Comparison of the effectiveness of two protocols for treating nursing home residents with advanced dementia.

The Serial Trial Intervention (STI) is a decision support tool to address the problem of underassessment and undertreatment of pain and other unmet needs of people with dementia. This study compared the effectiveness of the 5-step and 9-step versions of the STI using a two-group repeated measures quasi-experimental design with randomization of 12 matched nursing homes. The sample consisted of 125 residents with moderate to severe dementia. Both the 5- and 9-step STIs significantly decreased discomfort and agitation from pre- to posttest (effect sizes = 0.45 to 0.90). The 9-step version was more effective for comorbid burden and increased cortisol slope (effect sizes = 0.50 and 0.49). Process variables were all statistically significantly improved using the 9-step STI. Nurse time was not different between the two groups. The clinical decision support rules embedded in the STI, particularly the 9-step version, helped nurses change practice and improved resident outcomes.

Predictors of nonpharmacological and pharmacological treatments stopped and started among nursing home residents with dementia.

The purpose of this study was to describe the nonpharmacological and pharmacological treatments stopped and started over 6 weeks among a sample of nursing home residents with moderate to severe dementia and to identify nurse and resident factors associated with starting new and stopping ineffective/unnecessary nonpharmacological and pharmacological treatments. One hundred thirty-four nursing home residents with dementia and 39 nurses from 12 nursing homes in the Midwest participated in this study. Resident and nursing process data were collected on daily tracking forms completed by the primary nurse over a 6-week period. Both assessment-driven intervention and evaluation-driven follow through significantly predicted treatments stopped and new treatments started. The findings demonstrate that nurses serve an essential role in maintaining resident physiological and psychological homeostasis by vigilantly responding to residents' physical problems and behaviors with assessment-driven intervention and evaluation-driven follow through.

Development and psychometric evaluation of the Core Nurse Resource Scale.

AIMS: To examine the factor structure, internal consistency reliability and concurrent-related validity of the Core Nurse Resource Scale. METHODS: A cross-sectional survey study design was used to obtain a sample of 149 nurses and nursing staff [Registered Nurse (RNs), Licensed Practical Nurse (LPNs) and Certified Nursing Assistant (CNAs)] working in long-term care facilities. Exploratory factor analysis, Cronbach's alpha and bivariate correlations were used to evaluate validity and reliability. RESULTS: Exploratory factor analysis yielded a scale with 18 items on three factors, accounting for 52% of the variance in scores. Internal consistency reliability for the composite and Core Nurse Resource Scale factors ranged from 0.79 to 0.91. The Core Nurse Resource Scale composite scale and subscales correlated positively with a measure of work engagement (r=0.247-0.572). CONCLUSIONS: The initial psychometric evaluation of the Core Nurse Resource Scale demonstrates it is a sound measure. Further validity and reliability assessment will need to be explored and assessed among nurses and other nursing staff working in other practice settings. IMPLICATIONS FOR NURSING MANAGEMENT: The intent of the Core Nurse Resource Scale is to evaluate the presence of physical, psychological and social resources of the nursing work environment, to identify workplaces at risk for disengaged (low work engagement) nursing staff and to provide useful diagnostic information to healthcare administrators interested in interventions to improve the nursing work environment.

Do personality traits predict work outcomes of certified nursing assistants?

The purposes of this study were to describe personality traits of certified nursing assistants (CNAs) employed at nursing homes and explore relationships between personality traits, job satisfaction, and job performance. The sample included 177 CNAs providing direct care to residents in three nursing homes. CNAs with high and low job performance skills were distinguished by the cluster of traits associated with teamwork skills. Overall, 21.3% of the variance in job satisfaction was explained by the personality traits of Adjustment, Prudence, Likeability, Excitable, and Dutiful, F(8, 145) = 4.899, p < 0.001. The links found between personality, job satisfaction, and job performance provide important information about the personality traits of nursing staff who are most likely to enjoy and perform well in the nursing home setting. Knowledge of these links may be useful for hiring the appropriate person for direct care nursing home positions.

Factors associated with time to identify physical problems of nursing home residents with dementia.

