Aging in place: a new model for long-term care.

It is expected that at least 40 percent of the population over 75 will need extensive health care services late in their lives. The public has a negative view of nursing home placement that has, to some extent, been confirmed by research finding that the health of a frail older person deteriorates each time he or she is moved. The Aging in Place model of care for the elderly offers care coordination (case management) and health care services to older adults so they will not have to move from one level of care delivery to another as their health care needs increase. University Nurses Senior Care (UNSC) is the service entity of this project and provides as its core service care coordination with a variety of service options. These options include care packages or services at an hourly rate to meet individual client needs. The Aging in Place project will be evaluated by comparing project clients to residents of similar acuity in nursing homes and to similar clients receiving standard community support services. Data from this project will be important to consumers, researchers, providers, insurers, and policy makers.

The future of long-term care for the chronically ill.

Consumers want a range of services and care available for them if and when they may need them. They want long-term care that addresses six areas of concern: community-based services, continuity, coordination, caring, convenience, and cost. To develop new perspectives and new ways of providing the needed long-term services, it is time for health care leaders to work cooperatively with consumers to redesign long-term care, both community-based and institutional. Consumers and consumer advocates, working cooperatively with health care leaders, could reinvent home health care, nursing home care, and other long-term services such as "aging in place" for older people.

Implementation of a clinical information system in nurse-managed care.

The Penn Nursing Network Information System Project is a collaborative effort of practitioners, academic researchers, and a health-care software developer. The Penn Nursing Network, a group of nurse-managed practices owned and operated by the University of Pennsylvania School of Nursing, has taken a leadership role in the project. PNN is developing an information system specific to the needs of nurse-managed care and creating a data warehouse for nursing centres in the Philadelphia region. Important components of this project include the identification of key data elements to represent the problems treated, interventions performed, and outcomes sensitive to the nursing care provided. The Omaha System provided a useful framework for capturing the necessary data elements. However, additional data were needed. In addition, attention was paid to the development of a software program that would complement the workflow of the practitioner while capturing data efficiently. The main goal of the project is development of a longitudinal database reflective of clinical practice, to be used for both research and evaluation.

ANA standards for nursing data sets in information systems.

The American Nurses Association has established the Nursing Information and Data Set Evaluation Center. The purpose of this Center is to develop and disseminate standards pertaining to information systems that support the documentation of nursing practice, and to evaluate voluntarily submitted information systems against these standards. The need for an evaluation center arises out of a long history of calls for standards pertaining to nursing data and information systems. These calls have come from the Secretary of Health and Human Services Commission on Nursing, the National Commission on Nursing Implementation Project, and a joint Task Force appointed by the Congress of Nursing Practice Steering Committee on Databases to Support Clinical Nursing Practice and the Congress of Nursing Practice Committee on Nursing Practice Standards and Guidelines. Standards have been developed to evaluate the completeness, accuracy and appropriateness of four dimensions of nursing data sets and the systems that contain them: (1) nomenclature, (2) clinical content, (3) clinical data repository, and (4) general system characteristics.

Measuring the effectiveness of nursing care.

Identification and measurement of the outcomes of nursing care have received great attention in the past decade. With advances in information technology, large clinical data bases are being developed for use in outcomes evaluation. It is important that nurses be thoughtful in designing the data elements that will be included in these data bases. Key data elements include nursing diagnoses, interventions, and nursing sensitive outcomes. Multiple variables influence the outcome of health care. It is important in evaluation that system, patient, and provider characteristics be considered, especially when developing benchmarks for comparison of outcome achievement. Data related to the process of care are needed beyond provider encounter, and nurses must be cautious that the care they give is not credited to other providers. Longitudinal clinical data bases that contain key variables related to the delivery of nursing care can yield valuable knowledge on the best methods to measure and interpret the contribution of nursing care to the health of the nation.

OBRA '87: has it resulted in positive change in nursing homes?

This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as effecting positive change for nursing home residents. Interviews were conducted with 132 professional and non-professional staff in six states and 56 residents. Important issues about nursing home staffing and quality of care are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that nursing staff or quality have not deteriorated; administrators, licensed nurses, and certified nursing assistants indicate the quality of nursing care provided and the nursing staff levels have improved since OBRA '87 implementation. Regulators agree that quality of nursing care has improved, but nursing home advocates, regulators, and professional association staff indicate mostly no change or no opinion. There is a danger in interpreting that quality and staffing are adequate from these results. While both may have improved, they may not be adequate.

OBRA '87: has it resulted in better quality of care?

This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as affecting positive change for nursing home residents. Interviews were conducted with 59 residents and 132 professional and non-professional staff in six states. Important quality of care issues of resident rights, resident dignity, restraint use, resident assessment, as well as perspectives of residents themselves are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that residents have benefited from it. They identify the focus on resident rights as the most important accomplishment. Empowerment of residents through involvement in care decisions is noted by many as an important achievement. Many conclude that quality of care has improved and restraint use has decreased. The MDS is a useful tool from the standpoint of nursing home staff and regulators. This appraisal sharply contrasts their opinions about the Preadmission Screening and Resident Review (PASARR) screening tool. We believe that PASARR should be reexamined and that changes should be made in the process and/or implementation of the tool.

Nursing diagnoses and home care nursing utilization.

The purpose of this study was to identify, from routinely collected health care record data, patient characteristics that describe home care clients' health care needs and explain variation in home health care utilization. Retrospective data were obtained from a total of 317 home health care patient records from one home health care agency. Outcome variables of care included number of visits and hours of care. Predictor variables included nursing diagnoses, medical diagnoses, and patient demographic variables. Nursing diagnoses were classified by the Omaha System. Nursing diagnoses explained a significant amount of variance over and above the demographic and medical diagnosis variables in both the number of nursing visits and hours of nursing care. The results of this study suggest that data related to nursing diagnoses are a valuable source of information when examining home health care nursing resource use.