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A field study of residents' satisfaction or dissatisfaction with open-ward accomodations in a skilled-nursing facility revealed that 88 percent of the respondents preferred the open ward to any other type of room accomodation. Findings suggest that for residents with multiple functional disabilities, the open ward is a supportive environment. (Author/BL)

Examined clinical and social-structural factors contributing to hospitalization of nursing home residents. Using participant observation and event analysis of acute-illness episodes, concluded that 48.2 percent of nursing home patient (N=215) hospitalizations could have been avoided. Identified insufficient numbers and training of nurses, lack of diagnostic services, and pressure from staff and family to hospitalize as contributing factors. (Author/CM)

Given the increase of cultural diversity of the elderly population in the United States, nursing homes must be responsive to the needs of these residents. Research on the care of terminally-ill Chinese elders in nursing homes is limited. As part of a larger study on end-of-life care in nursing homes, data were obtained on 43 Chinese residents. Data were obtained through participant observation, event analysis, in-depth interviews with residents and their families, nursing staff, and physicians. The process of providing care was observed from the time they were identified as terminally-ill until their death. Many factors' influenced the care that Chinese residents received. Language and communication barriers had the greatest impact. Food preferences, cultural customs, religious beliefs, and end-of-life care beliefs also emerged as important considerations. These findings offer valuable information in helping to develop and implement interventions to improve terminal care for Chinese elders in nursing homes.

Prevention of pressure ulcers is fundamental to safe care of nursing home residents yet the role of hydration in pressure ulcer prevention has not been systematically examined. This randomized clinical trial was undertaken to determine whether administration of supplemental fluid to nursing home residents at risk for pressure ulcers would enhance collagen deposition, increase estimated total body water, augment subcutaneous tissue oxygenation, and was safe. After a baseline period, 64 subjects were randomized to receive the fluid volume prescribed or additional fluid (prescribed plus 10 mL/kg) for 5 days. Participants' potential to heal as measured with hydroxyproline was low at baseline and did not increase significantly during treatment when additional fluid was systematically provided. Fluid intake increased significantly during treatment. Estimates of total body water and subcutaneous oxygen did not increase, indicating hydration was not improved. Supplemental fluid did not result in overhydration as measured by clinical parameters. Further work is needed to examine the relationship between fluid intake and hydration in nursing home residents as well as the role of hydration in pressure ulcer prevention. [ABSTRACT FROM AUTHOR]

This ethnographic study investigated leadership from the perspective of directors of nursing (DONs) in proprietary nursing homes. Data from interviews and extensive participant observation with 10 DONs were analyzed using open coding and content analysis. The study drew on a priori concepts from transformational leadership theory to describe the role, DON approaches to leadership, and factors that facilitate or impede leadership in nursing homes. This article reports findings from a larger study related to conditions existing when participants entered the DON position. Antecedent conditions influenced organizational expectations of incoming DONs and shaped participants' leadership experiences. DONs filling long-standing vacancies had to reestablish the influence and authority of the role. Those replacing unsuccessful DONs confronted serious regulatory, care, and morale issues. In contrast, DONs with successful predecessors experienced organizational support and had confidence in their abilities to lead. [ABSTRACT FROM AUTHOR]

