Mary Ellen Dellefield's research while affiliated with University of California, San Francisco and other places

Publications (35)

Article
The work environment is a modifiable construct associated with the quality of nursing home care. This article describes and explains variables known to be associated with the work environment of nurses in nursing homes, including the history and characteristics of nursing homes; the nature of nursing work; the nursing skill mix, and care delivery....
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Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
Article
Background The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents. Purpose To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services. Met...
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Ongoing evidence of failures to provide cardiopulmonary resuscitation in skilled nursing facilities (SNFs) has resulted in the federal regulation - F678 Cardio-Pulmonary Resuscitation (CPR). Descriptions of CPR-related non-compliance and nursing practice failures are contained in Statements of Deficiencies (CMS-2567). These data provide a unique op...
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US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond t...
Article
Background: Surgical teams aspire to be safe and avoid preventable deaths. A lack of teamwork has been associated with safety failures, including adverse events and errors. Purpose: The purpose of the pilot study was to: (1) modify the Observational Teamwork Assessment in Surgery (OTAS) and the original data collection method to measure register...
Article
Research suggests that acute care patients cared for by baccalaureate-educated nurses have better outcomes. Directors of nursing (DONs) in skilled nursing facilities (SNFs) have lower rates of baccalaureate attainment than acute care nurses for unclear reasons. To understand the interest in advancing education, researchers surveyed SNF DONs in Conn...
Article
Background: In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs). Methods: During the...
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In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regardi...
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Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI). Consistent com...
Article
Nursing home care is expensive; second only to acute hospital care for inpatient Medicare costs. The increased focus on costs of care accrued by Medicare beneficiaries in nursing homes presents a valuable opportunity for registered nurses (RNs) to further demonstrate quantitatively the value they add to the capacity of the nursing home nursing skil...
Article
Sustaining pressure ulcer prevention (PUP) in nursing homes has been difficult to achieve. Implementation science researchers suggest that identification of individual staff and organizational factors influencing current practices is essential to the development of an effective and customized plan to implement practice changes in a specific setting...
Conference Paper
Purpose:To describe nurses’ perceptions of individual and organizational factors related to pressure ulcer prevention in nursing homes from a patient safety perspective. Rationale/Conceptual/Background: Pressure ulcers (PU) are largely preventable. However, it has been difficult to sustain PU prevention programs in NHs in spite of widely dissemin...
Article
The need for personhood-focused long-term care (LTC) is well-documented. A myriad of sociocultural, political, nursing/professional and organisational contexts facilitate or hinder registered nurses (RNs)' capacity to ensure personhood-focused LTC. Complexities derive from the countless interrelated aspects of these contexts, blurring clear distinc...
Article
The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data co...
Conference Paper
Purposes/Aims This study aims to describe nursing assistant (NA), licensed vocational nurse (LVN), and registered nurse (RN) perceptions of facilitators/barriers to implementing pressure ulcer prevention (PrUP) in 2 VA Community Living Centers. Knowledge, beliefs, values, attitudes, and work practices were examined. Background Implementation...
Article
Full-text available
Registered nurses (RNs) working in nursing homes (NHs) are a scarce professional resource. Their responsibilities include direct (e.g., assessment, physical care, and medication administration) and indirect care (e.g., documentation, supervision, and other activities performed away from the resident to manage their care environment). The purpose of...
Article
Huntington disease (HD) is a genetic neurodegenerative disorder that progresses over decades and is ultimately terminal. As HD advances, patients are frequently placed in institutional care settings, including nursing homes and hospices where family, nursing staff, and interdisciplinary team members are challenged to help patients live to their hig...
Article
The impending wave of aging boomers heightens long-standing concerns for the quality and cost of nursing home care. As industry and policy leaders continue efforts to remedy substandard nursing home care delivery practices, development of a well-prepared and adequately supported workforce of directors of nursing (DONs) is essential to ensuring the...
Conference Paper
Purposes/Aims: The study purpose was the development and implementation of a PDA-based tool used to directly observe registered nurse (RN) care practices related to five pressure ulcer (PU) risk factors, including immobility, incontinence, nutrition, pain, and PU treatment. Percentages of direct care (assessment, treatment, medications) and indirec...
Article
Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, ex...
Article
The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) is the foundational clinical framework for nursing home care, functioning as both a clinical assessment instrument and an assessment process. An RN is mandated by statute to complete or coordinate the work associated with this framework. Using both focus groups and questionnaires, 24 RN...
Article
Forty nursing staff from 2 urban VA-affiliated nursing homes participated in separate focus groups for certified nursing assistants, licensed vocational nurses, and registered nurses. Staff described their experiences with nursing supervisory and managerial staff work behaviors related to 5 common clinical practices, including incontinence, mobilit...
Article
The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) used in nursing homes (NHs) participating in the Federal Medicare and Medicaid programs is a state-of-the-art, computerized clinical assessment instrument. RAI/MDS-derived data are essential, used for NH reimbursement, quality measurement, regulatory quality monitoring activities, and cl...
Article
In a study of 59 veterans and healthcare workers, the reliability of a self-monitoring method used to track the frequency of a spiritually oriented stress reduction technique was assessed. During a 5-week program of silently repeating a mantram (a spiritual word or phrase) to lower stress and anger and improve spiritual well-being, portable wrist-w...
Article
Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent deficiency citation in nursing homes are not known. The purpose of this study was to examine the relationships between these two outcomes and selected organizational variables, including total nurse staffing levels, specialization, centralization, nursing wages,...
Article
Nurse managers working in nursing homes are challenged to develop strategies that maintain a balance among quality of care, nurse staffing levels, and workload within the context of federal and state nurse staffing requirements for nursing homes. One strategy to consider is the use of the Resource Utilization Groups (RUG-III) staffing benchmarks th...
Article
This article is a critical review the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. We reviewed educational and empirical literature. Interdisciplinary care planning and the written care plan are mandated processes that are imbedded in the regul...

