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At least 19 recordsLinked to original sources
PubMedDate not supplied

Preventing assaults by nursing home residents: nursing assistants' knowledge and confidence--a pilot study.

OBJECTIVE: To describe the frequency and context of assaults against nursing assistants (NAs) from residents and to describe NAs' beliefs about their violence prevention knowledge and self-efficacy to prevent assaults from residents. DESIGN: Survey. SETTING: Six nursing homes. PARTICIPANTS: A total of 138 nursing assistants. MEASUREMENTS: NAs completed two investigator-developed surveys, the Demographic and Employment Questionnaire and the Knowledge and Self-Efficacy Survey. The Demographic and Employment Questionnaire included questions about race, gender, age, and education, current and previous employment, number of residents usually assigned, frequency of assaults, and training on workplace violence. On the Knowledge and Self-Efficacy Survey, the participants used a five-point Likert scale to rate their knowledge and confidence in recognizing and preventing assaults from residents. RESULTS: Assaults against nursing assistants from residents in nursing homes were common; 59% stated they were assaulted at least once a week and 16% stated they were assaulted daily. Fifty-one percent stated that they had been injured in their lifetime from an assault from a resident, and 38% of those injured received medical attention for an injury. On the Likert items, nursing assistants reported that they believed they had the most knowledge (mean = 3.76) and confidence (mean 3.81) in their ability to recognize when a resident is agitated or becoming aggressive. In comparison, NAs rated lower their knowledge (mean = 3.45) and confidence in their ability (3.50) to keep residents from becoming agitated or aggressive (mean 3.50). NAs rated lowest their knowledge (3.42) and confidence (mean = 3.47) in their ability to decrease residents' agitation and aggressiveness once they become agitated or aggressive. CONCLUSIONS: These findings provide useful information that supports the need for violence prevention education and for developing violence prevention programs in nursing homes.

Journal Article↗
PubMed1993

Effects of physical therapy on functional status of nursing home residents.

Nursing home residents typically have decreased functional and physical status and high health care utilization and costs. This randomized trial evaluates whether physical therapy is beneficial for frail debilitated long-stay residents of nursing homes. Subjects are recruited from a cohort of academic and community nursing home residents who have resided in the nursing home for greater than 3 months and are over age 60 and dependent in at least two activities of daily living. Subjects randomized to the intervention group receive one-on-one physical therapy sessions three times weekly for 4 months, while control group subjects receive structured social visits three times weekly to control for potential Hawthorne effects. Physical therapy sessions generally last 30 minutes and consist of functional activity and general conditioning exercises; these exercises are individually tailored to the subject's level of physical and functional disability. Prime outcome variables are physical function assessed by an observer-administered, performance-based instrument and self-perceived health status assessed by the Sickness Impact Profile. Health care utilization and associated costs are calculated for the following areas: the nursing home, hospitalizations, outpatient visits and procedures, medications, and the intervention. A cost-effectiveness ratio dividing incremental health care utilization and physical therapy intervention costs by the observed improvement in physical function is calculated. It is expected that results of this study can be used to help determine whether long-stay nursing home residents should be eligible for physical therapy.

Activities of Daily Living↗
PubMed2002

Vision-specific health-related quality of life: content areas for nursing home residents.

Nursing home residents have a high prevalence of remediable visual impairment and blindness. Future research on the effectiveness of providing eye care to nursing home residents will need to include a vision-targeted health-related quality of life (HRQOL) instrument appropriate for this population. The purpose of this study was to identify the core content areas for such an instrument. In-depth interviews on vision-related issues were conducted with 40 residents. Interviews were audio-taped, transcribed, and coded using a standardized protocol. Binocular distance and near visual acuity were assessed using the resident's 'walking around' correction to examine whether one vision-specific HRQOL measure could address the needs of residents with 'good' and 'poor' vision. Overall 1070 vision-related comments were identified. Residents mentioned 315 problem comments that were grouped into 13 categories, including ocular symptoms (18% of comments), reading (15%), general vision (13%), psychological distress (12%), and activities of daily living (ADLs) (7%). Compared to published data on vision-specific content areas most relevant to community based persons, nursing home residents focused more on ocular symptoms and basic ADLs, with no mention of issues related to driving, home care, and finances. The majority of categories mentioned did not differ on the proportion of comments made- by those with 'good' and 'poor' visual acuity, suggesting that one vision-specific HRQOL instrument would be appropriate for residents with varying levels of visual acuity. Future work will focus on developing a vision-specific HRQOL instrument for nursing home residents.

Activities of Daily Living↗
PubMed1991

Problems of nursing home residents: nurse and resident perceptions.

