Stress, strength, and respect: Viewing direct care staff experiences through a trauma-informed lens.

Trauma-informed approaches may promote the well-being of CNAs and disrupt organizational practices that perpetuate inequities. There is a dearth of literature addressing evidence-based, trauma-informed training for direct care staff, yet CMS now requires trauma-informed care in nursing homes. Five focus groups exploring trauma and resilience-related concepts were conducted using an expressive-collaborative model with 18 CNAs at four nursing homes. A thematic analysis was conducted and themes were identified related to identity, relationships with residents, organizational values, and personal wellness. CNAs voiced frustration at limited time and support to implement well-being or stress management practices. Relationships with residents were sources of strength and, conversely, sources of emotional injury due to disrespect, disregard, and hostile behavior directed at CNAs. Central to health and well-being, CNAs called for change within facility cultures experienced as disrespectful, inequitable, and contrary to work-life balance. Trauma-informed training can be used to give particular attention to direct care staff. Administrators would benefit from learning about trauma and resilience among CNAs and precipitating organizational factors such as reasonable care ratios, equitable benefits, and peer support that impact CNA well-being, job satisfaction, and quality of care. The development and implementation of a trauma-informed training curriculum for CNAs are warranted.

Health-promoting lifestyles and their related influences among nursing assistants in nursing homes in China.

OBJECTIVE: The aims are to assess the health-promoting lifestyle status of nursing assistants in nursing homes in China and explore the roles of demographic, health conception, perceived health behavior self-efficacy, and job satisfaction in health-promoting lifestyles. METHOD: Using a cross-sectional descriptive design and convenience sampling, 285 nursing assistants from different nursing homes in Hangzhou were investigated using the Health-Promoting Lifestyle Profile II, Self-Rated Abilities for Health Practice Scale, Health Conception Scale, Minnesota Satisfaction Questionnaire, and a demographic questionnaire to measure their health-promoting lifestyle status. The collected data were analyzed using SPSS20.0. RESULTS: The total score of health-promoting lifestyles among investigated nursing assistants is 114 (13). Six dimensions are standardized, including interpersonal relations, health responsibility, stress management; nutrition, spiritual growth, and physical activity, listed in descending order of their values. The variables of gender, education, number of care recipients, and religion appear to significantly influence nursing assistants' health-promoting lifestyles (p<0.05). Perceived health behavior self-efficacy, health conception, and job satisfaction are significantly positively correlated with health-promoting lifestyles (p<0.05). Multiple regression analysis revealed that the predictor variables, such as gender, religion, number of care recipients, and perceived health behavior self-efficacy, can explain 48.4% of the variance in health-promoting lifestyles. CONCLUSION: The level of health-promoting lifestyles is mediocre in nursing assistants in China, with the highest score in interpersonal relations and the lowest score in physical activity. The variables of gender, education, number of care recipients, religion, and perceived health behavior self-efficacy can serve as effective predictors of health-promoting lifestyles.

Determinants of the nurses' and nursing assistants' request for antipsychotics for people with dementia.

BACKGROUND: Although physicians are responsible for writing the antipsychotic prescriptions for patients with dementia, the initiative is often taken by nurses or nursing assistants. To reduce antipsychotics uses, one needs to understand the reasons for nurses and nursing assistants to request them. This study gives an overview of the influencing factors for this request based on the Theory of Planned Behavior in which attitude, beliefs, and behavioral control is thought to influence the intention to request, which in turn affects the behavior to request for a prescription. METHODS: Eighty-one nurses and nursing assistants of one Dutch nursing home organization completed an online survey. RESULTS: Nurses and nursing assistants frequently agreed on items related to the positive effects of antipsychotics for the resident and for the staff. Nurses and nursing assistants with a lower job satisfaction were more likely to call for antipsychotics. Having more positive beliefs about treatment effects and feel of being more in control toward asking for antipsychotics were positively associated with intention to call. All variables explained 59% of the variance of intention. The current position (nurse/nursing assistant) was associated with actual behavior to call. The explained variance was 25%. CONCLUSIONS: Policy-makers should focus on the nurses' and nursing assistants' belief in positive effects of antipsychotics for the resident, which is not in line with available evidence. Nurses and nursing assistants should be educated about the limited effectiveness of antipsychotics.

