Developing a dedicated education unit in long-term care: a pilot project.

Within long-term care, the transitional care setting provides post-acute and short-stay rehabilitation to older adults, easing the transition between the acute care hospital and home or long-term care. The current nursing shortage makes it difficult for these facilities to attract and retain qualified nursing staff. In order to meet the rehabilitation needs for this patient population while at the same time addressing the challenge in nursing education of limited clinical placements and severe nurse faculty shortages, an academic-practice partnership was developed to establish a Dedicated Education Unit (DEU). The DEU is an innovative clinical education model in which experienced staff nurses serve as clinical teachers to nursing students. This paper describes the process of developing a DEU using the Partners in Caring Model as the framework. Formative and summative evaluation results and recommendations for program improvement of this pilot project are discussed.

Health disparities among health care workers.

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

The association of nurse practitioners' mortality risk assessments and advance care planning discussions on nursing home patients' clinical outcomes.

PURPOSE: To investigate the impact nurse practitioners' (NPs) documented mortality risk assessments (MRAs) and advance care planning (ACP) discussions have on clinical outcomes for newly enrolled Medicare Advantage nursing home patients. METHODS: Data collection in this mixed-method study consisted of quantitative data from a convenience sample of NPs' MRAs and medical record reviews 6 months later, and qualitative data from two NP focus groups. Quantitative analyses include descriptive statistics, bivariate ANOVA, and logistic regression. The qualitative content analysis included an iterative process of rereading transcribed notes, identifying codes, themes and significant statements. CONCLUSIONS: MRAs prioritize ACP discussions with patients/families (p = .0258). Positive clinical outcomes following ACP discussions include more patients with a comfort goal of care (86% increase), fewer patients with a full-code status (26% reduction), and a reduction in hospitalizations (p = .025). NPs agreed that ACP discussions have a positive impact on patient outcomes including a "good death." IMPLICATIONS FOR PRACTICE: MRAs and ACP discussions are beneficial to achieving better outcomes and fewer hospitalizations. Opportunity exists to further develop policy changes focused on enhancing the NPs' role in MRAs and ACP discussions with nursing home patients and families.