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Self-report of oral health services provided by nurses'aides in nursing homes.

PURPOSE: The purpose of this investigation was to identify the oral healthcare role of nurses' aides in nursing homes. Nurses' aides were asked to report what preventive and referral oral health services they provided, factors that encourage and discourage performance of these services, and their perceived knowledge of oral hygiene care procedures. METHODS: A random sample of 40% (n = 14) of nursing home facilities in southeastern Virginia was selected. A 14-item questionnaire was administered to 121 nurses' aides employed at 11 of these nursing home facilities during April, May, and June of 1991. Frequency and percentages were analyzed for discrete, nominally, and ordinally scaled data. RESULTS: Eleven of the 14 nursing homes selected agreed to participate, representing 32% of the nursing homes in the southeastern region of Virginia. Ninety-eight out of 121 questionnaires were completed and analyzed. Nurses' aides in nursing home facilities typically reported providing preventive oral health services such as mouthrinsing (71%), toothbrushing (63%), and denture cleaning procedures (37%) for nursing home residents. The majority of nurses' aides indicated that patient cooperativeness was a major factor that encouraged (71%) or discouraged (88%) the performance of oral health services. Aides typically reported suspicious and abnormal findings detected in residents' mouths to the nurse in charge of the shift (97 5). The majority of nurses' aides rated their knowledge of mouthrinses for residents with teeth (99%), denture cleaning (99%), toothbrushing (97%), fluoride mouthrinses for residences with teeth (90%), mouth checks for residents with teeth (91%), and flossing (61%) as adequate or excellent. However, a large percentage of nurses' aides rated their knowledge of saliva substitutes (45%) and flossing (39%) as poor. CONCLUSION: This study indicated that nurses' aides generally provide daily oral hygiene services to nursing home residents. Thus, the role of the dental hygienist should be to outline specific educational and curricular guidelines and conduct training programs for nurses' aides and to develop instructional materials to be used in nursing homes. Future dental hygiene graduates must be prepared to meet the needs of oral hygiene education for nurses' aides.

Aged↗

Institutional loyalty and job satisfaction among nurse aides in nursing homes.

The high rate of turnover among nurse aides employed in nursing homes has been associated with the low job status and the poor job benefits accorded workers. However, this is not always the case. Competitive benefit packages and limited labor market opportunities increase the likelihood that nurse aides in some nursing homes may stay on the job despite their dissatisfaction with it. The present study investigated "institutional loyalty," an attitudinal proxy for job turnover, among 219 nurse aides for its relationship to a number of job-related factors. Somewhat unexpectedly, the quality of the social environment of the nursing home was found to be as important as attitudes toward job benefits in accounting for institutional loyalty.

Attitude of Health Personnel↗

Violence experienced by nurses' aides in nursing homes: an exploratory study.

1. The growing aged population in the United States will result in an increase in nursing home patients, and in numbers of employees in these homes providing care to patients. Nurses' aides, an employee group that has not received much attention, will be the primary providers of this patient care. 2. In this preliminary study the abuse experienced by nurses' aides in nursing homes was both a psychosocial and ergonomic stressor, because it had emotional and psychological components, as well as actual physical injury. 3. Nurses' aides, like other workers, deserve a safe and healthful workplace. A large scale study should be done to determine the extent of abuse/violence directed toward nursing home employees. 4. If abuse is validated as a problem, aides should receive training in handling abusive patients. In addition, it is important to identify the factors related to patients' abusive behaviors and to test mechanisms for reducing these behaviors.

Burnout, Professional↗

Observation evaluation to assess race and educational bias in state-mandated standard testing of nurse aides in nursing homes.

This article presents an assessment of whether race, education, gender, or other testing bias was present in a state-mandated nurse aide competency test. This assessment was carried out with data from two sources: (a) a statewide standardized test for all nurse aides that was given by a nationally known testing company, (b) an independent observational evaluation with a Behaviorally Anchored Rating Scale (BARS) for nurse aides' performance that was carried out by the investigators. The results show that race and education level were predictors of performance on written and manual portions of the standardized test. Gender, age, and years of experience were also shown to predict test success. Comparing data from the two sources suggests that a possible bias in the standardized nurse aid test. The independent observation of performance on the job with the BARS is shown to be less biased.

Adult↗

Profile of home care aides, nursing home aides, and hospital aides: historical changes and data recommendations.

PURPOSE: To examine demographic characteristics and work conditions of home care aides, nursing home aides, and hospital aides in the late 1980s and late 1990s. DESIGN AND METHODS: This study replicated a previous study which examined the Current Population Survey (CPS) March supplement from 1987 to 1989. The present study examined CPS data from 1997 to 1999 both to obtain a profile of aides in the late 1990s and to compare 1990's work conditions and demographic characteristics with those of aides in the late 1980s. RESULTS: Whereas demographic characteristics and work conditions of hospital and nursing home aides show little change over the decade, home care aides today are generally younger, more educated, more likely to hold full-time positions, and more likely to have health benefits than their counterparts 10 years ago. Yet work conditions are still poorer for home care aides than for the other types of aides. IMPLICATIONS: Work conditions need further improvement, particularly for home care aides. More accurate data to describe paraprofessional care workers are also necessary to address the serious worker shortage problems.

Adult↗

Sleep disorder symptoms among nurses and nursing aides.

