Long-term care market competition and nursing home dementia special care units

BACKGROUND: The proliferation of noninstitutional long-term care (LTC) alternatives, particularly assisted living (AL), raises questions about how the nursing home (NH) industry is affected. Dementia special care units (SCUs), which provided NHs a competitive edge in the past, are of interest because they have traditionally served residents who now have other options. OBJECTIVES: To quantify the effect of LTC competition on the odds of SCU presence in a NH; among those NHs with an SCU, to quantify the effect of competition on overall acuity. RESEARCH DESIGN: Cross-sectional with LTC market defined as the NH's county. SUBJECTS: Nine hundred forty-two NHs, 88 with an SCU, in 122 Texas counties during 2004. MEASURES: LTC competition was measured by a NH's share of beds, the presence of another NH SCU, the presence of AL, the presence of dementia care in AL, and the presence of home health in the market. The outcomes were the presence of an SCU in a NH and the average level of resident acuity on those SCUs. RESULTS: Competition from another NH-based SCU was associated with the presence of an SCU in a NH [adjusted odds ratio, 3.3; 95% confidence interval (CI), 1.6-6.6] but there were no associations with other measures. Within NH-based SCUs, mean acuity was higher when there was AL in the market (beta, 1.6; 95% CI, 0.4-2.7), but there was no additional effect of AL dementia beds (beta, 1.6; 95% CI, 0.2-3.0). CONCLUSIONS: A NH's investment in specialized dementia care is influenced by the behavior of nearby NHs but not yet by other forms of LTC; however, the profile of residents served by SCUs is affected by AL competition.     

Work stress and physical assault of nursing aides in rural nursing homes with and without dementia special care units

PURPOSE: This study compared nursing aides (NAs) employed in rural nursing homes with and without dementia special care units (SCUs) on (1) exposure to and distress from disruptive behaviours exhibited by residents, (2) job strain and (3) physical assault. DESIGN AND METHODS: The data were drawn from a larger study conducted in Saskatchewan, Canada, in which all rural nursing homes of < or = 100 beds that had an SCU were matched to same-sized rural facilities with no SCU. Nursing aides (n = 355) completed a mailed survey questionnaire. RESULTS: Nursing aides employed in nursing homes with an SCU reported significantly less frequent exposure to disruptive behaviours (including aggressive and aversive behaviours) than NAs in non-SCU facilities, less distress when these behaviours were directed toward them, less exposure to aggressive behaviour during caregiving, lower job demands and lower job strain. There was a trend toward increased risk of being assaulted in the last year associated with being in a non-SCU facility. Having a permanent position, increased job strain, and feeling inadequately prepared for dementia care were significantly associated with higher risk of being assaulted. In the SCU facilities, NAs who worked more time on the SCU reported more assaults but less distress from disruptive behaviour, lower psychological job demands, lower job strain and greater work autonomy. IMPLICATIONS: Providing more dementia care training and reducing job demands and job strain may help to reduce work-related stress and physical assault of nursing aides employed in nursing homes.     

The stresses of hospitalization among AIDS patients on integrated and special care units

This study examined the stresses of hospitalization in AIDS patients and assessed the extent to which two different inpatient delivery systems differed with respect to perceived stresses in these patients. Patients from four AIDS dedicated special care units (SCU's) and five AIDS integrated units (IU's) in eight acute care hospitals were surveyed using a modified version of the Volicer Hospital Stress Rating Scale. Stresses related to loss of independence, separation from loved ones and problems with medications were experienced equally by both groups of patients. However, SCU patients had lower total hospital stress scores than IU patients in terms of the number of stresses experienced (p = 0.008) and how bothersome these stresses were perceived to be (p = 0.02). Additionally, patients on IU's more frequently experienced and were bothered by factors associated with ambiguity about their care and condition and feelings of abandonment and impersonal or discriminatory treatment.     

Organization and outcomes of inpatient AIDS care.

OBJECTIVE: To compare differences in AIDS patients' 30-day mortality and satisfaction with care in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals known to provide good nursing care. METHODS: Data were obtained on 1,205 consecutively admitted patients in 40 units in 20 hospitals and on 820 of their nurses. RESULTS: Mortality was lower and satisfaction was higher for AIDS patients in dedicated AIDS units and in nursing magnet hospitals. Primary nursing, end-of-life care counseling, and discharge planning were also more common. Higher nurse to patient ratios and AIDS physician specialty services were strongly associated with lower mortality. Patient satisfaction was strongly associated with organizational control of care by bedside nurses. Homosexuals were more likely to be admitted to dedicated AIDS units, which largely explains the under-representation of minorities and women. CONCLUSIONS: Dedicated AIDS units and magnet hospitals offer important benefits to AIDS patients, including lower odds on dying within 30 days of admission, higher patient satisfaction, and care meeting professional standards. Better nurse staffing, AIDS physician specialty services, and more organizational control by bedside nurses improve patient outcomes.     

