Janet K. Specht

Expanding the role of long-term care social workers: Assessment and intervention related to urinary incontinence

S. Sanders et al. — Thu, 18 Oct 2012 10:46:28 PDT

Urinary incontinence (UI) is a common and stigmatizing problem faced by long-term care (LTC) residents. It is typically addressed by medical professionals, with social work rarely involved. The purpose of this article is to illustrate how social workers can address the psychosocial implications of UI while working with residents and their family members as part of an interdisciplinary team. Using a case example and the NASW objectives for LTC, recommendations on how the role of the LTC social workers can be expanded to better address both the needs of residents, families, and the larger LTC system are provided.

Concept development of nursing-sensitive patient outcomes

Meridean L. Maas et al. — Thu, 18 Oct 2012 10:46:27 PDT

Evidence supporting nurtritional interventions for persons in early stage Alzheimer's Disease (AD)

S. C. Burgener et al. — Thu, 24 May 2012 10:56:05 PDT

Evidence supporting exercise interventions for persons in early-stage Alzheimer's disease

L. Buettner et al. — Tue, 08 Nov 2011 14:34:32 PST

The purpose of this article is to grade research evidence supporting exercise-based interventions for persons with early-stage dementias and to report the recommendations of a consensus panel. The search produced 11 databased articles testing the effects of exercise interventions on a variety of outcomes. The body of evidence to support exercise interventions in the prevention and treatment of Alzheimer's disease is growing and has potential as a treatment modality following translational studies in recreation therapy and other fields.

Decisional involvement: Staff nurse and nurse manager perceptions

C. A. Scherb et al. — Tue, 08 Nov 2011 14:34:24 PST

Enhancing involvement in organizational decisions is one strategy to improve the work environment of registered nurses and to increase their recruitment and retention. Little is known about the type of decision making and the level of involvement nurses desire. This was a descriptive study exploring staff nurse and nurse manager ratings of actual and preferred decisional involvement and differences between staff nurses and nurse managers. A sample of 320 RNs from a Midwestern health care network was surveyed using the Decisional Involvement Scale. Nurse managers and staff nurses had statistically significant differences in their perceptions of who was involved in actual decision making in the areas of unit governance and leadership and collaboration or liaison activities. There were statistically significant differences in preferred decisional involvement between staff nurses and nurse managers in the overall DIS scale and the subscales of unit governance and leadership and quality of support staff practice.

Nursing management innovations: A need for systematic evaluation

Joanne C. McCloskey et al. — Tue, 08 Nov 2011 14:34:16 PST

While emphasis in nursing is placed on research on clinical interventions, there has been little attention to the equally important management interventions. The concept of a management intervention or innovation is introduced here and five types of management innovations in nursing are identified. An overview of the research base for four of the innovations demonstrates the need for systematic evaluation.

Gender and aging

Janet K. Specht — Tue, 08 Nov 2011 14:34:08 PST

Nursing outcomes for evaluations of caregiver outcomes in a rural Alzheimer demonstration project

Janet K. Specht — Tue, 08 Nov 2011 14:34:00 PST

Outcomes of family involvement in care intervention for caregivers of individuals with dementia

Meridean Maas et al. — Tue, 08 Nov 2011 14:33:49 PST

BACKGROUND: Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships. OBJECTIVE: The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role. METHODS: A quasi-experimental design with nonequivalent groups and repeated pretest and posttest measures was used to examine the effects of the Family Involvement in Care intervention. The study recruited 14 Midwestern nursing home special dementia care units, matched by aegis and staff turnover, and randomized from matched pairs to experimental and control conditions. The samples included 185 family members and 895 staff. The Family Involvement in Care intervention is a protocol for family and staff negotiation of a written partnership agreement. Family caregiver outcomes were measured using instruments pretested for reliability and validity. Data were analyzed using hierarchical linear modeling. RESULTS: With adjustment for multiple tests, statistically significant beneficial intervention effects were found in three areas of family caregiver outcomes (emotional reactions to the caregiving role, perceptions of relationships with staff, and perceptions of care for relatives) and in one of three areas of staff outcomes (staff perceptions of the family caregiving role). For family members, effects were found for the measures assessing loss, captivity, staff disregard, resident activities, and physical care. Some of the intervention effects for family members were found only for caregivers of the same generation as the resident. For staff, effects were found for measures of dominion, disruption by family, and irrelevance of family. CONCLUSIONS: The results of the study indicate that the Family Involvement in Care intervention improves the caregiving experience of family members in nursing homes as well as nursing home staff attitudes toward family members. The intervention did not influence the perceived conflict with staff on the part of family caregivers or the perception of a partnership with family caregivers on the part of staff.