The nurse's consideration of the nursing home resident's perspective of his or her problems conveys respect for the resident as an individual and as a valued source of information concerning his or her own needs. Such consideration facilitates mutual setting of goals for patient achievement. The purpose of this study was to determine the similarities and differences between the nurse's perception of the nursing home resident's problems and the resident's perception of his or her problems. Thirty-one residents and their nurses completed questionnaires to identify perceived needs for assistance with daily activities and to assess the presence and degree of specified common problems. Out of 45 items, significant differences between nurse and resident ratings were found for the following 7 items: assistance needed for bathing and grooming, appetite problems, loss of bladder control, difficulty breathing at rest, decreased sense of smell, and loss of usefulness. Implications for nursing practice and nursing staff education are discussed.

Activities of Daily Living↗
PubMed1991

Conducting family meetings in nursing homes: resident, nurse, and family perceptions.

One facet of the teaching nursing home activities of the Maine-Dartmouth Family Practice Residency Program involves requiring residents to schedule a yearly family meeting in collaboration with nursing staff for each of the three to six nursing home patients for whom they are primarily responsible. During a one-year period, meetings were held for 45 of 63 nursing home patients (71%). All participants used a simple instrument to evaluate the experience. A general outline of the content and process of successful meetings is described. Results indicate that families, patients, nurses, and physicians found the meetings useful for sharing medical information and providing emotional support. Meetings typically reinforced or made only minor refinements in the ongoing plan of care. The implementation methods of the project are briefly described so that others might consider making yearly family meetings in nursing homes a part of their training programs.

Communication↗
PubMed2004

Timing in the communication of pain among nursing home residents, nursing staff, and clinicians.

BACKGROUND: The management of nursing home (NH) residents' pain requires adequate nursing assessment and clinician knowledge of pain therapies. However, the timely communication of pain from residents to nurses and from nurses to clinicians is equally necessary. Using a 4-step model (nursing assessment of pain, notification of clinicians regarding pain assessment, clinicians' assessment of pain and intervention), and nursing reassessment following an intervention, we describe the timing with which each of these steps occur. METHODS: In a telephone survey of directors of nursing from 63 of the 68 nursing homes in New Haven County, Connecticut, we determined (1) how often nurses assess pain in residents, (2) when nurses notify clinicians about residents' pain, (3) how often clinicians assess pain, and (4) when nurses reassess pain after a clinician's intervention. RESULTS: Whereas in 76% of NHs nurses assessed pain in residents without pain at least "quarterly," only in 46% of NHs was pain assessed in residents with pain at least "every shift." In 42% of NHs nurses notified clinicians at least when the regimen was "ineffective." Only 55% of directors of nursing reported that clinicians assessed pain at least every 30 to 60 days. Finally, in 73% of NHs nursing reassessment occurred at least 1 hour after intervention. CONCLUSIONS: There is considerable variability in how frequently nurses and clinicians assess pain, when clinicians are notified about pain, and how frequently nurses reassess pain. Studies are needed to determine optimal timing in the communication process of pain to allow better pain management outcomes and quality of care for NH residents.

Communication↗
PubMed1992

The relationship of antipsychotic drug use, behavior, and diagnoses among nursing home residents.

Nursing homes have been criticized for frequent use and possible misuse of psychoactive agents. These issues are of clinical concern and policy relevance, especially since the passage of the Omnibus Budget Reconciliation Act (OBRA) of 1987. Using a sample of 419 residents, the authors examined the relationships among antipsychotic drug (AP) use, behavior, and mental health diagnoses. Only 23.2% of the residents were administered APs on a routine and/or "as-needed" basis. Based on the Multidimensional Observation Scale for Elderly Subjects (MOSES) ratings, AP users were more irritable, disoriented, and withdrawn than were nonusers. Also, AP users demonstrated agitated behaviors more frequently. Notably, AP users and nonusers differed significantly in terms of documented mental health diagnoses. Among AP users, 70.1% had documented dementia, 8.3% were psychotic or had other psychiatric disorders, and 21.6% had no mental health diagnoses. In contrast, the majority of nonusers had no mental health disorders. Logistic regression revealed that diagnostic factors, frequency of agitation, level of withdrawal, and marital status were significant predictors of AP use.

Aged↗
PubMed1988

Relationship between depression and agitation in nursing home residents.