Creating and sustaining dementia special care units in rural nursing homes: the critical role of nursing leadership

Dementia Special Care Units (SCUs) are more likely to be found in larger nursing homes, which tend to be located in urban centres, rather than in smaller rural nursing homes. Reasons for the small number of rural SCUs are not known, although it has been speculated that space and staffing constraints, lack of a critical mass of residents needing specialized care and limited resources may be important factors. The purpose of this study was to describe the development of SCUs in eight small rural nursing homes (31-100 beds) in Saskatchewan, Canada, from the perspective of nursing directors involved in planning and implementing the units. Although the initial focus was on how and why the SCUs were established, the key finding was the critical role of nursing leadership and supervision in creating and sustaining the unit. Even the most successful SCUs required constant vigilance to maintain an effective program, highlighting their inherent fragility and the need for a designated, committed leader. Four key leadership activities were identified: perpetual reinforcement and enforcement of SCU goals and ideals; support, guidance and mentoring of staff; empowerment of staff; and liaison/public relations.     

Specialized care unit: family and staff perceptions of significant elements

Specialized care units (SCUs) for nursing home residents with dementia are increasingly prevalent. Although reported to promote positive resident outcomes, the specific characteristics of SCUs most likely to yield these outcomes have not yet been identified. This article presents the findings of a qualitative study that investigated the perceptions of family members and staff about SCU characteristics that contribute to positive outcomes for residents with dementia. All family and staff members interviewed agreed that the SCU fostered feelings of personal space, personhood, and an unforced routine. These findings are discussed and provide specific direction for care of nursing home residents with dementia.     

Cognitive impairment and resource use of nursing home residents: a structural equation model

BACKGROUND: Only a few studies have examined relationships between cognitive impairment and resource use of nursing home residents, and these studies have yielded mixed results. METHODS: To develop and test structural equation models for relationships between cognitive impairment, covariates, and resource use of nursing home residents on Alzheimer special care units (SCUs) and conventional units. RESEARCH DESIGN: Analysis of data obtained in 1999 from an Indiana nursing facility time study that measured resident-specific direct care minutes per day, and assessment data from the Minimum Data Set (version 2.0). PARTICIPANTS: Participants were 1290 residents without specialized nursing requirements or licensed therapies: 447 drawn from 22 SCUs in 16 facilities, 485 from 16 conventional units in the same facilities, and 358 from units in 13 facilities without SCUs. MEASURES: Direct care resource use (weighed minutes/d), Cognitive Performance Scale, activities of daily living (ADLs), clinically complex conditions, daily behavioral problems, physical restraints, psychotropic medication, and Alzheimer or dementia diagnosis. RESULTS: Cognitive impairment had a substantial indirect effect on resource use in facilities with and without SCUs. This effect was mediated largely through ADL dependency and SCU placement. Severity of cognitive impairment was strongly related to ADL dependency, and ADL, in turn, was a strongly related to resource use. Also, residents on SCUs used significantly more direct care resources than residents on conventional units. CONCLUSIONS: This study demonstrates relationships between cognitive impairment, covariates, and resource use for nursing home residents on SCUs and conventional units. It also raises issues about reimbursement for care of dementia residents.     

Resident care needs and work stressors in special care units versus non-specialized long-term care units

Differences in how elderly residents' care needs affect staff's experiences of work stressors between special care units (SCUs) for dementia and psychiatric residents and non-SCUs were investigated. The data were drawn from 390 staff members in 38 long-term care SCUs, and 587 staff in 53 non-SCUs in Finland. Residents' care needs were based on the Resident Assessment Instrument (RAI) system measured by the Minimum Data Set 2.0. Work stressors (time-pressure and role-conflicts) were assessed with a staff survey questionnaire. Multiple-group regression analysis showed that residents' dependency in activities of daily living (ADL) was related to increased work stressors only in SCUs. A high proportion of behavioral problems was related to fewer work stressors for SCU staff, but more for non-SCU staff. Work stressors may be reduced by specializing, so that residents with similar care needs are placed together and care is focused.     