Accentuate the positive: nursing's challenge for 2017.

Few of us will forget the momentous events of 2016 - a remarkable year on so many fronts. Brexit, a new prime minister and the election of Donald Trump as US president stand out as defining events, but there have also been less dramatic developments that will have a profound impact on the future of nursing.

What will 2017 hold for the nursing profession?

Education and training Nurse education will see huge changes in 2017. Most radical is the controversial end to bursaries for nursing students in England. From September, funding will come through the tuition fees and student loans system instead, a government move that led to mass protests in 2016.

Supporting assistant practitioners during their training.

Assistant practitioners, also known as associate practitioners, provide support to the registered healthcare workforce, practising with advanced knowledge and skills. Assistant practitioners require substantial training to obtain the skills and knowledge required for the role. This article identifies the challenges trainee assistant practitioners may encounter, and makes recommendations for how they can be best supported. The core areas where trainee assistant practitioners require support from their colleagues and mentors are workload, role clarity, mentoring, academic challenge and recognition as learners.

Incorporating Interprofessional Evidenced-Based Sepsis Simulation Education for Certified Nursing Assistants (CNAs) and Licensed Care Providers Within Long-term Care Settings for Process and Quality Improvement.

Improving resident safety and quality of care by maximizing interdisciplinary communication among long-term care providers is essential in meeting the goals of the United States' Federal Health care reform. The new Triple Aim goals focus on improved patient outcomes, increasing patient satisfaction, and decreased health care costs, thus providing consumers with quality, efficient patient-focused care. Within the United States, sepsis is the 10th leading cause of death with a 28.6% mortality rate in the elderly, increasing to 40% to 60% in septic shock. As a result of the Affordable Care Act, the Centers for Medicare & Medicaid services supported the Interventions to Reduce Acute Care Transfers 3.0 program to improve health care quality and prevent avoidable rehospitalization by improving assessment, documentation, and communication among health care providers. The Interventions to Reduce Acute Care Transfers 3.0 tools were incorporated in interprofessional sepsis simulations throughout 19 long-term care facilities to encourage the early recognition of sepsis symptoms and prompt communication of sepsis symptoms among interdisciplinary teams. As a result of this simulation training, many long-term care organizations have adopted the STOP and WATCH and SBAR tools as a venue to communicate resident condition changes.

Functional Assessment and Intervention by Nursing Assistants in Hospice and Palliative Care Inpatient Care Settings: A Quality Improvement Pilot Study.

This study assessed the impact of a nursing assistant-led functional intervention in an urban hospice. Thirty-three patients participated. A physical therapist trained 4 nursing assistants to assess 4 basic functional activities at admission and discharge and to provide daily activity training to intervention group participants. Control group participants were assessed at admission and discharge and received the usual standard of care. Both groups improved. The intervention group participants demonstrated significant improvement in the Timed up and Go test as well as their self-reported ability to achieve goals on the Patient-Specific Functional Scale. Control group participants made significant improvements in the ability to move from supine to sit in bed. These findings suggest that nursing assistants can provide activity-based assessment and intervention leading to improved function among patients in hospice.

Retention initiatives in the North Carolina Community College System.

Over the past 15 years, the North Carolina Community College System has provided education and instruction to 258,713 allied health professionals, 183,059 nurse aides, 27,125 associate-degree nurses, and 9,926 practical nurses. Innovations that can increase program retention will have a positive impact on the state's future health care workforce.

[Nursing team knowledge on behavioral assessment of pain in critical care patients]. / Conhecimento da equipe de enfermagem sobre avaliação comportamental de dor em paciente crítico.

This investigation consisted on a prospective cross-sectional study that aimed to describe the nursing team knowledge on behavioral assessment of pain. The study was conducted in a private hospital in the city of Sao Paulo, Brazil in November 2011, with nursing professionals from a general adult intensive care unit. They answered a questionnaire that contained sociodemographic data and questions related to knowledge about a behavioral assessment of pain. Descriptive data analysis was carried out and the average positive score was compared among categories using the Mann-Whitney test. Out of the 113 participants, over 70% have demonstrated knowledge of the main aspects of this assessment and there was no statistical significant difference among the professional categories. It was concluded that the knowledge of the professionals was satisfactory, but it can be improved.