Nursing staff and social workers independently rated the manifestations of agitation and depression in 408 nursing home residents. The role of dementia was also investigated. The relationship between agitation (3 factors: aggressive, physically nonaggressive, and verbally agitated) and depression (2 factors: social functioning and depressed affect) was examined. While residents who manifested either aggressive behavior (e.g., hitting, cursing) or physically nonaggressive behaviors (e.g., general restlessness, pacing) tended to be more cognitively impaired, aggressive behaviors were negatively related to the social functioning aspect of depression, and physically nonaggressive behaviors were not related to either aspect of depression. Verbally agitated individuals were more cognitively intact and displayed depressed affects. It is conceivable that depressed affect was perceived only in verbally agitated residents since these persons were able to communicate their depression to caregivers. This result raises questions concerning the meaningfulness of depression measurements in noncommunicative residents.

Aged↗
PubMed2002

Analyses of the minimum data set: comparisons of nursing home residents with multiple sclerosis to other nursing home residents.

This research compares nursing home residents with multiple sclerosis (MS) at admission to other nursing home residents using the minimum data set (MDS). These comparisons include sociodemographic characteristics and health status measures, as well as treatments and procedures received. We analysed 14,009 admission assessments in the MDS for residents with MS between June 22, 1998 and December 31, 2000. We also analysed 440,642 MDS admission assessments for all residents admitted to nursing homes during the year 2000, with any admission assessments for residents with MS excluded from this comparison group. Residents with MS were significantly younger at admission than other recently admitted residents. In addition, residents with MS tended to be significantly more physically disabled and also less cognitively impaired than other residents at admission, based on analyses of several measures of physical disability and cognitive performance. Nursing homes caring for residents with MS should provide services and programs, including mental health care, that address the needs of these younger, more physically disabled, and more cognitvely intact residents.

Activities of Daily Living↗
PubMedDate not supplied

Strategies for conducting dental examinations among cognitively impaired nursing home residents.

Many nursing home residents have poor oral health and are in need of treatment. A major barrier to providing care is the difficulty of examining cognitively impaired elders. In two research studies, 625 exams were conducted on 181 nursing home residents, the majority of whom suffered severe cognitive impairment. Qualitative data collected during the course of these two studies revealed strategies that permitted examiners to conduct the examinations successfully, including developing rapport with the residents, providing a quiet environment, and enlisting the help of the primary caregiver. The importance of interdisciplinary collaboration among health professionals, especially dentists and nurses, is discussed.

Aged↗
PubMed1997

The Wellness Group: a novel intervention for coping with disruptive behavior among [corrected] elderly nursing home residents.

Elderly nursing home residents face the challenge of coping with the loss of independence, reduced physical abilities, feelings of isolation, anxiety, depression, and helplessness. Maintaining one's integrity within the nursing home is a challenge easily lost. Issues of coping with disability, change in body image, the promotion of self-empowerment, and autonomy are critical to preserving the personhood of a nursing home resident. Current emphasis on the management of behavior has focused entirely on the control of disruption rather than the promotion of resident strengths and abilities. We developed a group therapy program designed to enhance self-awareness, self-esteem, and body awareness among the demented elderly. Techniques of meditation, relaxation, sensory awareness and guided imagery were introduced and reinforced. This group is easily reproducible and offers benefits to both residents and interdisciplinary staff.

Aged↗
PubMed1997

Accuracy of nurse aides' functional health assessments of nursing home residents.

BACKGROUND: Nurse aides provide assessments of nursing home residents' functional health for use in care planning and quality assurance. Nurse practitioner assessments can serve as a standard for analysis of nurse aides' accuracy. This study compared nurse aide to nurse practitioner assessments of nursing home residents' functional health with regard to possible bias and extent of correlation. METHODS: Nurse aides' accuracy in assessing nursing home residents' activities of daily living was evaluated by comparisons to assessments performed by a master's-prepared nurse practitioner using four functional assessment instruments: the Barthel Index, the Katz Index of Activities of Daily Living, the Multidimensional Observation Scale for Elderly Subjects, and the Scaled Outcome Criteria. Data were collected in a 159-bed nonprofit nursing home licensed for skilled and intermediate care. Residents had a wide variety of functional and cognitive abilities and disabilities. Ninety-six nursing home residents provided data for the study. Functional health assessments by 24 nurse aides, each assessing 4 different nursing home residents, were compared to those of 1 nurse practitioner. Statistical analysis of accuracy used paired samples t-tests and Pearson product moment correlation coefficients. RESULTS: Nurse aide assessments and nurse practitioner assessments were highly correlated. Most functional health assessments evidenced no significant nurse aide bias. When bias was present it usually resulted from nurse aides electing more optimistic choices when using an assessment instrument that offered fewer response levels for rating residents. CONCLUSIONS: Nurse aides can accurately use well-calibrated instruments to assess nursing home residents' functional health. Demonstration of assessment accuracy in nurse aides, who provide the majority of direct care for nursing home residents, documented a valuable clinical resource for planning and evaluating resident care.

