Nursing home recruitment: Trials,tribulations, and successes

Many challenges are inherent when conducting research in the older adult population as well as in the nursing home environment. The safety and quality of care provided in nursing homes need further examination through research. The purpose of this paper is to discuss research issues and recruitment barriers experienced by a research team collecting data for a study assessing the education and learning needs of nursing home nurses in central Illinois and related resident outcomes. Research barriers identified in this study include organizational and administrative barriers in addition to staff barriers. The strategy that was most helpful in gaining access to nursing homes in central Illinois was face to face contact. Future nursing home researchers are encouraged to familiarize themselves with the nursing home environment, communicate with nursing home trade associations, and develop personal contacts with area nursing home administrators.     

Relationships of rurality, home health care use, and outcomes

Rural elders have a disproportionate prevalence of illness and limited access to health services. The purpose of this study is to determine whether degree of rurality and home health care use influences home health care patient outcomes. An adaptation of the Outcomes Model for Health Care Research provided the framework for the study. A stratified random sample was selected from a database of risk-adjusted publicly reported patient outcomes from Medicare-certified home health care agencies and merged with agency factors from Medicare cost reports and U.S. Census data. Path analysis was performed to evaluate the relationships in the model. Hospitalization is the only outcome variable associated with community and agency characteristics or home health care use. Rurality does not have a direct effect on hospitalization; however, increased visits per patient and low-income community status are associated with increased hospitalization. Rurality may not have a direct effect on outcomes but instead acts through health care services.     

Relationships among leadership practices, work environments, staff communication and outcomes in long-term care

tourangeau a., cranley l., laschinger h. & pachis j. (2010) Journal of Nursing Management 18, 1060–1072
Relationships among leadership practices, work environments, staff communication and outcomes in long-term care Aim To examine the role that work relationships have on two long-term care outcomes: job satisfaction and turnover intention. Background It is easy to overlook the impact that human relations have in shaping work environments that are conducive to organizational effectiveness. Employee job satisfaction and retention are important organizational outcomes. Methods Six hundred and seventy-five nursing and other staff from 26 long-term care facilities were surveyed about their work environments, work group relationships, observed leadership practices, organizational support, job satisfaction and turnover intention. Results Higher job satisfaction was associated with lower emotional exhaustion burnout, higher global empowerment, higher organizational support, higher psychological empowerment, stronger work group cohesion and higher personal accomplishment. Higher turnover intention was associated with lower job satisfaction, higher emotional exhaustion burnout, more outside job opportunities, weaker work group cohesion, lower personal accomplishment and higher depersonalization. Conclusions No relationship was found between leadership practices and job satisfaction or turnover intention. Stronger work group relationships, stronger sense of personal accomplishment and lower emotional exhaustion have direct effects on increasing job satisfaction and lowering turnover intention. Implications To retain long-term care staff, attention should be paid to fostering positive work group cohesion, supporting and acknowledging staff accomplishments and minimizing staff burnout.     

Implementing assertive community care for patients with schizophrenia. A case study of co-operation and collaboration between mental health care and social services

The aim of this study was to describe the personal experiences of collaboration and co-operation between staff from the community mental health and social services programmes in their daily work with schizophrenic patients. An additional aim was to generate the first step in a theory of how staff in the field of health care and social services manages to integrate their efforts on an individual and organizational level. The study group consisted of five members of a multidisciplinary team who had been working for 2 years with assertive outreach intensive clinical case management. Verbatim-transcribed thematic interviews were analysed according to the comparative method for grounded theory. The analysis was focused on quality of interpersonal interaction between practitioners, representing different professions in community-based mental health care, as well as the professional relationship to the patients/clients and their relatives. In the light of an individual and organizational perspective, different typologies of interpersonal interactions appeared. Three main variables were identified: collaborative relationship, co-operative partnership and professional-amateurism. Our findings on these qualitative differences in interpersonal relations should be taken into account in the continuing reorganization of the community health care services. This knowledge can also help in overcoming barriers between patients, professionals and organizations in the mental health services.     