Issues in conducting research in nursing homes

Meridean Maas et al. — Tue, 08 Nov 2011 14:33:41 PST

Anticipation of increased numbers of older persons throughout the coming decades who will require care and assistance with chronic illnesses and functional deficits has correspondingly increased awareness of the need for nursing research to support best geriatric nursing practices. Although badly needed, research in nursing homes presents challenges. This article discusses issues and challenges of ethically acceptable and rigorous research in nursing homes that are related to the dependency and institutionalization of older persons and to setting, staff, and resident characteristics. Strategies for easing the challenges of nursing research in nursing homes are offered.

Gerontology coursework in undergraduate nursing programs in the United States

K. Gulp et al. — Tue, 08 Nov 2011 14:33:33 PST

Patterns and treatments of urinary incontinence on special care units

Janet K. Specht et al. — Tue, 08 Nov 2011 14:33:25 PST

Assessment of transient urinary incontinence in older adults (vol 109, pg 62, 2009)

A. Dowling-Castronovo et al. — Tue, 08 Nov 2011 14:33:18 PST

Wheelchair clinic

Janet K. Specht — Tue, 08 Nov 2011 14:33:10 PST

Nursing outcomes classification: A preliminary report of field testing

Meridean Maas et al. — Tue, 08 Nov 2011 14:33:01 PST

Clinically useful and measurable patient outcomes that are sensitive to nursing interventions are needed to determine the effectiveness of nursing care. Nursing Outcomes Classification (NOC) researchers are evaluating the reliability, validity, and usefulness of the first 190 published outcomes in 10 sites representing the continuum of care. Preliminary analysis of inter-rater reliability and construct or criterion validity of 15 outcomes are described. Results indicate NOC outcomes can be used to accurately document the effectiveness of nursing interventions.

Everyday excellence. A framework for professional nursing practice in long-term care

S. S. Lyons et al. — Tue, 08 Nov 2011 14:32:53 PST

RNs make measurable contributions to the health and wellness of individuals living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively affect resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based on eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness of this framework for professional nursing practice.

Integration of pressure ulcer treatment protocol into practice: Clinical outcomes and care environment attributes

Rita A. Frantz et al. — Tue, 08 Nov 2011 14:32:44 PST

The purpose of this study was to determine if a research-based protocol for pressure ulcer treatment that had been successfully implemented in a long-term care facility was sustained over time. A secondary aim was to describe the attributes of the care environment that may have contributed to or impeded the maintenance of this protocol. A retrospective chart review was conducted of all patients who developed incident stage II, III, or IV pressure ulcers in the facility over a one-year period five years after initial implementation of a pressure ulcer treatment protocol. Data regarding ulcer characteristics and type, frequency, and duration of treatments were collected. Subjects were followed until the ulcer healed, the subject died or was discharged, or the 1-year study period ended. Care environment attributes, including patient care hours, turnover and stability rates, salaries, decision-making structures, and facility mission were obtained from the facility's Human Resource Department and existing databases in the Nursing Services Department. Outcomes of protocol implementation were defined as ulcer healing and costs associated with treatment. Costs were calculated from the provider perspective and included cost of supplies and labor consumed in providing direct pressure ulcer care. Of the 46 incident ulcers treated during the one-year study period, 40 (87%) healed and five (11%) were unhealed when the subject died. One ulcer remained unhealed at the end of the study. The total cost for treatment of these incident ulcers was $18,688, with nursing labor comprising 80% of the total expenditures. Adherence to the protocol, which contained predominantly inexpensive moist wound healing treatment options, resulted in complete healing of most pressure ulcers at a relatively low cost to the facility. The organizational environment of the facility, which maintains staffing levels and salaries at higher than national averages and promotes staff nurse accountability and decision making, may have provided the necessary climate to overcome barriers to clinical integration and sustain the desired care practices.

Research-based protocol: Prompted voiding for persons with urinary incontinence

S. S. Lyons et al. — Tue, 08 Nov 2011 14:32:33 PST

Best practice initiatives in geriatric nursing: Experiences from the John A. Hartford Foundation Centers of Geriatric Nursing Excellence

T. A. Harvath et al. — Tue, 08 Nov 2011 14:32:26 PST

Iowa outcomes project: Nursing outcomes classification (NOC)

Marion Johnson et al. — Tue, 08 Nov 2011 14:32:08 PST