Conhecimento da equipe de enfermagem sobre avaliação comportamental de dor em paciente crítico / Conocimiento del equipo de enfermería en la evaluación del comportamiento del dolor en el paciente crítico / Nursing team knowledge on behavioral assessment of pain in critical care patients

Estudo transversal prospectivo que teve como objetivo descrever o conhecimento da equipe de enfermagem sobre uma avaliação comportamental de dor. Realizado em hospital privado da cidade de São Paulo, Brasil, em novembro de 2011, com profissionais de enfermagem de uma UTI geral adulto. Estes responderam a um questionário com dados sociodemográficos e questões referentes ao conhecimento sobre uma avaliação comportamental de dor. A análise dos dados foi descritiva e a média de acertos por categoria profissional foi comparada por teste Mann-Whitney. Dos 113 participantes, mais de 70% demonstraram ter conhecimento sobre os principais aspectos dessa avaliação e não houve diferença estatisticamente significativa entre as categorias profissionais. Concluiu-se que o conhecimento dos profissionais foi satisfatório, mas pode ser aprimorado.

Estudio transversal prospectivo que tuvo como objetivo describir el conocimiento del equipo de enfermería con relación a evaluación del comportamiento del dolor. Realizado en un hospital privado de la ciudad de São Paulo, Brasil en noviembre de 2011 con profesionales de enfermería de una UTI general adulto. La población estudiada respondió a un cuestionario con datos demográficos y preguntas relacionadas al conocimiento sobre una evaluación de comportamiento del dolor. El análisis de datos fue descriptivo y el promedio de aciertos por categoría profesional fue comparado por el test de Mann-Whitney. De los 113 participantes, el 70% demostró el conocimiento de los principales aspectos de esta evaluación y no hubo diferencia estadísticamente significativa entre las categorías profesionales. Se concluye que el conocimiento de los profesionales era satisfactorio, pero se puede mejorar.

This investigation consisted on a prospective cross-sectional study that aimed to describe the nursing team knowledge on behavioral assessment of pain. The study was conducted in a private hospital in the city of São Paulo, Brazil, in November 2011, with nursing professionals from a general adult intensive care unit. They answered a questionnaire that contained sociodemographic data and questions related to knowledge about a behavioral assessment of pain. Descriptive data analysis was carried out and the average positive score was compared among categories using the Mann-Whitney test. Out of the 113 participants, over 70% have demonstrated knowledge of the main aspects of this assessment and there was no statistical significant difference among the professional categories. It was concluded that the knowledge of the professionals was satisfactory, but it can be improved.

Development and mixed-methods evaluation of a pain assessment video training program for long-term care staff.

INTRODUCTION: Inadequacies in pain assessment and management in long-term care have been well documented. Insufficient pain education and inaccurate beliefs about the nature of pain and aging have been identified as possible contributors. The present study addresses the need for improved, efficient and feasible continuing pain education through the use of an assessment training video. METHODS: A total of 148 long-term care staff viewed and evaluated the training video. Knowledge changes and pain beliefs were assessed postvideo and at a four-week follow-up. Beliefs about pain, as well as pain and aging, were also examined using multivariate procedures to determine whether these variables influenced participants' evaluation of the video. Focus groups were also conducted, and transcripts were analyzed using thematic content analysis. RESULTS: Pain assessment knowledge improved postvideo and at the four-week follow-up. Participants positively evaluated the content and quality of the video. Individuals who held stronger beliefs (at baseline) about the organic nature of pain provided more positive evaluations. Barriers to implementation of practices in the video identified by the focus groups (and qualitative analysis) included time, workload and resistance to change. Facilitators to implementation included continued management support and observing the benefits to implementation. DISCUSSION: The present study provides support for the use of video training. However, based on the focus group results, top-down implementation approaches with ongoing management involvement throughout the implementation process may be needed to achieve sustained changes in pain assessment practices. A model useful for sustained implementation was proposed and discussed, and is hoped to facilitate future research.

A person-centered care intervention for geriatric certified nursing assistants.