Nurses and nursing aides (n = 418) currently working on a regular evening or day schedule were compared in terms of sleep disorder symptoms. The relationship between past nightwork and sleep disorder symptoms was also assessed. The prevalence of individual symptoms varied from 6 to 53%. Evening workers showed a pattern of sleep disorder compatible with sleep deprivation, whereas the pattern for day workers was more compatible with insomnia. Past nightwork was significantly associated with symptoms of day tiredness and the quantity of sleep obtained was influenced by past nightwork. The prevalence of a combination of four insomnia symptoms (initial, intermittent, and terminal insomnia and fatigue during the day) was 5.4% among current day workers but no cases were identified among evening workers. Among day workers, the trend for insomnia across levels of duration of past nightwork fell slightly short of conventional statistical significance (P = 0.09). The relationship between a combination of four symptoms was neither modified nor confounded by variables such as age, chronotype, intensity of past nightwork, and latency. In conclusion, although some sleep symptoms were associated with nightwork, a clear residual effect on a combination of symptoms could not be shown.

Adult↗

Work-related factors of low back pain among nursing aides in nursing homes for the elderly.

This survey was performed in December 1991 on 555 nursing aides (NAs) in 32 Special Nursing Homes for the Elderly (SNHs) in Kochi Prefecture, Japan. The purpose of the survey was to establish the relationship between low back pain among NAs in SNHs, and the degree of dependency in the activities of daily living (ADL) of the patients under their care. In order to investigate the work-related factors of low back pain, a questionnaire was sent to the NAs, requesting information on the NAs' low back pain condition. Another questionnaire was sent to the 32 SNHs, concerning the status of patients in the respective SNHs. Of the 463 NAs questionnaires which were returned, 443 female NAs' responses were analyzed. The following findings were observed. The prevalence of low back pain among the NAs was high (the one month prevalence was 77.0%), and of the afflicted NAs, 98 (24.5%) were visiting a health care provider. The NAs with low back pain experienced difficulty in completing their care-giving tasks, and complained about their working conditions and working environment more often than the NAs without low back pain. In addition, this study showed that, at SNHs where the proportions of dependence in patients' ADL were high, the prevalence of low back pain among their NAs was high. This fact was also confirmed by multiple logistic regression. We, therefore, suggest in this study that patients' care needs are associated with low back pain among NAs.

Activities of Daily Living↗

Work stress and physical assault of nursing aides in rural nursing homes with and without dementia special care units.

PURPOSE: This study compared nursing aides (NAs) employed in rural nursing homes with and without dementia special care units (SCUs) on (1) exposure to and distress from disruptive behaviours exhibited by residents, (2) job strain and (3) physical assault. DESIGN AND METHODS: The data were drawn from a larger study conducted in Saskatchewan, Canada, in which all rural nursing homes of < or = 100 beds that had an SCU were matched to same-sized rural facilities with no SCU. Nursing aides (n = 355) completed a mailed survey questionnaire. RESULTS: Nursing aides employed in nursing homes with an SCU reported significantly less frequent exposure to disruptive behaviours (including aggressive and aversive behaviours) than NAs in non-SCU facilities, less distress when these behaviours were directed toward them, less exposure to aggressive behaviour during caregiving, lower job demands and lower job strain. There was a trend toward increased risk of being assaulted in the last year associated with being in a non-SCU facility. Having a permanent position, increased job strain, and feeling inadequately prepared for dementia care were significantly associated with higher risk of being assaulted. In the SCU facilities, NAs who worked more time on the SCU reported more assaults but less distress from disruptive behaviour, lower psychological job demands, lower job strain and greater work autonomy. IMPLICATIONS: Providing more dementia care training and reducing job demands and job strain may help to reduce work-related stress and physical assault of nursing aides employed in nursing homes.

Adult↗

[Experience in applying legal conditions according to the nursing insurance regulation--ambulatory rehabilitation, nursing aids and nursing care eligibility].

UNLABELLED: The Statutory Health Care (Nursing) Insurance in Germany, called "Pflegeversicherung (PVG)", financially supports nursing care at home and in nursing homes. If suggested by an authorized examining person (MDK), it provides access to ambulatory rehabilitation and to various aids to facilitate nursing care of patients cared for at home. Also, the PVG mandatory requires the visit by a nurse every three to six months (nursing care checkup) if the patient is cared for by family members without support of professional nursing services. Little is known about the realisation of the suggestions given by the examining person from MDK and about the realisation of the nursing care checkup in actual practice. Our study tried to find answers to these questions. For this purpose, we visited 150 patients at home and asked them about rehabilitation efforts, whether the recommended additional aids had been supplied, and whether nursing care checkups had been successfully performed. RESULTS: For 41 patients, rehabilitatory exercises were suggested, but only 7 were actually realised. 89 patients were supposed to receive various aids, but only 31 were actually delivered. Whenever rehabilitation was performed, it was nearly without exception thanks to the initiative of relatives supported by their private doctor. Nursing care checkups should have been performed in 80 patients, but had been realised in only 11 cases. The care providing relatives considered such "care checkups" to be ineffective, costly and useless. CONCLUSION: The nonfinancial services granted by the PVG were not translated into reality in most instances, and if so, it was due to efforts of relatives and private doctors, not to efforts of the statutory bodies. Apparently this task was more than these bodies could handle during this early phase of services by the PVG. Therefore, the private doctors (family doctors) should be informed of the results of the examination done by MDK. The need for the nursing care checkup should be reconsidered.

Aged↗