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Biomedical subjects

Susan C Reinhard

Publications and source records attributed to Susan C Reinhard.

14 recordsLinked to original sources
PubMed2005

Continuous quality improvement as an innovation: which nursing facilities adopt it?

PURPOSE: We identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI. DESIGN AND METHODS: We performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey ( Zinn, Weech, & Brannon, 1998) and The New Jersey NH Profiles Chart. We also performed a discriminant analysis. Of 350 NHs, 46% returned completed questionnaires. RESULTS: Using variance innovation, resource dependence, and institutional perspectives for our framework, we found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters. IMPLICATIONS: Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.

Diffusion of Innovation↗
PubMed2005

Experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes.

In 2003, The John A. Hartford Foundation Institute for Geriatric Nursing, New York University Division of Nursing, convened an expert panel to explore the potential for developing recommendations for the caseloads of advanced practice nurses (APNs) in nursing homes and to provide substantive and detailed strategies to strengthen the use of APNs in nursing homes. The panel, consisting of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care, developed six recommendations related to caseloads for APNs in nursing homes. The recommendations address educational preparation of APNs; average reimbursable APN visits per day; factors affecting APNs caseload parameters, including provider characteristics, practice models, resident acuity, and facility factors; changes in Medicare reimbursement to acknowledge nonbillable time spent in resident care; and technical assistance to promote a climate conducive to APN practice in nursing homes. Detailed research findings and clinical expertise underpin each recommendation. These recommendations provide practitioners, payers, regulators, and consumers with a rationale and details of current advanced practice nursing models and caseload parameters, preferred geriatric education, reimbursement strategies, and a range of technical assistance necessary to strengthen, enhance, and increase APNs' participation in the care of nursing home residents.

Aged↗
PubMedDate not supplied

Nurse delegation of medication administration for older adults in assisted living.

Assisted living (AL) is a relatively new form of long-term care that offers residents personal care services and more independence in a home-like environment. Introduced to the United States in the 1980s, AL is changing the conventional thinking about how to care for frail older adults. One important issue to explore is registered nurse (RN) delegation to unlicensed assistive personnel (UAP), particularly for medication administration. This study provides a national perspective on medication delivery in AL settings from the perspectives of state Board of Nursing (BON) executives. Qualitative interviews using semi-structured interview guides were conducted with BON executives to validate a legal summary of AL regulations and nurse practice acts, and to identify nursing issues pertaining to medication management in AL across the United States. In this study, there was considerable variation across states regarding medication administration and the role of both the RN and the UAP. BON executives displayed a range of knowledge about nursing practice issues in AL, with many reporting low familiarity with this setting. Mechanisms for systematic review of quality of delegation were not in place. Medication administration and nurse delegation were dynamic issues, with practice and policy evolving concurrently. This study highlights the limited articulation of policies between agencies and across states in the important and growing setting of assisted living. Nurses have the opportunity to shape this evolving practice arena and to enhance awareness of the professional and clinical issues inherent in working with UAP in medication delivery.

Assisted Living Facilities↗
PubMedDate not supplied

Current approaches to postfall assessment in nursing homes.

OBJECTIVE: Falls in nursing homes occur among a large percentage of residents. Their onset necessitates a postfall assessment (PFA) be performed by clinical staff to determine likely etiology. The absence of an empirically validated comprehensive postfall assessment tool has led to considerable variability in the types of PFAs performed. The purpose of this study was to examine the types of PFA tools available, their content, and to compare this with national recommendations for fall assessment in geriatric practice. SETTING: A convenience sample of 379 long-term care facilities, with a cumulative census of over 40,000 residents, in New Jersey were solicited to return to the Director of Long-Term Care Surveys at the NJ Department of Health and Senior Services a copy of any PFA tools used in practice. METHODS: A review of the types of assessment tools used in each of the responding facilities were tabulated and coded as belonging to one of five categories: (1) fall-risk assessment short form, (2) fall-risk assessment long form, (3) fall prevention protocols such as fall programs and postfall assessment forms, (4) incident reports, and (5) other. A subset of 20 facilities used a specific PFA. This content was further analyzed and compared with national and professional recommendations for PFA that included five domains: (1) history of the fall, (2) environmental issues, (3) physical examination, (4) functional assessment, and (5) laboratory and other diagnostics. RESULTS: Of 379 facilities solicited, 149 responded (40%) to reveal a wide array of tools used for the purpose of PFA. These included: risk assessment tools, fall prevention programs, policies and procedures for fall management, and incident reports. Overall, most facilities used fall-risk assessment tools in place of PFA (63.7%; n=95). Many of the nationally recommended guidelines for PFA were not included in the tools included in this sample, with the exception of environmental questions that were evident in all PFAs surveyed (100%). Other fall circumstances related to time, mobility, and footwear were included less often (70% n=14) as were use of diuretics (55%;=11), mental status and ambulation ability (45%; n=9) of the falling older adult. CONCLUSION: Despite recommendations in the geriatric literature, comprehensive postfall assessment tools were unavailable for use by nursing home staff. When a PFA was performed, there was no consistency among facilities sampled. Data collected was minimal and unlikely to reveal the full range of possible underlying etiologies. Improved, validated PFA tools are needed to aid clinical staff in evaluating older adults who have fallen.

Accidental Falls↗