Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings.

Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from 'Communication Accommodation Theory'. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice.

Interventions that improved a practice environment: "making a difference".

This paper reports on the intervention phase of a participatory action study designed to improve the practice environment within a critical care unit in a research teaching hospital. The intervention strategy involved the hiring of a facilitator who worked with unit staff to engage in a process of addressing their priority issues related to the practice environment. Examples of interventions included staff retreats, communication workshops, task groups and leadership training. Challenges and key learnings are reported.

Improving the practice environment: a pilot project in a critical care unit.

The objective of this pilot project was to determine whether engaging critical care unit staff in designing and implementing enhancements to the practice environment would positively impact the clinical environment and staff outcomes. The project used a one-group pre-post test design and a participatory action process. Significant changes in the practice environment were observed in the priority areas identified by the unit staff. Results indicated that team collaboration and respectful work relationships improved following interventions.

To tell or not to tell? Professional and lay perspectives on the disclosure of personal health information in community-based dementia care.

Developments in information technology and the ongoing restructuring of health services to increase provision in community settings militate in favour of a streamlining of communications and the exchange of information about patients among health and social care providers. Yet the principles of confidentiality and privacy appear to inhibit this process. In order to explore the practical, ethical, and legal imperatives attendant upon personal health information exchange, we conducted a series of interviews with professional care providers, persons with early-stage dementia, and their family caregivers. The findings indicate some degree of discordance. Professionals reported valuing disclosure both to colleagues and family caregivers on the basis of its being in the patients' best interests. Patients also valued inter-professional exchange, but sought strong control over disclosure to family members. Family caregivers valued being kept informed of the patient's condition, even without the latter's consent. Implications for research and policy are discussed.

A survey of nursing home organizational characteristics associated with potentially avoidable hospital transfers and care quality in one large British Columbia health region.

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.

Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis.

AIM: This paper reports a review of the literature on the association between critical care nurse staffing levels and patient mortality. BACKGROUND: Statistically significant inverse associations between levels of nurse staffing and hospital mortality have not been consistently found in the literature. Critical care settings are ideal to address this relationship due to high patient acuity and mortality, high intensity of the nursing care required, and availability of individual risk adjustment methods. METHODS: Major electronic databases were searched, including MEDLINE, EMBASE, and the Cumulative Index of Nursing and Allied Health Literature. The search terms included critical/intensive care, quality of health care, mortality/hospital mortality, personnel staffing and scheduling, and nursing staff (hospital). Only papers published in English were included. The original search was conducted in 2002 and updated in 2005. RESULTS: Nine studies were selected from 251 references screened. All nine were observational. Six were conducted in the United States of America, one in Austria, one in Brazil, and one in Scotland. The unadjusted risk ratio of nurse staffing (high vs. low) on hospital mortality were combined meta-analytically (five studies). The pooled estimate was 0.65 (95% confidence interval 0.47-0.91). However, after adjusting for various covariates within each study, the individually reported associations between high nurse staffing and low hospital mortality became non-significant in all but one study. CONCLUSION: The impact of nurse staffing levels on patients' hospital mortality in critical care settings was not evident in the reviewed studies. Methodological challenges that might have impeded correct assessment of the association include measurement problems in exposure status and confounding factors, often uncontrolled. The lack of association also indicates that hospital mortality may not be sensitive enough to detect the consequences of low nurse staffing levels in critical care settings.

Changing times: understanding social workers' motivation to be field instructors.

Renewing the profession of social work is historically dependent on social work practitioners volunteering to be field educators for students placed in their agencies. During the past decade, with massive funding cuts to social and health services and changes in professional practice, the availability of field instructors has been threatened. This article reports on social workers' motivations to become field instructors. The findings from qualitative interviews with 20 social workers randomly selected from a range of field agencies indicate that current organizational culture has a powerful influence on social workers' motivations to volunteer to become field instructors. The implications of this shift are discussed in relation to rejuvenating the profession of social work. Collaboration among organizations, professional associations, and schools of social work at the local and national level is critical.

The impact of hospital restructuring on social work field education.

Hospital restructuring has had a dramatic impact on social work practice and field education. In a qualitative focus group study of nine educational coordinators responsible for educational programs in teaching hospitals with 25 to 100 social workers each, four main themes emerged: (1) difficulty managing field education when the actual change experienced in restructuring hospitals was far less progressive and systemic than the hospital missions espoused; (2) a struggle to maintain stable student programs when change was unpredictable; (3) the importance of support, reciprocity, and advocacy from the university; and (4) the need to be creative in delivering the educational program while undergoing organizational change.

Social work in restructuring hospitals: program management five years later.

Hospital restructuring in North America has involved re-engineering, downsizing, reorganizing, and remodeling of traditional hierarchical functional organizations into multisite programmatic conglomerates. The implications for professional disciplines have been dramatic in that departments such as social work have been dismantled and social work practice has come under the domain of program managers representing multiple disciplines. In this study 12 hospitals in Ontario, Canada, that were studied in the early stages of restructuring in 1995 expanded to 22 sites by 1999. The effect of the mergers and moves to program management on the social work profession was examined. The key findings are that social work line positions were not lost, but accountability and recruitment were no longer in the hands of the discipline. These findings suggest that it is more critical now than ever for social workers to champion their contributions to health.

Thriving in program management environments: the case of social work in hospitals.

The shifts in hospitals from single-site functionally organized university and community hospitals to multilayered, mega institutions have had dramatic effects on social work practice. Through this longitudinal research we examine, using a strengths perspective and qualitative interviews, the strategies social workers in 22 hospitals across Ontario, Canada, utilized to survive and thrive. The findings identify the importance of clearly articulating one's value to the organization, staying current, and being flexible.