Nursing morale: predictive variables among a sample of registered nurses in Australia

Aim  This study investigates the determinants of morale among Registered Nurses in Queensland, Australia.
Background  In light of the public discussions on the issues facing the future of nursing, it is critical to understand the factors that influence morale.
Methods  A 160-question instrument sought information from Registered Nurses on their perceptions of 'self', work and morale. A response rate of 41% was achieved ( n  = 343) from a convenience sample of three acute hospitals.
Results  Following binary logistic regression modelling for organizational morale, significant relationships were found with patient care provision and team interaction. Binary logistic regression modelling for personal morale revealed positive relationships with team interaction, consultation, professional recognition and lower levels of patient abuse.
Conclusion  The results point to a number of organizational and professional issues that can be considered by health care administrators and policy makers to develop workplaces that have a positive impact on the morale of nurses.     

Nurses under threat: a comparison of content of 28 aggression management programs

Staff who work in the health service are now recognized as a high-risk group for assault in the workplace. Recently, professional and industrial organizations have begun to suggest appropriate curricula for training staff in aggression management. However, there is currently a plethora of aggression management training programs (AMP) available, varying both in content and in duration. In this paper, 28 programs were evaluated against 13 major content areas derived from the recommendations made from key professional and industrial organizations, and what may be today considered appropriate/ideal content areas for AMP. Information on programs available in English was sought via standard databases, the Internet, program providers, and through networking with colleagues and professional organizations. The majority of the programs reviewed covered personal safety issues for staff and patients, together with legal issues. The use of restraint, pharmacological management of aggression and seclusion were features of programs specifically addressing the needs of health care staff in mental health settings. Most programs appeared not to address the psychological and organizational costs associated with aggression in the workplace. This is surprising since the literature suggests that the effects of violence are wide and varied, including increased absenteeism and sick leave, property damage, decreased productivity, security costs, litigation, workers' compensation, reduced job satisfaction together with recruitment and retention issues. Also, few programs were based on a systematic evaluation of their outcomes. Suggestions for program development and their teaching are discussed.     

Safety Concerns Affecting Delivery of Home Health Care

Abstract Factors influencing the remarkable growth of home health care include increased elderly population, decreased average length of hospital stay, and technological advancements that reduce the need for hospitalization. Societal changes have prompted increasing concern about personal risk to home care providers. The purpose of this pilot study was to: 1) ascertain factors related to perception of risk by home health care administrators and staff and to identify strategies used by home health care administrators to reduce risk to staff; and 2) determine whether quality of care is affected when home-visit situations present risk. A convenience sample of 36 home health care administrators and 62 staff was surveyed about risks and measures provided by the home health care agency to minimize risk. Factors associated with risk are geographic location, high incidence of crime, inappropriate patient or caregiver behavior, infectious diseases, and evening assignments. Strategies used to minimize risk include safety programs, preplanning of visits, personal protective equipment, escorts, and buddy systems. Perceived ability to refuse high-risk assignments, however, is questionable, as 66% of the staff stated that they leave a situation "as soon as possible." These findings will be used to strengthen inservice programs and to provide a basis for future studies.     

Empowerment in the public health practice

Public health personnel are the first-line workers of preventive care and medical services. In the face of rapid social and demographic changes, empowerment and on-job training have become important approaches to enhance the function of nurses. Health centers act like the "peripheral nerves" of the government healthcare system, as they must both reflect the needs of community residents and fully implement government mandated services. While widely distributed, health centers face manpower shortages and disorderly information collection and distribution systems. Empowerment and on-job training programs can enhance public heath staff knowledge in order to cope with heavy workloads and shift toward multi-dimensional development. This paper examines the experience of the New Taipei City Public Health Bureau in conducting health center empowerment programs from four perspectives, including personal cultivation and organizational cultivation. It was found that public health staff self-recognition of professional values can also be further strengthened through alliances within the community, and that establishing personal relationships with patients by "treating patients as relatives" was effective in realizing health center objectives. This paper also reminds agency supervisors that staff training is a critical management task. Health authorities should thus introduce in a timely manner organizational management, on-job training, service reengineering, and other related corporate philosophies; facilitate staff empowerment; consolidate core professional knowledge; and construct intellectual and social capital that meets health unit needs in order to enhance health center competitiveness and public health staff knowledge.     

