Health Care Administration and Organization

Collection of articles on Health Care Administration and Organization is available here.

Working Dynamics of Licensed Nurses and Nurse Aides in Nursing Homes: A Scoping Review.
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Beynon C, Siegel EO, Supiano K, Edelman LS.
Journal of gerontological nursing. 2022 May;48(5):27–34.
Collaboration between licensed nurses (LNs) and nurse aides (NAs) is critical in the provision of quality care for residents living in nursing homes (NHs). The current scoping review explores how working dynamics between LNs and NAs in the NH setting are researched and described in the literature. Thirty-five articles were identified and reviewed that address the LN/NA relationship in the context of (a) the LN role as a supervisor and leader; (b) variation in structure; (c) expanding, understanding, and supporting staff roles; and (d) communication. We found that the LN/NA relationship has been primarily explored through the LN lens and often studied in the context of role expansion and revision associated with new models of care. Our contribution to the literature includes the following main points: efforts to improve LN/NA collaboration may be hindered without substantial structural change; collaboration may be limited within the hierarchal LN/NA relationship; LNs and NAs in NHs need greater support, recognition, and empowerment; and NAs require a representative voice. [Journal of Gerontological Nursing, 48(5), 27-34.].

Nursing Staff’s Role in Detecting Urinary Tract Infections in Nursing Homes: An Integrative Review.
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Delgado KF, Roberson D, Haberstroh A, Wei H.
Journal of gerontological nursing. 2022 May;48(5):43–50.
Despite evidence-based protocols, inappropriate antibiotic use still presents a systemic global threat to health care in nursing homes (NHs). Nursing staff are responsible for recognizing signs and symptoms that may indicate urinary tract infections (UTIs). The current integrative review was designed to examine the state of the literature related to the role of nursing staff in UTI identification and care in NHs. This review, which includes 19 articles published between 2011 and 2020, identified that, although prescribers are the experts in UTI management, nursing staff in NHs were the individuals who recognized changes and communicated residents’ needs to prescribers. Further research is required to understand nursing staff’s decision making and unique perspectives and determine if evidence-based protocols align with current practice in the NH setting. [Journal of Gerontological Nursing, 48(5), 43-50.].

From dementia mindsets to emotions and behaviors: Predicting person-centered care in care professionals.
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Kunz LK, Scheibe S, Wisse B, Boerner K, Zemlin C.
Dementia (London, England). 2022 May;14713012221083392.
BACKGROUND AND OBJECTIVE: High-quality care standards for dementia care are increasingly based on person-centered care principles. To better understand facilitating factors of person-centered care this research focuses on individual characteristics of care professionals. Applying mindset theory to dementia care, we examined dementia mindsets (viewing dementia symptoms as either malleable or fixed) in care professionals. We tested whether there is a positive relationship between a malleable dementia mindset and person-centered care as well as a negative relationship between a fixed dementia mindset and person-centered care. Moreover, we examined whether care professionals’ emotional responses in care situations help explain associations between dementia mindsets and person-centered care. RESEARCH DESIGN AND METHOD: In two cross-sectional studies, care professionals of long-term care facilities (total N = 370) completed a measure of dementia mindsets and reported their emotional and behavioral responses to five care scenarios. Regression and mediation analyses were performed. FINDINGS: The tested hypotheses were partially supported. A fixed dementia mindset predicted reported person-centered care negatively, while a malleable dementia mindset did not. Mediation analyses suggest that reduced negative emotions may underlie the association between a malleable mindset and reported person-centered care, while reduced positive emotions in care situations may underlie the association of a fixed mindset and reported person-centered care. Study 2 partially replicated these findings. A fixed mindset and positive emotional responses were the most robust predictors of reported person-centered care. DISCUSSION AND IMPLICATIONS: This study extends knowledge on facilitators (positive emotional responses to care situations) and barriers (fixed dementia mindset) to person-centered care in care professionals working with persons with dementia. We discuss how dementia mindsets and emotional responses to care situations may be a fruitful target for trainings for care professionals.

Communication in dementia care: Experiences and needs of carers
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Nguyen H, Eccleston CE, Doherty KV, Jang S, McInerney F.
Dementia. 2022 Mar;21(4):147130122210800.
To ensure the well-being, quality of life and quality of care of people living with dementia, carers need to have the necessary communication knowledge and skills to respond appropriately to a person’s changing abilities and needs. Understanding carers’ communication experiences and needs in the context of dementia care is an important step in enabling effective education and support for carers. This study aimed to investigate communication challenges faced by carers and their coping strategies, influencing factors, and communication education and training needs. The sample involved 258 carers enrolled in an online dementia care program, and data were collected using a 16-item questionnaire. Descriptive statistics and non-parametric inferential statistics, including Chi-square, Mann–Whitney U, Kruskal–Wallis and Spearman’s rho, were used to analyse the data. The participants reported experiencing a range of challenges in communicating with people living with dementia and employing various strategies in addressing these challenges, either independently or with the support of others. Improvements in a number of factors would be beneficial for carers, including more time for caring, more care and social support, as well as enhanced skills in communicating with people living with dementia. A large majority of the participants indicated their need for education or training in communication knowledge and skills, and those with higher learning needs were likely to be younger, care workers and other health professionals, and those with less care experience. Recommendations are made for future research and efforts to maximise effective education and support for carers of people living with dementia.

