[Show abstract][Hide abstract] ABSTRACT: Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6- month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff-family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff-family interaction positively. Findings suggest explanatory processes in staff-family interactions, while pointing toward promising interventions.
[Show abstract][Hide abstract] ABSTRACT: In this study, the authors describe certified nursing assistants' (CNA) Explanatory Models (EMs) of depression and aspects of their EMs that may contribute to the underdetection of depression in nursing homes. Interviews with 18 CNAs working in two nursing homes are guided by Kleinman's Explanatory Models of Illness framework. Interview data are content analyzed and CNAs' descriptions of depression are compared to the MDS 2.0 Mood Screening criteria and to the DSM-IV-TR diagnostic criteria for depression. The result is that the CNAs are unsure about the duration and normalcy of depression in residents. Although they have no formal training, CNAs feel responsible for observing for signs of depression and describe verbal and nonverbal ways of interacting when providing emotional care to residents. CNAs hold potential to improve the detection of depression and contribute to the emotional care of residents. Attention to staff knowledge deficits and facility barriers may enhance this potential.
Western Journal of Nursing Research 05/2008; 30(6):653-72. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify barriers to and facilitators of the diffusion of clinical practice guidelines (CPGs) and clinical protocols in nursing homes (NHs).
Four randomly selected community nursing homes.
NH staff, including physicians, nurse practitioners, administrative staff, nurses, and certified nursing assistants (CNAs).
Interviews (n=35) probed the use of CPGs and clinical protocols. Qualitative analysis using Rogers' Diffusion of Innovation stages-of-change model was conducted to produce a conceptual and thematic description.
None of the NHs systematically adopted CPGs, and only three of 35 providers were familiar with CPGs. Confusion with other documents and regulations was common. The most frequently cited barriers were provider concerns that CPGs were "checklists" to replace clinical judgment, perceived conflict with resident and family goals, limited facility resources, lack of communication between providers and across shifts, facility policies that overwhelm or conflict with CPGs, and Health Insurance Portability and Accountability Act regulations interpreted to limit CNA access to clinical information. Facilitators included incorporating CPG recommendations into training materials, standing orders, customizable data collection forms, and regulatory reporting activities.
Clinicians and researchers wishing to increase CPG use in NHs should consider these barriers and facilitators in their quality improvement and intervention development processes.
Journal of the American Geriatrics Society 10/2007; 55(9):1404-9. · 4.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dissemination of research findings to practice and maintenance of rigor and validity in qualitative research are continuing challenges for nurse researchers. Using three nursing home case studies as examples, this article describes how exit interview-consultation was used as (a) a validation strategy and (b) a rapid research dissemination tool that is particularly useful for nursing systems research. Through an exit interview-consultation method, researchers validated inferences made from qualitative and quantitative data collected in three comprehensive nursing home case studies that examined nursing management practices. This exit interview-consultation strategy extends the traditional member-check approach by providing confirmation at the individual and organizational level. The study examined how using the exit interview-consultation strategy can potentially assist nursing home organizations to increase their capacity for improving operations. Benefits from research participation are often indirect; this study's results suggest that exit interview-consultation can provide direct and immediate benefits to organizations and individuals.
Western Journal of Nursing Research 01/2007; 28(8):955-73. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study describes how Minimum Data Set (MDS) coordinators' relationship patterns influence nursing home care processes. MDS coordinators interact with nursing home staff to coordinate resident assessment and care planning, but little is known about how they enact this role or influence particular care processes beyond paper compliance. Guided by complexity science and using two nursing home case studies, the authors describe MDS coordinators' relationship patterns by assessing the extent to which they used and fostered good connections, new information flow, and cognitive diversity. MDS coordinators at one site fostered new information flow, good connections, and cognitive diversity, which positively influenced assessment and care planning, whereas those at the other site did little to foster these three relationship parameters, with little influence on care processes. This study revealed that MDS coordinators are an important new source of capacity for the nursing home industry to improve quality of care.
