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Purpose: The purpose of this study was to compare a variety of resident and staff outcomes across two types of staffing patterns, permanent and rotating assignment, and work shift. Although studies have examined these staffing patterns as part of multicomponent intervention packages, few studies have examined the isolated effects of staffing pattern by using an experimental design. Design and Methods: A between-groups comparison design was used to compare residents and certified nursing assistants (CNAs) from four nursing homes; two self-identified as using permanent assignment (PA) staffing and two as using rotating assignment (RA) staffing. Measures yielded data on verbal interaction among residents and staff, resident disruptive behavior, and specific aspects of resident-staff behavior during care routines. Other assessments included resident personal appearance and hygiene, expressed affect, and CNAs' job satisfaction, burnout, absenteeism, and turnover rates. A treatment fidelity check was conducted to confirm PA and RA staffing patterns. Results: Staffing patterns were significantly different between self-identified PA and RA nursing homes. Residents in PA nursing homes and on morning shifts received significantly higher ratings of personal appearance and hygiene. Rates of expressed sadness and interest among residents differed by staffing patterns and shift. However, these differences do not appear to be clinically significant. Although absenteeism was higher in PA nursing homes, these CNAs reported greater job satisfaction than CNAs from RA nursing homes. As expected, evening shifts across nursing homes had significantly higher turnover rates and significantly more resident disruptive behavior. Implications: Quality-of-care outcomes were similar among the two types of nursing homes, despite significantly different staffing patterns. Though staff permanency rates in PA nursing homes (50%) were twice that of RA nursing homes (26%), more research is needed to determine feasibility of higher rates of staff permanency (i.e., > 50%) and effects on resident and CNA outcomes. Key Words: Nursing assistant, Staffing patterns, Direct observational time sampling

This study presents preliminary data on the efficacy of two environmental 'white noise' audiotapes for the treatment of verbal agitation in severely demented nursing home residents. The researchers employed a computer-assisted real-time observational system to assess both the frequency of verbal agitation and the actual use of the intervention on the nursing units (treatment fidelity). Intervention by nurse aides (NAs) on the unit was preceded by a researcher-controlled functional analysis phase that provided information regarding which of the two audiotapes would be most effective for individual residents. Results indicate a 23% reduction in verbal agitation with this individualized treatment strategy on the nursing units. These results were obtained even though treatment fidelity data showed that the audiotapes were used during only 51% of the observations. The authors discuss the need for formal staff management procedures for increasing staff compliance with treatment regimens.

A computer-aided real-time data collection system used for monitoring and recording the disruptive vocalization (DV) of 11 residents in a nursing home showed that the average duration and frequency of DV occurrence were 6 seconds and 22 per hour, respectively. The occurrence of DV increased along the day and reached a maximum in the evening, indicating its correlation with the sundowning hypothesis. High DV frequency correlated with high ADL damage and high DV duration and frequency correlated with high cognitive damage.

Examines the efficacy of auditory stimulation intervention for verbal agitation treatment in demented nursing home residents. Use of environmental `white noise' audiotapes; Verbal agitation reduction; Individual response.