Care of the Dialysis Patient in the Long Term Care Setting

No abstract available for this article.     

Occupational Deprivation or Occupational Adaptation of Mexican Americans on Renal Dialysis

The aim of this study was to explore the occupational changes and perceptions experienced by Mexican Americans with end‐stage renal disease (ESRD) and their families living with dialysis. In‐depth interviews were conducted with 17 Mexican Americans with ESRD and 17 family members. The participants with ESRD described altered or lost activity patterns, capacities and freedoms. With a heightened awareness of death, the family members made altered occupational choices, which were consistent with their cultural values. Changes in the physical body, adhering to the dialysis regimen and environmental restrictions created barriers to occupational participation. These findings suggest that living with dialysis facilitate occupational deprivation among individuals with ESRD and adaption among the family members within cultural alignments. This phenomenon could affect the design of occupational therapy intervention and call for research on the role of occupation therapy services with this population. Copyright © 2015 John Wiley & Sons, Ltd.     

Drift as Adaptation: Foster Care and Homeless Careers

Tension between policies mandating permanency planning and those requiring treatment in the least restrictive setting leaves many children labeled seriously emotionally disturbed, drifting through placements. An ethnographic study of boys in a residential treatment center in Central Texas suggests that the overrepresentation of former out-of-home care youth among the long-term homeless population may be viewed as the continuation into adulthood of a pattern of drift that began earlier while in out-of-home care. A close-up view of 12 residents of a residential treatment center suggests that forces of drift are more powerful than caseworkers and youth. Implications for policy and practice aimed at breaking the pattern are discussed.     

Doing Better to Do Good: The Impact of Strategic Adaptation on Nursing Home Performance

Objective. To test the hypothesis that a greater commitment to strategic adaptation, as exhibited by more extensive implementation of a subacute/rehabilitation care strategy in nursing homes, will be associated with superior performance.
Data Sources. Online Survey, Certification, and Reporting (OSCAR) data from 1997 to 2004, and the area resource file (ARF).
Study Design. The extent of strategic adaptation was measured by an aggregate weighted implementation score. Nursing home performance was measured by occupancy rate and two measures of payer mix. We conducted multivariate regression analyses using a cross-sectional time series generalized estimating equation (GEE) model to examine the effect of nursing home strategic implementation on each of the three performance measures, controlling for market and organizational characteristics that could influence nursing home performance.
Data Collection/Abstraction Methods. OSCAR data was merged with relevant ARF data.
Principal Findings. The results of our analysis provide strong support for the hypothesis.
Conclusions. From a theoretical perspective, our findings confirm that organizations that adjust strategies and structures to better fit environmental demands achieve superior performance. From a managerial perspective, these results support the importance of proactive strategic leadership in the nursing home industry.     

自动化腹膜透析患者的护理

腹膜透析治疗肾衰竭在世界范围内已经历了40余年,作为肾衰竭一体化治疗方法之一的自动化腹膜透析（autom ated peritoneal dialysis,APD）也日益受到重视。在世界范围内,腹膜透析患者数不超过所有肾脏替代疗法的10%,总人数趋于稳定。但APD却持续增长,     

The Family Medicine Team as Providers of Home Dialysis Care in Kibbutzim in Israel

Sixteen patients with terminal renal failure who live in kibbutzimin Israel were interviewed. Over 50% of these patients receivedialysis treatment in their home kibbutz under the supervisionof the family medicine team as compared with only 12.4% of alldialysis patients in the country who are treated at home. Theimplications of dialysis in the kibbutz are discussed, particularlythe relevance of the overall responsibility of the kibbutz forall its members' needs in the provision of dialysis facilities.The relevance of community-based dialysis in general is discussed.     

深圳市厂区社区健康服务中心的设置及其服务功能的初步探讨

以宝安区观澜医院富士康星河社区健康中心的实践为例．研究探索目前深圳市厂区社区健康服务中心的设置及其服务功能．提出了厂区社区健康服务功能的诸多特殊性,并为功能的完善做了大量有益的工作;     

The Affordable Care Act and Long-Term Care: Marginal Advancement on the Status Quo

The purpose of this analysis is to evaluate the sufficiency of the Long-Term Services and Supports (LTSS) provisions contained within the Patient Protection and Affordable Care Act (ACA). Beyond the ambitious but fatally flawed Community Living Assistance Services and Supports Act, the ACA’s LTSS changes represent only marginal advances over the status quo. Moreover, the impact of the ACA’s strategies varies with the extent to which the federal and state governments opt to invest in them, through funding, implementing, and enforcing the modest changes enacted. The ACA’s LTSS provisions, while welcome, are unlikely to result in the major changes necessary to meet both current and future demand for care.     