Analyzing the Layout of Long-Term Care Facilities: A Psycho-Spatial Approach.
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Rom Y, Palgi Y, Isaacson M.
HERD. 2022 Apr;15(2):22–42.
When planning long-term care facilities (LTCFs), architects strive to design buildings that support high well-being (WB) levels for those who live and work in them. To achieve this goal, architects must understand what defines WB in old age and how these qualities can be achieved through the designed physical layout. This task must be achieved while tackling additional challenges, such as considering the official planning guidelines, codes, and additional requests given by the client. During the planning process, architects use their subjective impressions by visiting similar institutions, their personal experience as architects, and their subjective assumptions on what residents and caregivers may consider desirable. Once built, there are a lack of methodological ways to evaluate an existing LTCF unit’s plan as a supportive tool for higher levels of WB. The current study aims to create a methodological tool to analyze LTCF units’ layout, giving scores to each plan based on five aspects of WB that they support. In our article, we demonstrate this methodology’s application on 40 plans of LTCFs, demonstrating its effectiveness. We believe that the approach presented in this article will contribute to furthering the quality of planning of LTCFs benefiting residents and caregivers alike.

“It Makes You Feel Good to Help!”: An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care.
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Theurer KA, Stone RI, Suto MJ, Timonen V, Brown SG, Mortenson WB.
Canadian journal on aging = La revue canadienne du vieillissement. 2022 May;1–9.
Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.

Who’s in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic.
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Vellani S, Zuniga F, Spilsbury K, Backman A, Kusmaul N, Scales K, et al.
Gerontology & geriatric medicine. 2022;8:23337214221090804.
Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic. Five broad categories of staff working in LTC homes were as follows: (1) those responsible for personal and support care, (2) nursing care, (3) medical care, (4) rehabilitation and recreational care, and (5) others. There is limited availability of data related to measuring staff complement in the home and those with similar roles had different titles making it difficult to compare between countries. Nevertheless, the survey results highlight that some categories of staff were either absent or deemed non-essential during the pandemic. We require standardized high-quality workforce data to design better decision-making tools for staffing and planning, which are in line with the complex care needs of the residents and prevent precarious work conditions for staff.

Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia
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Yoon JM, Trinkoff AM, Galik E, Storr CL, Lerner NB, Brandt N, et al.
Journal of the American Medical Directors Association. 2022 May.
ObjectivesThe Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia.

Association between staff turnover and nursing home quality – evidence from payroll-based journal data.
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Zheng Q, Williams CS, Shulman ET, White AJ.
Journal of the American Geriatrics Society. 2022 May.
BACKGROUND: Staff turnover is considered an important indicator of nursing home quality. We used auditable staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal (PBJ) system to calculate turnover measures for nurse staff and administrators and examined the relationship between turnover and nursing home quality. METHODS: Our analyses included data from 13,631 nursing homes that submitted complete staffing data through PBJ for 2018Q3 – 2019Q4. We identified turnover based on gaps in days worked by eligible employees, allowing us to calculate turnover measures that do not depend on termination dates reported by nursing homes, which are not captured in PBJ. We linked staff turnover measures to nursing home quality measures and star ratings published on CMS’ Care Compare website in January 2020 and examined the relationship between turnover and quality of care. We used ordinary least squared models for continuous outcomes and ordered logit models for categorical outcomes, controlling for facility, and county characteristics. RESULTS: Mean annual turnover rates were about 44% for RNs and 46% for total nurse staff. On average, there was one administrator leaving each nursing home during this period although about half of nursing homes had no administrator turnover. Turnover rates varied greatly across nursing homes. For-profit and larger nursing homes had higher turnover rates. Higher turnover was consistently associated with lower quality of care. CONCLUSIONS: Our study highlights the importance of staff turnover due to its relationship to nursing home quality. In January 2022, CMS started posting turnover measures on Care Compare to allow consumers to use this information in their assessment of nursing home quality and to motivate nursing homes to implement innovative strategies to retain staff. While these actions are challenging, they are nonetheless warranted for improving the quality of care for nursing home residents.