As part of an ethnographic study exploring what it means for nursing home residents to 'do well,' we examined patterns of advocacy on which they relied to have an effective voice. The purposive sample included 17 older, long-stay residents from a for-profit chain nursing home and a large public skilled nursing facility. Data collection included in-depth interviews, participant observation, and document review. Depending on personal history, health status, and facility context, participants relied on family and friends, trusted staff, fellow residents, or themselves as advocates. Although residents varied in their abilities and willingness to express concerns, a program matching staff advocates with residents at the chain nursing home fostered participants' sense that they were heard and their needs addressed. Attending to patterns of advocacy and the effect of the nursing home environment on resident communication are essential for individualizing care and promoting systems to ensure residents have a voice and are heard. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little research exists examining patient experiences of life with supraventricular tachycardia (SVT). Realistic expectations of symptoms, patient management strategies, and treatment options are important components of patient education and treatment decisions. AIM: This descriptive qualitative study explored patients' experiences living with SVT. METHODS: Grounded theory methodology was used with semi-structured interviews of 25 SVT patients undergoing radiofrequency ablation treatment. RESULTS: The main core category that emerged from the data was the 'struggle to be believed'. The struggle or work of living with SVT entails: (1) living with the uncertainty of the occurrence and duration of an episode, (2) 'covering up' to manage symptoms and appear normal, (3) searching for causative factors to prevent further episodes, and (4) experimenting with management techniques to shorten or end episodes. CONCLUSION: Clinical diagnosis and referral for ablation treatment were more difficult for women suggesting existence of a gender bias. As with many other chronic conditions, the illness trajectory work is formidable. Patients in this study with SVT, however, reported facing the additional difficulty of being believed. Disruptions in self-esteem and personal relationships are the effects of not being believed. Providers could avoid minimizing women's symptoms by listening seriously and offering realistic expectations; including insight into patient experiences and the trajectory of the dysrhythmia; and efficacy of drug and ablation treatments. [ABSTRACT FROM AUTHOR]

Twenty-four percent of Americans die in nursing homes, and 80% to 95% of nursing home care is delivered by certified nursing assistants (CNAs). Interview data were collected from 27 CNAs at three facilities. Data were coded and analyzed for recurrent themes using the concepts of empathy and role taking. The results revealed that CNAs used role taking to guide their caregiving actions and to understand the emotional experience of residents. Compassionate detachment, a hallmark of empathy, was evident in effective care, but problems with the ability to detach were also revealed. Organizational factors that supported empathy and those that undermined empathy were also examined. Recommendations for improving care are discussed in this article. Copyright © 2007 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Given the increase of cultural diversity of the elderly population in the United States, there is a need for increased sensitivity of culturally diverse residents. Research on the care of terminally ill Chinese elderly individuals in nursing homes is limited. As part of a larger study on end-of-life care in nursing homes, data were obtained on 34 Chinese residents. Data were obtained through participant observation, event analysis, and in-depth interviews with residents and their families, nursing staff, and physicians.The process of providing care was observed from the time residents were identified as terminally ill until their death. The most significant factors influencing the care Chinese residents received were communication barriers, dislike of Western food, and differing cultural beliefs and customs. These findings offer valuable information in helping to develop and implement interventions to improve the terminal care of Chinese elderly individuals in nursing homes. [ABSTRACT FROM AUTHOR]

Background: To date, no firm conclusions can be reached regarding the effectiveness of reminiscence for dementia. Researchers have emphasized that there is an urgent need for more systematic research in the area.Objective and Method: A single-blinded, parallel-groups (one intervention, one comparison, and one no-intervention group) randomized controlled trial (RCT) was adopted to investigate whether a specific reminiscence program leads to higher levels of psychosocial well-being in nursing home residents with dementia. The intervention adopted a life-story approach, while the comparison group provided friendly discussions to control for any changes in outcome as a result of social contacts and attention. The Social Engagement Scale (SES) and Well-being/Ill-being Scale (WIB) were the outcome measures used. The outcomes of the groups were examined with reference to the baseline (T0), immediately (T1), and six weeks (T2) after intervention. The final sample had 101 subjects (control group: n=30; comparison group: n=35; intervention group: n = 36). Using multivariate analysis with repeated measures, no significant differences in outcome were found between groups at either T1 or T2. Wilcoxon signed rank tests were performed for each group comparing outcomes between T1 and T0, T2 and T1, and T2 and T0. Significant differences were observed in the intervention group when comparing T1 and T0 WIB (p = .014), but not for the other groups.Conclusion: Although the intervention did not lead to significant differences between the three groups over time, there was a significant improvement in psychosocial well-being for the intervention group. [ABSTRACT FROM AUTHOR]