Care for emergency department patients who have experienced domestic violence: a review of the evidence base

Aims. A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence. Background. The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence. Method. Systematic review. Results. At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under‐detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information. Conclusion. Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented. Relevance to clinical practice. The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self‐efficacy.     

Response to the COVID-19 Pandemic Among Posthospital Brain Injury Rehabilitation Providers

Rehabilitation after significant acquired brain injury (ABI) to address complex independent activities of daily living and return to family and community life is offered primarily after initial hospitalization in outpatient day treatment, group home, skilled nursing, and residential settings and in the home and community of the person served. The coronavirus 2019 pandemic threatened access to care and the health and safety of staff, persons served, and families in these settings. This article describes steps taken to contain this threat by 7 leading posthospital ABI rehabilitation organizations. Outpatient and day treatment facilities were temporarily suspended. In other settings, procedures for isolation, transportation, cleaning, exposure control, infection control, and use of personal protective equipment (PPE) were reinforced with staff. Visitation and community activities were restricted. Staff and others required to enter facilities were screened with symptom checklists and temperature checks. Individuals showing symptoms of infection were quarantined and tested, as possible. New admissions were carefully screened for infection and often initially quarantined. Telehealth played a major role in reducing direct interpersonal contact while continuing to provide services both to outpatients and within facilities. Salary, benefits, training, and managerial support were enhanced for staff. Despite early outbreaks, these procedures were generally effective, with preliminary initial infections rates of only 1.1% for persons served and 2.1% for staff. Reductions in admissions, services, and unanticipated expenses (eg, PPE, more frequent and thorough cleaning) had a major negative financial effect. Providers continue to be challenged to adapt rehabilitative approaches and to reopen services.     

Reframing resilience: Strengthening continuity of patient care to improve the mental health of immigrants and refugees

Refugee and immigrant populations experience many pre‐ and post‐migration risk factors and stressors that can negatively impact their mental health. This qualitative study aimed to explore the system‐level issues that affect the access to, as well as quality and outcomes of mental health care for immigrants and refugees, with a particular focus on challenges in the continuity of patient care. A multidisciplinary group of health providers, including nurses, identified six themes including (i) perceived access to care; (ii) coordination amongst health care providers; (iii) patient connections with community organizations; (iv) coordinated care planning; (v) organizational protocols, policies and procedures and (vi) systemic and health care training needs. Although patient resilience is seen as a pivotal way for vulnerable populations to cope with hardship, there is a clear need for creating a resilient health care system that is able to anticipate and adapt to adverse situations. The findings from this study have implications for nurses, who are uniquely positioned to advocate for public health policy that improves the continuity of health care by creating systemic resilience.     

Quality of care in nursing home organizations: establishing a health services research agenda

Health services research has led to exciting new findings about the critical importance of the amount and type of nursing staff in nursing homes for improving the processes and outcomes of care. This paper reviews recent theoretical and research issues and outlines areas where research is needed. The nursing home research agenda for the future needs to concentrate on: (1) the relationship between structural measures of nursing (eg, staffing levels, education, turnover rates) and the outcomes and processes of care; (2) adequate processes of care and ways to improve the reliability of clinical outcome measures; (3) better ways to risk-adjust for resident characteristics; (4) the impact of nursing home characteristics (eg, ownership) and public policies (eg, reimbursement) on structural factors, processes, and outcomes; and (5) cost-effectiveness studies of nursing care at the organizational or system level.     

Managing the care of patients discharged from home health: a quiet threat to patient safety?

