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OBJECTIVE: The purpose of this study was to examine selected case mix indicators for their usefulness in separating the variation in outcomes due to differences in resident characteristics versus variation due to differences in nursing care. We explored two methods for combining resident assessment data into a case mix index (CMI). DESIGN: Secondary analysis. SETTING: Nursing homes. POPULATION: The sample for this study was part of a larger, ongoing study about the outcomes of nursing management practice in nursing homes. The criterion for inclusion in the study sample was nursing homes that had one or more RN FTE(s). Of the 380 nursing homes contacted, 195 participated, with 164 completing data. INTERVENTIONS: Two types of case mix indicators were examined in this study. A facility-level, composite index of case mix was compared to a prevalence-based, multi-indicator of case mix, which measured the prevalence of selected resident characteristics. Resident outcomes were defined as the results of nursing care experienced by the residents within each home and were derived from the CARE Form. Ten indicators were selected because they reflected quality of the nursing care. Hierarchical multiple regression analysis was used to compare the ability of the facility-level, composite CMI to the prevalence-based, multi-indicator CMI, comprised of 22 separate risk indicators, in explaining the variance contained within the four resident outcomes. MAIN OUTCOME MEASURE(S): The correlations demonstrated that the facility level, composite CMI was not related to behavioral problems or fractures but was significantly correlated to complications of immobility and restraint use. In a similar fashion, the relationships between the 22 prevalence-based risk factors and resident outcomes were strongest between the complications of immobility and restraint use. RESULTS/CONCLUSIONS: The prevalence-based, multi-indicator CMI, composed of 22 separate resident risk factors, consistently explained more variance in outcomes than the facility level, composite CMI. Our findings suggest that the composite CMI does not explain substantial variance in resident outcomes, at least as defined in this study. The inability to discern whether a risk factor was preexisting to an adverse outcome or the results of an adverse outcome increases the potential for over estimating the influence of risk factors on outcomes. Recommendations for further include replicating this study in samples from states that use a different resident assessment form in case mix reimbursement. [ABSTRACT FROM AUTHOR]

Background: The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination., Objective: The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention., Methods: This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study., Results: The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale)., Conclusions: An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Chronic health failure is a leading cause of hospital readmissions and is reaching epidemic proportions in the United States. Explanatory models of illness can provide insight about how people with heart failure perceive their etiology of heart failure. Six themes were found in this descriptive, qualitative study to explore the perceived origin of heart failure in 50 participants. Forty percent of the people were unaware of why they had the diagnosis. Misconceptions and misinformation were common, including confusion about whether the symptoms themselves caused the disease.

Many students who enter accelerated nursing programs have not been exposed to the analysis, prediction, and decision-making skills needed by today's RN. To foster practice with complex concepts in the classroom and to give teachers immediate feedback about student in-class mastery of core material, use of an audience participation system within the classroom may be useful. This article reports the implementation of a classroom performance system and the results ofa program evaluation project designed to capture the system's impact on student and faculty satisfaction and student learning outcomes. Project results and implications for further work are presented.