Terminally ill residents, their families, and care providers were interviewed and observed in 4 assisted living facilities (ALFs). Families supported the residents' desires to die at home, and dying residents had sustained, caring relationships with some staff. Facilities varied in terms of the services they could provide at the end of life. The staff did not always have sufficient training in care at the end of life, and staffing ratios did not always accommodate the intense care needs of dying people. ALF and hospice staffs did not plan, coordinate, or communicate sufficiently in providing care services. This study suggests that the privacy and autonomy that make ALFs desirable living environments may create challenges when dying residents require increasingly intense monitoring and care. [ABSTRACT FROM AUTHOR]

With the increasing number of foreign nursing students enrolled in university nursing programmes in the United States and the paucity of relevant studies it would seem essential to assess the difficulties foreign nursing students encounter in their adjustment to university nursing programmes and to evaluate the mechanisms that facilitate their adaptation. Data from this study was based on the results of 82 questionnaires completed by foreign nursing students enrolled in university nursing programmes nationwide. Language difficulties, a faculty to a great extent unfamiliar with foreign cultures, rapid pace, insufficient clinical experience, and highly competitive programmes were found to cause the foreign nursing students problems in their educational experiences. In addition to identifying the difficulties foreign nursing students have in adjusting to a university nursing programme, this paper proposes and discusses changes that would help make the foreign nursing students' experiences more meaningful and effective. [ABSTRACT FROM AUTHOR]

Health promotion and disease prevention in nursing homes (NHs) are important but highly neglected issues. This study compares the care of residents in 2 proprietary NHs (a dependency-promoting environment) with the care of residents on a hospice unit at a government-owned facility (a health-promoting environment). Inadequate staffing, supervision, and education contributed to the lack of health promotion and ultimately a low quality of care. The care in proprietary NHs, however, must be examined within the context of NH corporations, a multibillion dollar profit-making industry. When making profits is a priority, it is challenging for staff to provide quality care. [ABSTRACT FROM AUTHOR]

The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs., (Copyright 2008, SLACK Incorporated.)

Purpose: To investigate the factors that influence the dietary practices and eating patterns of low-weight, community-living older adults (aged 65 and older) and to examine the nutritional advice given to them by healthcare providers (HCPs) (e.g., nurse practitioner, medical doctor)., Data Sources: A qualitative approach was used to study a convenience sample of older women. Semistructured interviews were conducted. Thematic analysis and open coding were used to analyze data., Conclusions: Eating alone, social isolation, and stressors are the main reasons reported by participants for low weight. Data gathered in this study provide important insights into possible reasons for low weight in community-living older adults., Implication for Practice: As HCPs, it is important to bring low weight to the attention of older adults and educate them regarding appropriate weight for their age (body mass index [BMI] range >21 to <27 kg/m2 for age 65 and older), to understand that older adults with a BMI of <24 may be at increased risk for poor nutritional status, and to weigh older adults at each office visit to assess change in BMI. Small changes in eating patterns and food intake can potentially play an important role in stabilizing weight. Strategies that address eating alone, social isolation, and stressors need to be pursued.

Purpose: This study investigated the physical environment and organizational factors that influenced the process of providing care to terminally ill nursing home residents., Design and Methods: Participant observation, interviews, and event analysis were used to obtain data in two proprietary facilities., Results: The physical environment was not conducive to end-of-life care. The rooms were crowded, there was little privacy, and the facilities were noisy. Inadequate staffing and lack of supervision were among the most significant organizational factors that influenced care. Often, residents did not receive basic care, such as bathing, oral hygiene, adequate food and fluids, and repositioning. A consequence of inadequate staffing was the development of pressure ulcers; 54% of the residents had pressure ulcers; 82% of these residents died with pressure ulcers., Implications: Findings suggest that the nursing home environment in these two facilities, as now structured, is an inappropriate setting for end-of-life care.

