. These insights are needed to ensure that nursing home residents receive the safe care. The purpose of this dissertation is to explore factors that influence the safety of residents in nursing homes by conducting three separate studies and using Donabedian's Structure Process Outcome (SPO) framework. The first study examines facility characteristics that predict higher patient safety culture scores given by top managers among a nationally representative sample of nursing homes. Using the same sample, the second study examines the relationships among the three components of Donabedian's SPO model as they relate to patient safety: structure (patient safety culture), processes of care (restraint use) and a common patient safety outcome, resident falls. The final study uses a sample of Florida nursing homes and the SPO model to examine the relationships between nursing staff turnover, processes of care, and patient safety outcomes in nursing homes. Findings from this dissertation can contribute to a greater understanding of what predicts higher levels of patient safety in nursing homes. In the first analysis, facility characteristics that are traditionally related to quality of care in nursing homes are predictive of higher patient safety culture scores. In the second analysis, higher ratings of patient safety culture are related to better processes of care and a decreased likelihood of resident falls. In the final analysis, results indicate that Certified Nursing Assistant (CNA) turnover had an independent effect on two patient safety outcomes, falls and UTIs, and that this effect is mediated by processes of care within the nursing home. Collectively, the findings from this dissertation may have important implications for policy makers, providers, and consumers of nursing home services.

No description available.

No description available.

No description available.

No description available.

No description available.

<p>2015-06-04</p>

No description available.

No description available.

Aim: The aim of this study was to compare the effect of multifocal and monofocal contact lenses in the accommodative response and contrast sensitivity in young emmetropic adults. Method: The requirements to take part in the current study were no ocular pathology, healthy corneas, no refractive surgery and an acuity of at least 1.0 on the Snellen chart with a good binocular vision. Thirteen individuals participated in the study, 9 females and 4 males, with an mean age of 22.6 years (SD=3.4). In separated fittings, participants were fitted with: 1) multifocal lenses, centre-distance design and 0.00D (add +2.00D) (Coopervision Biofinity) and with 2) single vision  +2.00D (Coopervision Biofinity. Refraction was assessed 3 times in both eyes: with each fitting and also without any lens. A Metropsis system (CRS) was used to measure the contrast sensitivity and visual acuity. Results: In this study we found statistically significant differences in accommodative response between the conditions non-lens and multifocal contact lens (p&lt;0.05) and non-lens and monofocal lens (p&lt;0.001). The difference between the multifocal lens and monofocal lens was not statistically significant. The results from the contrast measurement showed an increased contrast thresholds with the multifocal contact lens when compared with non-lens. Conclusion: This study shows that the multifocal lens reduce only partially the accommodative response in young individuals. In addition multifocal contact lenses, fitted in emmetropic participants, reduced contrast sensitivity.