Citations

... 12 Most NHs follow the minimum federal regulations for staffing. 13 These regulations require 1 RN on duty 8 consecutive hours per day, 7 days per week, and 1 RN on call when a licensed practical nurse (LPN) is on duty. [14][15][16] The national average for licensed nursing staff hours per resident is 1 hour 44 minutes per day (RN = 46 minutes; LPN/licensed vocational nurse [LVN] = 58 minutes). ...
... Furthermore, the specified staffing requirements are typically considered to be insufficient and to provide a lower limit for quality (Harrington et al., 2012;Mueller et al., 2006). Indeed, inadequate staffing ratios are an important reason for quality shortfalls in nursing homes (Harrington et al., 2016(Harrington et al., , 2020. We follow Hackmann (2019) and Lin (2014) and measure care quality by case-mix weighted certified staffing ratios. ...
... Proponents of BSN programs note BSN graduates to be better prepared to demonstrate professional behaviors with higher levels of leadership capacity (Holle et al., 2019). Table 2 provides results, and our findings support this with 61% of BSNs reporting they serve on a nursing council or professional committee as compared to 39% of ADNs at Year 3. Data further showed that RNs from both groups were most often engaged with unit-based councils or committees followed by hospital/organizational committees and, lastly, community service. ...
... There is a small amount of literature on prior experiences with virtual LCs (17)(18)(19)(20)(21)(22). The prior virtual LCs have been primarily nurse-led, and all (as known to the authors of the present work) within the VA health care system in the US. ...
... This vulnerable group requires complex health, personal, and social care, provided in ways that has meaning for residents [12] and that emphasize the importance of relational care and quality of life [13]. While media have highlighted the significant challenges with nursing home care during pandemic times [14][15][16], the quality of care provided in this sector has been recognized as suboptimal for decades, and many groups have called to improve nursing home structures and care processes [17][18][19][20][21]. ...
... Motor dysfunction may be a contributing factor to poor hygiene in middle or late stage HD, if patients do not have the physical help that they require for their activities of daily living. However, many individuals with HD actually seem to have an aversion to bathing or showering, often refusing to do so (Ferrini, 2009). This is commonly a point of contention in the household; family members spend time and energy trying to coax patients to wash. ...
... 20 4. Case management: a critical factor in older adult health, having a recognized role in the quality of gerontological services. 21,22 It is performed by the mini-team nurse, identifying older adults who need more intensive monitoring. ...
... 12 Using this model, the state spent nearly $16 million in 2004 and 2005, with the most requested and second most costly category being salaries and benefits. 12 Nurse staffing levels are generally associated with higher NH quality, 13,14 thus maintaining staffing levels during disasters is crucial. However, past work suggests that obtaining an adequate level of direct-care nurse staffing during a hurricane and thereafter is difficult. ...
... The third recommendation that met the APEASE criteria is "education for residents and families" under the intervention function Education. In two qualitative studies examining the experience of care staff in implementing evidence-based guidelines, involving families and residents when introducing evidence-based interventions were perceived by care staff as a facilitator to implementation [49,50]. Educating residents and families on not only the importance of fracture prevention but also how to advocate for the use of evidence-based interventions may increase the motivation and opportunity for the staff to carry out the guideline. ...
... 36 The external environment associated with the availability of these key resources include profit/ nonprofit ownership, rural/urban location, size, and Medicaid acceptance. 37 These external structural characteristics have been linked to PCC practices. For example, prior studies have shown that higher quality nursing homes are more likely to adopt PCC practices than their lower quality counterparts. ...