Health Care Administration and Organization

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

Care homes education: what can we learn?
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Armstrong SF, Gluck T, Gorringe A, Stork A, Jowett S, Nadicksbernd JJ, et al.
BMJ open quality 2021 feb;10(1).
Medical care received by care home residents can be variable. Initiatives, such as matron-led community teams, ensure a timely response to alerts about unwell residents. But early recognition of deterioration is vital in accessing this help. The aim of this project was to design and deliver an education programme for carers. It was hypothesised that the implementation of a teaching programme may result in improved medical care for residents. By understanding the enablers and barriers to implementing teaching, we hoped to identify the components of a successful teaching programme. Four care homes in Enfield received training on topics such as deterioration recognition over a 1-year period. The project was evaluated at 3, 6 and 9 months. Each evaluation comprised: pre-and-post-teaching questionnaires, focus groups, analysis of percentages of staff trained, review of overall and potentially avoidable, hospital admission rates. A Plan-Do-Study-Act cycle structure was used. The programme was well-received by carers, who gave examples of application of learning. Modules about conditions frequently resulting in hospital admission, or concerning real cases, demonstrated the best pre-and-post lesson change scores. However, the reach of the programme was low, with attendance rates between 5% and 28%. Overall, the percentage of staff trained in deterioration recognition ranged from 35% (care home one) to 12% (care home three). Hospital admissions reduced from 37 hospital admissions to 20 over the duration of the project. Potentially avoidable admissions reduced from 16 to 5. Proving causality to the intervention was difficult. Factors facilitating delivery of training included a flexible approach, an activity-based curriculum, alignment of topics with real cases and embedding key messages in every tutorial. Barriers included: time pressures, shift work, low attendance rates, inequitable perception of the value of teaching and IT issues. Care home factors impacting on delivery included: stability of management and internal communication systems.please ensure space here.

Characteristics of nursing home units with high versus low levels of person-centred care in relation to leadership, staff- resident- and facility factors: findings from SWENIS, a cross-sectional study in Sweden.
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Backman A, Sandman P, Sk\oldunger A.
BMC geriatrics 2021 sep;21(1):498.
BACKGROUND: The context of care consists of factors that determines the extent to which staff can offer person-centred care. However, few studies have investigated factors that can explain variation in levels of person-centred care among nursing home units. The aim of this study was to explore factors characterizing nursing home units with high and low degree of person-centred care, with focus on leadership, staff, resident and facility factors. METHODS: Cross-sectional data from residents, staff, and managers in 172 randomly selected nursing homes in Sweden were collected in 2014. Activities of Daily Living Index, Gottfries’ cognitive scale, Person-centred Care Assessment Tool together with demographic information and estimations of leadership engagement was used. Independent samples t-test and Chi2 test were conducted. RESULTS: Highly person-centred units were characterised by leaders engaging in staff knowledge, professional development, team support and care quality. In highly person-centred units’ staff also received supervision of a nurse to a larger extent. Highly person-centred units were also characterised as dementia specific units, units with fewer beds and with a larger proportion of enrolled nurses. No differences in degree of person-centred care were seen between public or private providers. CONCLUSIONS: This study provides guidance for practitioners when designing, developing and adapting person-centred units in aged care contexts. Managers and leaders have an important role to promote the movement towards a person-centred practice of care, by supporting their staff in daily care, and engaging in staff knowledge and professional development. Targeting and adjusting environmental factors, such as provide small and dementia adapted environments to match the residents’ personal preferences and capacity are also important when striving towards person-centredness.

Exploring clinical leadership in long term care: An integrative literature review.
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Enghiad P, Venturato L, Ewashen C.
J Nurs Manag 2021 sep.
AIM: To understand the concept of clinical leadership and clinical leadership development for nurses working with older adults in long-term care health care facilities. BACKGROUND: In Canada, clinical care within long-term care is undertaken by registered nurses and licensed practical nurses working with health care aides. Effective clinical leadership is essential for providing quality nursing care. EVALUATION: An integrative literature review using the framework of Whittemore and Knafl (2005). All selected articles were quality appraised using the Critical Appraisal Skills Program, and the accuracy, authority, coverage, objectivity, date, and significance checklist. KEY ISSUES(S): The analysis resulted in four themes: ambiguous definitions; practice-based and value-driven care; the impact of clinical leadership; and clinical leadership development for Canadian nurses. CONCLUSION: The findings suggest that ambiguity surrounds the concept of clinical leadership, with the term denoting both “management” as a formal administrative role, and “leadership” in general. More recently, the clinical leadership focus has been on informal leadership by nurses at the bedside, where personal and professional values align with clinical action. IMPLICATIONS FOR NURSING MANAGEMENT: Effective clinical leadership can have a positive impact on quality care and employee job satisfaction.

Certified nursing assistants’ experiences with self-compassion training in the nursing home setting.
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Lathren C, Sheffield-Abdullah K, Sloane PD, Bluth K, Hickey JVTS, Wretman CJ, et al.
Geriatr Nurs 2021 sep;42(6):1341-1348.
Certified nursing assistants (CNAs) in nursing home (NH) settings experience considerable work-related and personal stress. Self-compassion is a personal resource linked to improved stress coping and may be particularly relevant to health care workers. In this study, we explored NH CNA’s experiences with self-compassion training based on their narrative replies. Twenty-two CNAs (100% female, mean age 48 years, 82% Black/African American) from 3 mid-sized, non-profit NHs in the Southeast US completed either a standard 8-week, 20 h self-compassion training or a 6-week, 6 h modified version designed for health care providers. Qualitative data analyses from post-training focus group discussions identified four themes pertaining to changes in: (1) stress management, (2) appreciation and support, (3) caregiver role, and (4) connection to others. Findings suggested self-compassion training is feasible and beneficial for the stressors that CNAs experience. In the era of COVID-19 and beyond, self-compassion training is a promising method to improve CNAs’ well-being.