PURPOSE: To pilot test a multicomponent intervention to increase certified nursing assistants' (CNAs) awareness of person-centered care. To establish the feasibility of implementing an intervention involving videotaped biographies of residents and videotapes of resident/CNA caregiving interactions. DESIGN AND METHODS: A training program was provided at two nursing homes (NHs) using a wait-list control design. Levels of dyadic relationship closeness and satisfaction were compared prepost. Video recordings of CNA/resident interactions were coded for person-centered care using two observational instruments. RESULTS: Based on data from 19 resident/aide dyads, the findings were that resident's perceptions of relationship closeness increased significantly posttraining at both NHs, NH1, z = -1.89, p < .05, and the NH2, z = -1.95, p < .05. Effects were also seen with the CNA's perceptions of satisfaction and closeness, and resident satisfaction. IMPLICATIONS: The findings suggest that this type of intervention is feasible and warrants further research.

Reduced postpartum hemorrhage after implementation of active management of the third stage of labor in rural Honduras.

OBJECTIVE: To assess outcomes after auxiliary nurses were trained and given resources to use active management of the third stage of labor (AMTSL) for all women giving birth in a low-resource, low-risk, rural, public birth center setting in northern rural Honduras. METHODS: Auxiliary nurses received training on estimation of blood loss before the preintervention phase of the study (July 2004 through April 2005) and AMTSL, including use of intramuscular oxytocin, and estimation of blood loss prior to the intervention phase (July 2007 through June 2008). Preintervention and intervention data on use of oxytocin, blood loss postpartum, hemorrhage rates, and management interventions were collected and compared. RESULTS: After nurses received training on AMTSL using intramuscular oxytocin, the use of intramuscular oxytocin during the third stage of labor increased from 63.8% to 96.5%. Postpartum hemorrhage rates decreased from 14.8% to 5.9% (P=0.001). Use of intrapartum oxytocin, which can have adverse effects, also increased: from 6.1% to 22.7% (P<0.001). CONCLUSION: Training auxiliary nurses to perform AMTSL using oxytocin in this birth center setting was effective in reducing the rate of postpartum hemorrhage; however, increased use of intrapartum oxytocin may be an unintended outcome of the increased accessibility of oxytocin.

Developing the clinical abilities of care workers in Japan.

The increasing number of frail older people being admitted to Japan's care homes makes it difficult for healthcare professionals alone to attend to all their needs. By law, care workers are not allowed to carry out any clinical procedures but, in response to the situation, the Japanese Ministry of Health, Labour and Welfare has allowed this group of workers to carry out limited clinical activities, such as oral suctioning and percutaneous endoscopic gastrostomy tube feeding at one type of Japanese care home, welfare care homes. Care workers must be supervised by healthcare professionals and follow guidelines. The ministry has further decided to introduce a certification system, so that from 2015 certified care workers will be able to engage lawfully in these activities.

Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants.

AIMS: This paper is a report of a study of association between workplace injuries experienced by nursing assistants in nursing homes in the United States and four factors that may affect injury rates: initial nursing assistant training, training at the current facility, lifting devices, and time to execute daily duties. BACKGROUND: High injury rates among nursing personnel have been reported in multiple settings across countries. The existing literature is divided on the effectiveness of training and assistive devices in reducing injury rates among nursing assistants. METHODS: We examined associations between whether or not the nursing assistant has experienced an injury and four key factors: quality of initial injury prevention training, injury prevention training at current facility, lift availability and whether or not the nursing assistant has sufficient time to complete resident activities of daily living. We estimated a survey-weighted logit model using 2004 National Nursing Assistant Survey data. RESULTS/FINDINGS: The odds of an injury in the past year were lower among nursing assistants who reported always having a lift available when needed (41% lower odds), available facility training to reduce workplace injuries (39%), and sufficient time to complete resident activities of daily living (35%). Quality of initial training to prevent work injuries was not significantly associated with injury status. CONCLUSION: Regions without widespread access to lifting devices may be able to reduce injury rates by increasing the availability of lifting devices. The potential for reductions in injury rates in the United States is greatest from improving training and ensuring adequate time for resident care, as most facilities currently have lifts available.