Western Journal of Nursing Research 05/2006; 28(3):294-309. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization, and innovation in nursing homes. Two facilities participated in 6-month case studies using field observations, shadowing, and depth interviews. In one facility, the dominant pattern of communication was a vertical "chain of command" between care providers, characterized by thin connections and limited information exchange. This pattern limited cognitive diversity and innovation in clinical problem solving. The second facility used an open communication pattern between medical and frontline staff. The authors saw higher levels of information flow, cognitive diversity, innovation, and self-organization, although tempered by staff turnover. The patterns of communication between care providers in nursing facilities have an important impact on their ability to provide quality, innovative care.
Qualitative Health Research 03/2006; 16(2):173-88. · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increasing longevity, a rising prevalence of psychiatric and medical comorbidities, and dramatic changes in the nature and organization of health care delivery systems have direct implications for the theoretical frameworks and methods that will be needed to shape future geropsychiatric nursing (GPN) science. This article reviews scientific advances and persisting gaps in the knowledge base in 17 discrete areas. Topics encompass specific disorders associated with aging as well as health and quality-of-life considerations that are prominent in the geropsychiatric nursing research literature of the past two decades. The unique interests and capabilities of nurse scientists suggest broad themes for future GPN specialty and interdisciplinary research.
Journal of the American Psychiatric Nurses Association 01/2006; 12(2):75-99.
[Show abstract][Hide abstract] ABSTRACT: In a nursing home case study using observation and interview data, the authors described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection but also led to actions such as infantilization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Furthermore, the authors found that CNAs were isolated from clinicians; little resident information was exchanged. They suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care.
Qualitative Health Research 11/2005; 15(8):1006-21. · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Golden Rule guides people to choose for others what they would choose for themselves. The Golden Rule is often described as 'putting yourself in someone else's shoes', or 'Do unto others as you would have them do unto you'(Baumrin 2004). The viewpoint held in the Golden Rule is noted in all the major world religions and cultures, suggesting that this may be an important moral truth (Cunningham 1998). The Golden Rule underlies acts of kindness, caring, and altruism that go above and beyond "business as usual" or "usual care" (Huang, 2005). As such, this heuristic or 'rule of thumb' has universal appeal and helps guide our behaviors toward the welfare of others. So why question the Golden Rule? Unless used mindfully, any heuristic can be overly-simplistic and lead to unintended, negative consequences.A heuristic is a rule of thumb that people use to simplify potentially overwhelming or complex events. These rules of thumb are largely unconscious, and occur irrespective of training and educational level (Gilovich, Griffin & Kahneman 2002). Rules of thumb, such as the Golden Rule, allow a person to reduce a complex situation to something manageable-e.g., 'when in doubt, do what I would want done'. Because it is a simplifying tool, however, the Golden Rule may lead to inappropriate actions because important factors may be overlooked.In this article we describe "The Golden Rule" as used by administrators, supervisors, charge nurses, and CNAs in case studies of four nursing homes. By describing use of this rule-of-thumb, we aim to challenge nurses in nursing homes to: 1) be mindful of their use of "The Golden Rule" and its impact on staff and residents; and 2) help staff members think through how and why "The Golden Rule" may impact their relationships with staff and residents.
Director (Cincinnati, Ohio) 01/2005; 14(1):255-293.
[Show abstract][Hide abstract] ABSTRACT: We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of staff connection were associated with higher care plan specificity and innovation. Connection of the frontline nursing staff was crucial for (1) implementation of the formal care plan and (2) spontaneous informal care planning responsive to changing resident needs. Although regulations could theoretically improve cognitive diversity and information flow in care planning, we observed instances of regulatory oversight resulting in less specific care plans and abandonment of an effective care planning process. Interventions which improve staff connectedness may improve resident outcomes.
Health care management review 31(4):337-46. · 1.30 Impact Factor