This study describes new problems emerging over 6 weeks for nursing home residents with advanced dementia and factors associated with time to identify the problems. The sample of 65 developed 149 new acute problems or exacerbations of existing conditions over the 6 weeks of data collection. The majority of these problems involved uncontrolled pain, new infections, and severe psychoses. Nurse assessment skill was associated with a shorter time to identify the new problem and more time spent on the problem. A higher ratio of new to existing interventions was also associated with a shorter time to identify the problem. Other patient characteristics associated with time to identify problems included nonspecific vocalizations, physical signs, cognitive status, and length of stay. While future research is warranted, findings from this study highlight the frequency of problems requiring treatment and suggest that improved assessment of residents may decrease the time to identify new problems.

Engagement at work: a review of the literature.

OBJECTIVES: Engagement at work has emerged as a potentially important employee performance and organizational management topic, however, the definition and measurement of engagement at work, and more specifically, nurse engagement, is poorly understood. The objective of this paper is to examine the current state of knowledge about engagement at work through a review of the literature. This review highlights the four lines of engagement research and focuses on the determinants and consequences of engagement at work. Methodological issues, as identified in the current research, and recommendations for future nurse-based engagement research are provided. DESIGN: A systematic review of the business, organizational psychology, and health sciences and health administration literature about engagement at work (1990-2007) was performed. DATA SOURCES: The electronic databases for Health Sciences and Health Administration (CINAHL, MEDLINE), Business (ABI INFORM), and Psychology (PsycINFO) were systematically searched. REVIEW METHODS: Due to the limited amount of research that has examined engagement among the nursing workforce, published research that included varying employee types were included in this review. The selection criteria for this review include those studies that were: (1) written in English and (2) examined engagement at work in employee populations of any type within any work setting. RESULTS: The literature review identified four distinct lines of research that has focused on engagement within the employee work role. Of the 32 engagement-based articles referenced in this paper, a sample of 20 studies report on the examination of antecedents and/or consequences of engagement at work among varying employee types and work settings. Key findings suggest organizational factors versus individual contributors significantly impact engagement at work. A common implication in this body of research was that of the performance-based impact. CONCLUSIONS: The study of nurses' work engagement and its relationship to nurses' organizational behavior, including work performance and healthcare organizational outcomes can be achieved by first building upon a conceptually consistent definition and measurement of work engagement. Future research is needed to provide nurse leaders with a better understanding of how nurse work engagement impacts organizational outcomes, including quality of care indicators.

Predictors of work engagement among medical-surgical registered nurses.

This descriptive, cross-sectional study examines the relationship of job satisfaction, turnover cognitions, job search behavior, and nurse demographics to work engagement among a sample of 167 registered nurses employed on medical and/or surgical units within six hospitals. Professional status, interaction, and thinking of quitting together explain 46%, F(3,160) = 47.546, p < .001, of the variance in work engagement. Additionally, the job satisfaction components of professional status and interaction are shown to significantly moderate the relationship between thinking of quitting and work engagement (t = 1.96, p < .05). Results suggest improvements in work environment processes that are consistent with professional status and interaction at work, such as integration of a professional nursing practice model and development and positioning of transformational leaders at every level of the organization, are needed.

Nurses' experience with the clinical application of a research-based nursing protocol in a long-term care setting.

AIM: To describe nurses' experience with the clinical application of a research-based nursing protocol (The Serial Trial Intervention) within a long-term care setting. DESIGN: A descriptive, qualitative study was conducted with a convenience sample of eight nurses from three nursing homes, who assessed and treated residents with dementia according to the Serial Trial Intervention protocol. METHODS: Each nurse participated in a semi-structured interview between September 2003 and May 2004. Interviews were audiotaped and transcribed verbatim. Qualitative content analysis of the data, including thematic analysis, was used to identify patterns of experience. RESULTS: Three themes emerged that offer insight into the factors contributing to implementation of research-based practice in a clinical setting. These include determining to intervene, pertinent steps of the protocol and facilitators and barriers. CONCLUSIONS: The interplay between the protocol, the residents receiving care, the nurses providing care and the setting in which the care is provided, are interacting to affect the outcomes expected. RELEVANCE TO CLINICAL PRACTICE: Nurses who recognize the research process, the need for continual improvement in patient care and who possess competency in comprehensive physical assessment are needed to implement this evidence-based protocol successfully. The regulatory atmosphere, workload structure and interdisciplinary collaboration are additional factors contributing to the successful use of the Serial Trial Intervention.