Nursing assistants and resident satisfaction in long-term care: A systematic review.
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Li X, Dorstyn D, Mpofu E, O Neill Liam, Li Q, Zhang C, et al.
Geriatr Nurs 2021 sep;42(6):1323-1331.
BACKGROUND: The number of nursing assistants (NAs) in the long-term care industry is on the rise, helping to service the needs of an increasingly aging population. Understanding influences on NAs service qualities and resident satisfaction is important to sustainable long-term care services. To date, the research evidence about NAs factors and resident satisfaction has not been synthesized. We aimed to address this gap in the evidence. RESEARCH DESIGN AND METHODS: Utilizing a mixed-methods systematic review, we searched PubMed, PsycINFO, AgeLine, MEDLINE, Scopus, and Google Scholar databases for journal articles with primary data published from database inception to March 2021. Both qualitative and quantitative literature were considered and a narrative summary provided. Study reporting quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists and Critical Appraisal Skills Programme Checklist. RESULTS: A total of 25 articles, spanning 9 countries and regions, were included in the review. Study reporting quality was good. A positive relationship between aged-care resident satisfaction and NAs job satisfaction (n = 8) was identified. Resident satisfaction was enhanced through NA training programs (n = 7), quality of daily interaction with NAs (n = 6), and the overall contribution of NAs in promoting residents` experiences (n = 4) DISCUSSION: The current findings highlight the important role of NAs in improving resident care in long-term care settings. Nursing home administrators need to better understand the value of NAs and to provide supports for growth and development in their work. Continuing the professional development of NAs can not only improve their skills but also benefit resident satisfaction and organizational sustainability.

Level of nurse supportive supervision and its influencing factors in long-term care facilities.
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Lin L, Liu X, McGilton KS, Yuan Y, Li H, Dong B, et al.
Geriatr Nurs 2021 sep;42(6):1316-1322.
Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW’s years of working, the RN’s education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs.

The demotivating impact of absenteeism in nursing homes.
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Roussillon Soyer Claude, St-Onge S, Igalens J, Balkin DB.
J Nurs Manag 2021 sep;29(6):1679-1690.
AIM: The study explores how prevailing absenteeism frustrates or thwarts nurses’ and nursing assistants’ basic psychological needs (autonomy, competence and relatedness), using self-determination theory. BACKGROUND: Our study responds to the call to investigate how organisational characteristics influence employees’ psychological need, satisfaction and their attitudes and behaviours. METHOD: We conducted a semantic analysis of the discourse of 42 nurses and nursing assistants working in nursing homes for older dependent people in France. RESULTS: The analysis subdivides participants’ discourse into four themes: short-term absenteeism, lack of competence, lack of recognition and work overload. These themes are all linked to participants’ perceived deficits or threats concerning their psychological needs. CONCLUSIONS: The prevailing absenteeism has a harmful spiral impact on nurses’ and nursing assistants’ attitudes and behaviours, and, ultimately, on the quality of care received by the patients. IMPLICATIONS FOR NURSING MANAGEMENT: Our study confirms the need to adopt various managerial actions to address the following interrelated issues: controlling short-term absences, reducing work overload and giving training and recognition.

Residential aged care staff awareness of and engagement with dementia-specific support services and education.
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Williams R, Ockerby C, Rawson H, Redley B, Hutchinson A.
Australasian journal on ageing 2021 sep;40(3):e223-e233.
OBJECTIVE: To examine residential aged care (RAC) staff awareness of and engagement with dementia-specific support services and education. METHODS: A cross-sectional survey of staff (n = 179) from 36 Victorian RAC facilities. RESULTS: 60% (n = 107) of respondents were aware of dementia-specific support services, but only 27% (n = 48) accessed services in the previous 2 years. Approximately 77% (n = 137) were aware of dementia-specific education, with 66% (n = 115) completing education in the previous 2 years. A significantly higher proportion of registered nurses had accessed dementia-specific support services in the past 2 years compared with enrolled nurses and personal care assistants (P < 0.001). CONCLUSION: A relatively large proportion of RAC staff were unaware of available dementia-specific support services and education. While approximately two thirds accessed such education, only one in four accessed dementia-specific support services. To optimise the quality of care for people with dementia, strategies to increase awareness of and access to these resources are warranted.

Ownership, quality and prices of nursing homes in Australia: Why greater private sector participation did not improve performance.
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Yong J, Yang O, Zhang Y, Scott A.
Health Policy 2021 sep.
OBJECTIVE: This study examines whether greater private-sector participation in aged care can lead to better outcomes by comparing quality of care and prices of residential aged care facilities across three ownership types: government-owned, private not-for-profit and for- profit facilities. Australia, like many other countries, has been implementing market-oriented reforms aiming to promote greater consumer choice and increase the role of markets and private-sector participation in aged care. METHODS: Using retrospective facility-level data, the study relates several measures of quality of care and a measure of price to ownership types while controlling for facility characteristics. The data covered six financial years (2013/14-2018/19) and contained 2,900 residential aged-care facilities, capturing almost all facilities in Australia. About 55% were private not-for-profit, 30% private for-profit and 15% government-owned. RESULTS: Government-owned facilities provide higher quality of care in most quality measures and charge the lowest average price than private for-profit and not-for-profit facilities. DISCUSSION: Reforms promoting private-sector participation in aged care are unlikely to result in effective competition to drive quality up or prices down unless sources of market failure are addressed. In Australia, the lack of public reporting of quality and the complex pricing structure are key issues that prevent market forces and consumer choice from working as intended.