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Nancy Dunton

Publications and source records attributed to Nancy Dunton.

9 recordsLinked to original sources
PubMed2006

Non-normal path analysis in the presence of measurement error and missing data: a Bayesian analysis of nursing homes' structure and outcomes.

Path analytic models are useful tools in quantitative nursing research. They allow researchers to hypothesize causal inferential paths and test the significance of these paths both directly and indirectly through a mediating variable. A standard statistical method in the path analysis literature is to treat the variables as having a normal distribution and to estimate paths using several least squares regression equations. The parameters corresponding to the direct paths have point and interval estimates based on normal distribution theory. Indirect paths are a product of the direct path from the independent variable to the mediating variable and the direct path of the mediating variable to the dependent variable. However, in the case of non-normal distributions, the point and interval estimates of the indirect path become much more difficult to estimate. We address the issue of calculating indirect point and interval estimates in the case of non-normally distributed data. Our substantive application is a nursing home research problem in which the variables in the path analysis of interest involve variables with normal, Bernoulli, or Poisson distributions. Additionally, one of the Poisson variables is observed with error. This paper addresses estimating point and interval estimation of indirect paths for variables with non-normal distributions in the presence of missing data and measurement error. We handle these difficulties from a fully Bayesian point of view. We present our substantive path analysis motivated from a nursing home structure, process, and outcomes model. Our results focus on the impact job turnover in the nursing homes has on nursing home outcomes.

Data Interpretation, Statistical↗
PubMed2006

Inter-rater reliability of nursing home surveys: a Bayesian latent class approach.

In the U.S., federal and state governments perform routine inspections of nursing homes. Results of the inspections allow government to generate fines for findings of non-compliance as well as allow consumers to rank facilities. The purpose of this study is to investigate the inter-rater reliability of the nursing home survey process. In general, the survey data involves 191 binary deficiency variables interpreted as 'deficient' or 'non-deficient'. To reduce the dimensionality of the problem, our proposed method involves two steps. First, we reduce the deficiency categories to sub-categories using previous nursing home studies. Second, looking at the State of Kansas specifically, we take the deficiency data from 1 year, and use Bayesian latent class analysis (LCA) to collapse the sub-categories to a binary variable. We evaluate inter-rater agreement using deficiency data from two separate survey teams on one facility, a matched-pair design. We evaluate the agreement of the two raters on binary data using the weights from the LCA. This allows a two-by-two contingency analysis using a Bayesian beta-binomial model. We elicit informative prior distributions from the nursing home providers. Together, with the experimental data, this provides a posterior distribution of the kappa agreement of the raters for nursing home deficiency citation data.

Bayes Theorem↗
PubMed2006

An exploration of nursing home organizational processes.

The purpose of this study is to explore the relationship between nursing home staffs' perceptions of organizational processes (communication, teamwork, and leadership) with characteristics (turnover, tenure, and educational preparation) of the nursing home administrator (NHA) and director of nursing (DON). NHAs and DONs rate communication, teamwork, and leadership significantly higher than direct care staff do (registered nurses, licensed practical nurses, certified nurse aides [CNAs]). CNAs have the lowest ratings of communication and teamwork. Turnover of the NHA and DON is significantly and negatively associated with communication and teamwork. Two thirds of DONs surveyed hold less than a baccalaureate degree; this does not influence staffs' ratings of communication, teamwork, and leadership. Findings from this study highlight the need to explore differences in perceptions between administrative and direct care staff and how these may or may not influence staff development and quality improvement activities in nursing homes.

Administrative Personnel↗
PubMed2006

Unit type differences in RN workgroup job satisfaction.

Using cross-sectional data from the 2004 National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey, differences in RN workgroup job satisfaction were examined among 10 unit types--medical-surgical, step-down, critical care, pediatric, maternal-newborn, psychiatric, emergency department, rehabilitation, surgical services, and outpatient clinics and labs. The national sample included RN workgroups in 2,900 patient care units (55,516 RNs; 206 hospitals in 44 states). Workgroup satisfaction across all unit types was moderate. RN workgroups in pediatric units were the most satisfied, whereas those in surgical services and emergency department unit types were least satisfied. A consistent finding across all unit types was high satisfaction with the specific domains of nurse-to-nurse interaction, professional status, and professional development versus much lower satisfaction with task, decision making, and pay. Findings can be used to inform and develop investigations that examine specific aspects of the work environment for RN workgroups in various unit types.

Data Collection↗
PubMed2004

Herbal and vitamin/mineral supplement use by retirement community residents: preliminary findings.

A survey questionnaire assessed supplement use by free-living residents of a retirement community. Of the 318 respondents (mean age 82.2 years), 20% of women and 20% of men reported using herbal supplements, with 62% of these using them at least once per week. Most herbal supplements users (97%) also used vitamin/mineral supplements. Sixty-eight percent of herbal supplement users felt very much/somewhat informed about taking the supplements. Forty-four percent, however, were not sure whether there was testing before marketing; 33% were not sure about side effects. Half (52%) relied "very much/somewhat" on doctors/nurses as information sources; 40% relied on dietitians.

Aged↗
PubMed2004

The NDNQI-Adapted Index of work satisfaction.

The valid measurement of nurses' job satisfaction is critical because job satisfaction is important for the retention of qualified nurses to provide patient care in hospitals. Two studies were conducted to adapt the Stamps Index of Work Satisfaction (1997b) to measure work satisfaction at the patient care unit level for use by the National Database of Nursing Quality Indicators (NDNQI). In Study 1 (n = 918 RNs) exploratory factor analysis of data obtained using the NDNQI-Adapted Index replicated the conceptual dimensions of the Stamps measure. Associations with scores on Job Enjoyment were evidence that the Index measured the intended construct. Using theta, the reliability of the composite subscales was .91. The adapted Work Satisfaction subscale scores explained 46% of the variance in Job Enjoyment, with each subscale contributing uniquely (p < .001). In Study 2 (n = 2277 RNs) confirmatory factor analysis using structural equation modeling supported the 7-subscale structure for the Adapted Index (CFI [719] = .88; RMR = .05). Replication of associations between scores on the Index subscales and Job Enjoyment provided further evidence regarding validity of the data, since the Work Satisfaction subscales explained 56% of the variance in Job Enjoyment. The feasibility of using an on-line version of the Adapted-Index for data collection was demonstrated. The findings from the two studies indicate that the adapted Index of Work Satisfaction has a structure similar to the original instrument and is a reliable and valid measure of work satisfaction at the patient care unit level.

Factor Analysis, Statistical↗
PubMedDate not supplied

Reliability testing of the National Database of Nursing Quality Indicators pressure ulcer indicator.

A criterion-referenced Web-based test was designed and administered to 256 individuals at 48 randomly sampled National Database of Nursing Quality Indicators (NDNQI) member hospitals to determine the reliability of the NDNQI pressure ulcer indicator. Overall kappa values for pressure ulcer identification, staging, and sourcing indicate moderate to near perfect reliability. Findings suggest that nurses can accurately differentiate pressure ulcers from other ulcerous wounds in Web-based photographs, reliably stage pressure ulcers, and reliably identify community versus nosocomial pressure ulcers.

American Nurses' Association↗