Activities of Daily Living↗
PubMed1992

Influences of prolonged bed rest and cognitive impairment on nursing home residents.

Seventy nursing home residents with and 87 without cerebrovascular diseases (CVD) were examined by the modified Stockton Geriatric Rating Scale (modified SGRS) which measures four aspects of impairments; physical disability, socially irritating behavior, communication failure and apathy. They were divided into 3 subgroups according to walking ability; prolonged bed rest, walking with aids and walking by themselves in both groups. Physical disability of mental decline was significantly aggravated more than that of normal intelligence in all the subgroups. Although communication failure and apathy of mental decline had deteriorated more than those of normal intelligence in prolonged bed rest in residents without CVD, apathy of the former had deteriorated more than that of the latter in walking by themselves in residents with CVD.

Aged↗
PubMed2003

Hospice and nonhospice nursing home residents.

OBJECTIVE: To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. DESIGN: Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in 1999. SETTING: Nursing homes. PARTICIPANTS: Residents of nursing homes designated as either hospice or end-stage on admission MDS. MEASUREMENTS: Percentage of hospice residents having various conditions as compared with other end-stage residents. RESULTS/CONCLUSIONS: Overall the clinical conditions of both hospice and nonhospice end-stage residents were similar. A greater percentage of hospice residents were found to have living wills, DNR orders, and cancer, and to be in moderate or severe pain. Hospice and nonhospice residents experienced similar time from admission to death or discharge (20 and 36 days, respectively). Based on the clinical condition of the two groups, it would appear that there are limited clinical reasons for the low utilization of the hospice benefit in nursing homes. The increased prevalence of advance care planning may lead toward use of hospice or may result from hospice enrollment. Hospice services seem to be thought of more frequently for residents with cancer and residents experiencing pain. Nursing homes must recognize their role as caregivers to the dying before palliative care is seen as a need for nursing home residents. Nursing homes need education in determining when a patient is appropriate for palliative care as only 4% are designated as end of life, and only 2% are shown to be receiving hospice care in hospice-contracted facilities.

Activities of Daily Living↗
PubMedDate not supplied

Factors that relate to activity engagement in nursing home residents.

Many nursing home residents are unoccupied and at risk for poor health outcomes because of inactivity. The purpose of this study was to identify characteristics of residents with dementia that predict engagement in activities when activities are implemented under ideal conditions. Data from a clinical trial that tested the efficacy of individually prescribed activities were used to address the study aim. Thirty subjects were videotaped daily for 12 days during 20-minute activity sessions. Measures of engagement (time on task and level of participation) were taken from these videotapes. Univariate logistic regression analyses indicated that cognitive status and physical function explained a significant amount of variance in engagement. Efforts to promote function may facilitate even greater benefits from prescribed activities by improving capacity for engagement.

Aged, 80 and over↗
PubMed1995

Maintaining ambulation in the frail nursing home resident: a nursing administered walking program.

This article describes a walking program that was implemented at a 550-bed long-term care facility. The program was developed in order to promote functional mobility in the frail nursing home population. The aim of the program is to establish a nursing procedure that focuses on the individual resident's need to walk, and to improve or maintain the ambulatory status of the frail elderly. Twenty nursing home residents from the first three units on which the program was implemented were evaluated before and after the implementation of the program. The data show that the participants improved their ambulatory status after participating in the walking program. This improvement was accompanied by a decrease in the proportion of residents falling.

Activities of Daily Living↗
PubMed1993

Self-reported hearing difficulty and audiometric thresholds in nursing home residents.

BACKGROUND: Nursing home practitioners usually assess the general health and functional abilities of each resident at the time of admission. If audiometric screening is not routinely available, assessment of the resident's hearing status will probably consist only of asking questions about hearing difficulty. In this study we explored which questions, when answered positively, were most strongly associated with moderate or severe hearing impairment. METHODS: A total of 198 newly admitted nursing home residents answered questions regarding their hearing in common listening situations, and then underwent audiometric assessment. RESULTS: Fifty-four percent of the residents had a pure tone average hearing level of > 25 dB at 500, 1000, and 2000 Hz and were therefore considered impaired. A single general question regarding hearing had a sensitivity of 69% in determining the presence of such impairment. Three specific questions which assessed hearing--in a group, while watching television, and while on the telephone--had a collective sensitivity of 83%. Asking the three questions was significantly (P = .003) more effective than asking only the general question. CONCLUSIONS: A set of specific questions significantly improved the identification of residents whose hearing loss affected their daily living activities compared with the use of a single hearing loss question.

Aged↗