No description available.

No description available.

Nursing home residents often experience loneliness and social isolation. Research indicates that visitation via the telephone can decrease feelings of social isolation and loneliness. The purpose of this study was to introduce visual images to the telephone conversations of this population. It was hypothesized that the residents receiving this intervention would evidence decreased levels of loneliness and a greater sense of social support. This hypothesis was not supported by the data; however, emotional and social loneliness scores did show positive trends that may have been due to the intervention.

Research shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nurses' aides at a central Florida nursing home. A descriptive qualitative design was done utilizing a focus group discussion, individual interviews, and a self-administered questionnaire. The findings indicated that a lack of facility support, inadequate staffing, inadequate end of life care education, family and patient denial of prognosis, as well as decreased primary care physician involvement affect the delivery of comfort care for patients at the end of life in the nursing home. This study supports the need for end of life education to HCPs and the need for adjustments in staffing to meet the complex needs of patients in the nursing home who are at the end of life. A new finding of this study reflects the use of an angel cart to aid in the provision of comfort care for patients at the end of life. Recommendations for future research were made based on study results

No description available.

No description available.

This dissertation aims to examine racial and ethnic inequities in nursing home (NH) palliative care services and potentially avoidable hospitalizations at the end of life. Health disparities are pervasive in NHs, but disparities in NH end-of-life care (i.e. palliative care services, hospital transfers) have not been comprehensively examined. Chapter One provides an overview of this dissertation, which explores inequities in nursing home end-of-life care. Chapter Two is a systematic review that synthesized the current state of the science in racial and ethnic disparities in NH end-of-life care. Chapter Three was designed to describe palliative care services in U.S. NHs and associations with differences in the concentrations of Black and Hispanic residents, respectively, and the impact by region. Chapter Four is an analysis of racial and ethnic differences in NH potentially avoidable hospitalization incidence rates. Finally, Chapter Five is a synthesis of this body of work. It contains a summary of findings of this dissertation, a discussion of the results, practice and policy implications, and directions for future research.

This research investigated selected aspects of the effects on adult children of placing a parent in a nursing home; specifically, the ease of placement, change in parent-child relationships, and effects on the personal life of the adult child as perceived by the child. Scales constructed for use in measuring these dependent and several independent variables in an original study were revised on the basis of factor analysis, internal consistency analysis and subjective judgement. The revision of the scales was based on the original study's data. The revised scales were included in a shorter, more focused questionnaire utilized in the present study. Results of the original study and evidence from existing literature formed a basis for hypotheses tested in the present study. Revised questionnaires were mailed to 175 adult children listed as guarantors of patients in seven nursing homes. A 66.9% usable response rate was obtained. Stepwise regression was utilized to test the hypotheses. The results indicated that the more concerned the child was about the parent's placement and the less the child favored the placement, the more difficult it was for the child to carry out the decision to place his or her parent. The placement of a parent did not appear to be accompanied by deterioration of the parent-child relationship. Rather, it tends to either remain the same or improve. Those children who are most likely to have perceived positive change in the relationship were those who had more concerns about the parent being in a nursing home, had younger parents, saw their parent as making a good adjustment to being in a nursing home, and did not view their own aging positively. None of the independent variables were significant predictors of perceived effects on the personal life of the adult child. Support for potential positive changes in parent-child relationships as a result of a parent being placed in a nursing home was discussed. Recommendations for further research utilizing the family theory framework of Bowen (1978) was presented. / Ph. D.

This dissertation investigates the effectiveness of and disparities in timely goals of care (TGOC) discussions in nursing homes (NHs), as well as hospitalizations due to infections. Chapter One provided an overview of the dissertation, including its aims and conceptual frameworks. Chapter Two is a systematic review of the current evidence concerning the timing of goals of care discussions in NHs and their impact on end-of-life outcomes. Chapter Three examines the differences in TGOC discussions in NHs for Black. Chapter Four analyzes the association between TGOC discussions and hospitalizations due to infections. Finally, Chapter Five synthesizes all findings. Key findings demonstrate that while effective TGOC discussions are associated with reduced hospitalizations due to infections in NH residents, significant racial and ethnic disparities exist, particularly among NHs with higher proportions of Black residents and those located in socioeconomically disadvantaged areas. These findings highlight the need for improved TGOC practices and targeted interventions to address systemic barriers and ensure equitable end-of-life care.

This study confirms that depression is highly prevalent in nursing homes. In addition, this study reveals incongruency between depression rates and recognition rates of depression in the nursing home environment.