Threats to patient safety can originate from the overuse or underuse of care, in addition to provider-initiated errors. The past decade has seen a dramatic decrease in the duration and volume of home health services provided per patient by Medicare-certified home health agencies (HHAs). Research findings have been mixed with respect to the impact of home health utilization on patient safety and outcomes. This study aimed to explore a related yet fundamental question: How confident are home health nurses that their patients can manage their care when discharged from home health services?     

Infection control in the community: a pragmatic approach

Infection can have a detrimental and potentially life-threatening impact on the health and wellbeing of patients. Infection control and prevention is as important in the community as it is in an acute hospital. This article summarizes the key infection and prevention issues in community nursing. It offers a pragmatic approach as community settings may be challenging to both infection control and community healthcare professionals. Patient safety is the top priority, and ensuring that safe practices are followed to reduce the risk of infection regardless of healthcare setting is paramount. There are many external factors that may impede infection control practices when delivering care in a patient's own home, and this article sets out the factors that must be considered in order to manage the risk.     

Issues and dynamics of sexually assaulted adolescents and their families

Interpersonal violence such as sexual assault creates a variety of traumatic responses. Adolescents encounter a significantly high rate of exposure to sexual assault. In the aftermath of sexual assault, issues and dynamics related to traumatic responses include ongoing fear and threats to personal safety, stability, and structure of the family and environment. Each issue is of concern for community and health care practitioners. Sexual assault has a detrimental effect on adolescent intrapsychic development and interpersonal relationships. Symptoms are disturbing and disruptive to daily routines, negatively affect adolescent normal growth and development, and can result in post-traumatic stress disorder. Issues and dynamics regarding sexual assault are explored, with suggestions on how to help adolescents avoid developing a negative world view and long-term negative health consequences.     

Emergency nurses' experience with violence: does it affect nursing care of battered women?

OBJECTIVE: To determine what effect nurses' experience of interpersonal violence had on proposed nursing care of battered women ED patients. METHODS: One hundred ninety-five emergency nurses completed surveys on their personal experiences with violence involving patients or intimate partners and on their proposed nursing care of battered women given 2 vignettes. RESULTS: Seventy percent of participants experienced violence perpetrated by a patient; 40% of the nurses reported violence perpetrated by their intimate partners; and 19% had used force on their partners. Prior assault of a nurse by a patient or partner did not affect the proposed nursing care that would be provided by that nurse to battered women ed patients. Female nurses who committed violence against their intimate partners proposed less nursing care than did those who did not commit violence against their intimate partners for the vignette describing a woman who had received minor injuries. CONCLUSIONS: This study documents the vulnerability of nurses to assault by patients and intimate partners. This vulnerability does not affect their proposed nursing care of battered women. An exception is nurses who themselves commit violence against intimate partners. Findings point to the need to increase safety for nurses in the workplace and provide employee assistance to help nurses confront violence at home.     

Physician disruptive behaviors: Five year progress report

Disruptive behaviors in health care can have a significant adverse effect on staff interactions that can negatively impact staff satisfaction, staff performance, and patient outcomes of care. As referenced in a previously published article, the Obstetrics and Gynecology specialty is one of the service areas where these behaviors occur more frequently. Despite growing evidence of the ill effects of these types ofbehaviors many organizations are still having a difficult time in addressing these issues in an effective manner. Gaining a better understanding of the nature, causes, and impact of these behaviors is crucial to finding the right remedies for solution. Nobody intentionally starts the day planning to be disruptive, it's just that things get in the way. A combination of deep seated factors related to age and gender preferences, culture and ethnicity, life experiences, and other events that help shape values, attitudes and personalities, and more external factors related to training, environmental pressures, stress and burnout, and other personal issues all contribute to the mix. Given the complexities of today's health care environment, each person needs to recognize the importance of being held accountable for appropriate actions and behaviors that affect work relationships and care coordination that impact patient care. Early recognition, early intervention, and taking a pro-active supportive approach to improve individual behaviors will result in better relationships, less disruption, more satisfaction, and better outcomes of care.