眼科住院病人对护理工作满意度及其影响因素调查

目的 提高眼科住院病人对临床护理工作的满意度。方法 根据文献自行设计病人满意度调查表。采取方便抽样的方法选择眼科符合人选条件的住院病人80例,调查眼科住院病人对护理工作的满意度及其影响因素。结果 病人对护士的专业技能和病区管理满意度最高,病人对健康教育指导、心理护理和护士的主动服务意识的满意度较低,病人对护理工作的满意度与其职业与医疗费用的支付方式无关,与收人情况及文化程度呈负相关关系（P〈0．01或P〈0．05）。结论 护理过程中,应重视护理服务的各个方面,满足不同人群的健康需求,达到病人最高满意度。     

护理满意度特征性预测指标的研究

目的探讨护理满意度特征性预测指标。方法采用问卷调查的形式,对1500名患者护理满意度情况进行统计分析。结果护理满意度与患者的性别、学历、年龄相关（P〈0．05）,与居住地（农村或城市）及费用类别（自费或医保）不相关。结论性别、年龄、学历是护理满意度具有特征性的预测指标,而居住地及医疗费用类型对预测护理满意度无指导意义。     

Patient satisfaction with nursing care in Alexandria, Egypt

The study assessed the satisfaction of medical and surgical patients in a university hospital in Egypt using the La Monica/Oberst Patient Satisfaction Scale. In spite of the nursing shortage in that hospital, the results indicated that patient satisfaction was high. The implications for nursing care are discussed in terms of the validity of the scale and the objectivity of clients when responding to the questionnaire.     

The influence of telephonic nursing care coordination on patient satisfaction in a predominantly low-income, high-risk pregnancy population

The effect of telephonic nursing case management on patient satisfaction in a predominantly non-Caucasian low-income, high-risk pregnancy population was studied. Patient satisfaction of care was significantly higher for treatment group participants than for controls on 9 of 10 items measuring satisfaction. The satisfaction score of the treatment patients, constructed by summing scores for each item, averaged 8 points higher than the control group's score. Demographics made little difference. Telephonic case management was the strongest predictor of satisfaction in a multiple regression analysis. Satisfaction was unrelated to mode of delivery, infant birth weight, or gestational age. The satisfaction levels of treatment patients were high, whether or not they had outpatient charges. Participants rated the program highly for the nurses' ability to answer questions, overall program experience, the opportunity to ask the nurses questions, health teachings and instructions received, and confidence in the nurse coordinating their care or their child's care.     

Family visitation on special care units.

1 With placement of a family member with Alzheimer's disease on a SCU, the family does not relinquish the caregiving role, rather they take on different roles in relation to the residents. 2 Family visitation of the residents on the SCU is an integral part of family involvement in care of individuals with Alzheimer's disease, as well as SCU functioning. 3 Within the context of changing relationships with the residents, family members visited the residents as a sense of duty to "be faithful," to monitor care by "being their eyes and ears," and to foster a sense of family through ongoing relationships and family rituals. 4 Nurses have critical roles in promoting physical, emotional, and interactive environments which foster family visitation on SCUs.     

不同特征住院病人对护理服务满意度差异比较研究

目的:探讨不同特征和健康状况的住院病人对护理服务满意度水平的差异。研究方法:采用多阶段抽样的方法选取北京市4家"三甲"综合医院的病人1520名,采用纽卡斯尔病人对护理服务满意度量表(NSNS)测量他们对护理服务满意度;采用自行设计的人口学因素、健康相关因素问卷调查病人特征。结果:不同年龄、不同受教育程度、不同经济状况、不同自我感觉健康状况的病人对护理服务满意度差异有统计学意义(P0.01),住院期间接受手术的病人满意度低于未手术者(P0.01);住院日数越长,满意度越高(P0.05)。结论:不同人口学特征和健康状况的病人护理需求及对护理服务评价不同,建议在临床工作中根据病人特征实施个体化护理,以满足病人需求,提高满意度。     

Patient satisfaction with nursing care in a colorectal surgical population

This paper describes one arm of a much larger, multi-site study whose hypothesis was that evidence-based nursing practice is more effective than routine nursing care in improving patient outcomes and health gain. This arm of the study investigated patient satisfaction as an outcome measure for those patients undergoing colorectal surgery. The study's relevance for nurses is in the potential feedback for reviewing nursing practice and health care delivery. Patient satisfaction with nursing care was measured through a validated questionnaire, the SERVQUAL, followed by interviews with a percentage of the study population. The results of this arm of the study confirm the importance of measuring patient satisfaction through a triangulated method which investigates thoroughly, providing feedback for continuous quality improvement. The in-depth interviews provided greater insight into the results of the questionnaire, enabling clear feedback to nursing staff at the different sites of the study. Results of the questionnaire revealed age, sex and education levels of patients as major influences on individual perceptions of nursing care. Patients whose surgery resulted in stomas were also less satisfied with health-care delivery.