The author presents findings from studies investigating the factors that influence the quality of care in nursing homes. The findings disclose that multiple factors, such as lack of individualized care, inattention to problems such as dysphagia and oral health care, and especially inadequate staffing and lack of professional supervision contribute to malnutrition, dehydration, and weight loss among nursing home residents. She describes how these qualitative studies had a significant impact on long-term health care policy. She urges investigators to publish research in the public realm accessible to those who can effect change and thus prevent pain and suffering among nursing home residents. Furthermore, she emphasizes the importance of publishing qualitative findings in a language understandable by the media, policy makers, governmental agencies, politicians, and the lay public.

Purpose: This article reviews the literature on "The Experience of Dying" and presents data from a larger, ongoing study of an ethnography of dying in nursing homes. The purpose of the ethnographic study was to investigate the process of providing end-of-life care to residents who were dying in nursing homes., Design and Methods: Participant observation, in-depth interviews, and event analysis were used to obtain data in three nursing facilities., Results: The review of the literature disclosed that research on the experience of dying is limited; most of the studies have been conducted in acute care hospitals among people who were dying of cancer. The ethnographic study found that lack of attention to cultural needs, cognitive status, inadequate staffing, and inappropriate and inadequate communication between health care providers and nursing home residents and their families were the predominant factors that influenced the experience of dying., Implications: Future research is needed on: The experience of dying for patients with dementia, for people in a comatose state, and for non-English speaking patients; symptom management; health care provider/patient-family interaction; the burden of caregiving for families; and the consequences of the constraints within our health care system for people who are dying in various settings.

This article presents a case study describing and analyzing ethical issues in the care during the last 11 weeks of life of a 101-year-old nursing home resident. The case presented here is part of a larger ongoing ethnographic study of death and dying in nursing homes. Two nursing care issues with ethical implications are discussed. First, the resident could not eat or drink independently, but she received no assistance with her meals. Second, she remained in a wheelchair for many hours and developed three pressure ulcers on her buttocks. Furthermore, she became tired when sitting in the wheelchair for long periods of time, fell out of the wheelchair, and subsequently was restrained "for her safety." Using selected principles from the International Council of Nurses and the American Nurses Association code for nurses, the resident's care is discussed and recommendations for improving the care of nursing home residents are presented.

The experts concluded that current data show that the average nurse staffing levels (for RNs, LVN/LPNs, and NAs) in nursing homes are too low in some facilities to provide high quality of care. Caregiving, the central feature of a nursing home, needs to be improved to ensure high quality of care to residents. Because detailed time studies have not been conducted on the amount of time that is required to provide high quality of care to residents, expert opinion is currently the best approach to addressing the problem of inadequate staffing. Increases in the education level and training of nursing staff are also strongly recommended as a step to improving quality of care and reducing turnover rates in nursing homes. These recommendations are designed for consideration by Congress, HCFA regulators, policymakers, nursing home administrators, and nurses. Ideally, Congress would pass legislation establishing these recommendations as minimum standards for all nursing homes or direct HCFA to establish detailed minimum nurse staffing standards to ensure that staffing levels take into account the number and the case-mix of the residents. Alternatively, HCFA could introduce minimum staffing standards through the regulatory process. In 1999 there were a number of efforts at the state level to increase minimum staffing levels. Mohler (1999) surveyed selected states and found that 21 states had either proposed new legislation or were considering proposals for new legislation or new regulations. In California, for example, in 1999 the state budget approved $31 million in new state funds (to be matched with $31 million in federal Medicaid dollars) to increase nursing home staffing minimum requirements from 2.8 to 3.2 hr per resident day and to increase wage rates. Overall, nursing facilities need to be held accountable by HCFA for providing adequate levels and types of staffing to meet the needs of their residents, especially because government is paying for 61% of the expenditures. Adopting these minimum standards will have an important impact on improving the quality of the nation's nursing home care. Additional research is needed to determine appropriate levels and types of staff to provide high quality of care to residents. These studies could test the proposed staffing standards against existing staffing levels to examine the impacts on quality. As new data become available on staffing levels, revisions of staffing standards should be made if necessary to ensure that high standards are maintained.