Stress,Adaptation and Coping in a Maternal-Fetal Intensive Care Unit

The emotional needs of 18 patients in a maternal-fetal intensive care unit wcre assessed using a semistructured interview. Patients were asked to rank ordcr thc stresses they experienced while on the unit as well as the supports which they felt enabled them to cope with the hospitalization. Responses were analyzed taking into account the duration of the patients' hospitalizations and the differences in two settings of the intensive care unit. Being away from home and family, physical discomforts, medication side effects, and feelings of helplessness and loss of control were the cornmon stresses noted. Physicians, nurses and family and friends werc the most frequently mentioncd supports.     

Adaptation of the Person-Centered Maternity Care Scale in the United States: Prioritizing the Experiences of Black Women and Birthing People

IntroductionMistreatment by health care providers disproportionately affects Black, Indigenous, and other people of color in the United States. The goal of this study is to adapt the global Person-Centered Maternity Care (PCMC) scale for use in the United States, with particular attention to the experiences of Black women and birthing people.MethodsWe used a community-engaged approach including expert reviews and cognitive interviews to assess content validity, relevance, comprehension, and comprehensiveness of the PCMC items. Surveys of 297 postpartum people, 82% of whom identified as Black, were used for psychometric analysis in which we assessed construct and criterion validity and reliability. The University of California, San Francisco California Preterm Birth Initiative's Community Advisory Board, which consists of community members, community-based health workers, and social service providers in Northern California, provided input during all stages of the project.ResultsThrough an iterative process of factor analysis, discussions with the Community Advisory Board, and a prioritization survey, we eliminated items that performed poorly in psychometric analysis, yielding a 35-item PCMC-U.S. scale with subscales for dignity and respect, communication and autonomy, and responsive and supportive care. The Cronbach's alpha for the full scale is 0.95 and for the subscales is 0.87. Standardized summative scores range from 0 to 100, with higher scores indicating more PCMC. Correlations with related measures indicated high criterion validity.ConclusionsThe 35-item PCMC-U.S. scale and its subscales have high validity and reliability in a sample of predominantly Black women. This scale provides a tool to support efforts to reduce the inequities in birth outcomes experienced by Black, Indigenous, and other people of color.     

Routinization of stress control programmes in organizations: a study of Swedish teachers

The aim of the study was to design and evaluate a stress controlprogramme which can be carried out by employees in work organizationswithout direct assistance from specialists. The target groupwas Swedish high school teachers. Using a two-step model, socalled health teams at six high schools were trained by a specialist.A health team is usually comprised of three to five voluntarilyrecruited persons, generally a school nurse and a few teachers.After this training, the health teams arranged voluntary circleswith their colleagues at their respective schools. A treatmentgroup of teachers (n = 56) followed the programme. Programmeparticipants learned relaxation, discussed various aspects ofstress, and were equipped with target group adapted trainingmaterials. The circles met five to eight times at 2–3week intervals, 1–3 h per session; all sessions were heldduring the subjects' spare time. Compared with a control groupof teachers (n = 33), the programme participants reported significantlydifferent mean responses in the following respects at a post-trainingassessment: (i) fewer perceived stressors in the work situation;(ii) more use of emotion-focused coping strategies such as distancing,positive reappraisal, seeking social-emotional support, andself-control, (iii) improved health behaviour (drinking, exercise,nutrition, relaxation and smoking); (iv) fewer physical andemotional stress reactions; (v) a more cheerful overall moodstate and a higher sense of well-being and work satisfaction;(vi) less work-related ill health; (vii) a lower intensity ofreaction in response to daily hassles; and (viii) an increasein actions taken against stressors-individually and collectively-atwork and in the private situation. It was suggested that routinizationof stress control programmes in work organizations requiresthe following: the presence of goal-oriented and entrepreneurialintraorganizational change agents to lead the programmes, thepresence of a specialist to train and supervise the local changeagents, the availability of comprehensive and target group adapted(raining aids, and formal implementation of the programme inthe organizational structure.     

The Impact of Electronic Health Record Implementation and Use on Performance of the Surgical Care Improvement Project Measures

Objective

To examine the impact of electronic health record (EHR) deployment on Surgical Care Improvement Project (SCIP) measures in a tertiary-care teaching hospital.

Data Sources

SCIP Core Measure dataset from the CMS Hospital Inpatient Quality Reporting Program (March 2010 to February 2012).

Study Design

One-group pre- and post-EHR logistic regression and difference-in-differences analyses.

Principal Findings

Statistically significant short-term declines in scores were observed for the composite, postoperative removal of urinary catheter and post–cardiac surgery glucose control measures. A statistically insignificant improvement in scores for these measures was noted 3 months after EHR deployment.

Conclusion

The transition to an EHR appears to be associated with a short-term decline in quality. Implementation strategies should be developed to preempt or minimize this initial decline.