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1.
J Clin Nurs ; 29(7-8): 1162-1174, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31889360

RESUMO

AIMS AND OBJECTIVES: To explore nursing home residents' perspectives on their relationships with other residents, family members and staff. BACKGROUND: The cultivation of social relationships is central to promoting well-being in nursing homes, as these relationships allow residents, family members and staff to be valued as unique persons and empowered as partners in care. Few studies have examined how nursing home residents perceive the relationships in their social networks, both within and beyond the facility. DESIGN: Qualitative secondary analysis. METHODS: We analysed individual and group interviews obtained during "stakeholder engagement sessions" with cognitively intact residents (N = 11 sessions; N = 13 participants) from two nursing homes in North Carolina. The interviews were conducted as part of a larger study on person-directed care planning. We integrated thematic and narrative analytic approaches to guide the analysis of interview data, using a three-cycle coding approach. The COREQ checklist was followed. RESULTS: Four broad themes emerged from this analysis: (a) peer relationships foster a sense of belonging, purpose, achievement and significance; (b) residents' relationships with family members support a sense of belonging, continuity and significance; (c) mutual respect and reciprocity between residents and nursing home staff promote a sense of belonging and significance; and (d) organisational factors pose barriers to forging meaningful relationships. Each type of relationship-peer, family and staff-made distinctive contributions residents' psychosocial well-being. CONCLUSION: Recognising the diverse roles of different actors from residents' social networks raises questions for future research to optimise the distinctive contributions of network members that promote residents' psychosocial well-being. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for nursing home staff to understand how residents' social relationships influence residents' psychosocial outcomes. Staff training programmes are needed to support residents' rights and to dispel inaccurate interpretations of regulations that threaten sustained meaningful relationships.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Relações Interpessoais , Casas de Saúde/organização & administração , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Família/psicologia , Feminino , Humanos , Masculino , Relações Profissional-Paciente , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
2.
Geriatr Nurs ; 39(1): 18-23, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28633954

RESUMO

As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research.


Assuntos
Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/normas , Satisfação do Paciente , Atividades Cotidianas , Idoso , Cuidadores , China , Feminino , Humanos , Masculino , Projetos Piloto , Pesquisa Qualitativa , Qualidade de Vida
3.
Sociol Health Illn ; 39(2): 227-243, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27891628

RESUMO

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings.


Assuntos
Antropologia Cultural , Cuidadores/psicologia , Demência/enfermagem , Assistência Centrada no Paciente/métodos , Poder Psicológico , Atitude do Pessoal de Saúde , Inglaterra , Humanos , Autocuidado
4.
J Am Med Dir Assoc ; 25(8): 105039, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38796167

RESUMO

OBJECTIVES: Direct care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance. DESIGN: An observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018. SETTING AND PARTICIPANTS: The sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides. METHODS: We used bivariate analyses to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among DCWs by care setting. We then used stepwise multivariable logistic regression analyses to explore the associations between insurance coverage and health service use. RESULTS: The sample included 1499 DCWs. Compared with hospital aides, home care workers and nursing and residential care aides had lower insurance coverage rates, were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Health insurance through Medicaid was associated with the highest odds of health care access and utilization and the lowest odds of cost barriers for DCWs. CONCLUSIONS AND IMPLICATIONS: Given the projected 9.3 million total job openings in the direct care workforce from 2021 to 2031, policy and practice interventions designed to support DCWs' health are essential for ensuring continuous and quality care for older adults and people with disabilities and serious illness.


Assuntos
Cobertura do Seguro , Humanos , Estados Unidos , Masculino , Feminino , Cobertura do Seguro/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto , Seguro Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde
5.
J Am Med Dir Assoc ; 23(2): 207-213, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34973168

RESUMO

The diverse array of individuals who receive long-term services and supports share one common experience, which is the need for assistance with personal care and/or other daily activities. The direct care workers (including nursing assistants, home health aides, and personal care aides) who provide this assistance play a critical role in keeping individuals safe, supporting their health and well-being, and helping prevent adverse outcomes. Yet despite decades of research, advocacy, and incremental policy and practice reform, direct care workers remain inadequately compensated, supported, and respected. Long-standing direct care job quality concerns are linked to high turnover and job vacancy rates in this workforce, which in turn compromise the availability and quality of essential care for older adults and people with disabilities-which has never been more evident than during the COVID-19 pandemic. This special article makes the case for transforming direct care jobs and stabilizing this workforce as a centerpiece of efforts to reimagine long-term services and supports system in the United States, as a public health priority, and as a social justice imperative. Drawing on research evidence and examples from the field, the article demonstrates that a strong, stable direct care workforce requires: a competitive wage and adequate employment benefits for direct care workers; updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, while also enhancing career mobility and workforce flexibility; investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles; and an elevated position for direct care workers in relation to the interdisciplinary care team. The article concludes by highlighting federal and state policy opportunities to achieve direct care job transformation, as well as discussing research and practice implications.


Assuntos
COVID-19 , Serviços de Assistência Domiciliar , Idoso , Humanos , Assistência de Longa Duração , Pandemias , Reorganização de Recursos Humanos , SARS-CoV-2 , Estados Unidos , Recursos Humanos
6.
Gerontol Geriatr Med ; 8: 23337214221090803, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35529694

RESUMO

Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic. Five broad categories of staff working in LTC homes were as follows: (1) those responsible for personal and support care, (2) nursing care, (3) medical care, (4) rehabilitation and recreational care, and (5) others. There is limited availability of data related to measuring staff complement in the home and those with similar roles had different titles making it difficult to compare between countries. Nevertheless, the survey results highlight that some categories of staff were either absent or deemed non-essential during the pandemic. We require standardized high-quality workforce data to design better decision-making tools for staffing and planning, which are in line with the complex care needs of the residents and prevent precarious work conditions for staff.

7.
J Am Med Dir Assoc ; 23(2): 225-234, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34979136

RESUMO

Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. The key constructs of AL as originally conceived were to provide person-centered care and promote quality of life through supportive and responsive services to meet scheduled and unscheduled needs for assistance, an operating philosophy emphasizing resident choice, and a residential environment with homelike features. As AL has expanded to constitute half of all long-term care beds, the increasing involvement of the real estate, hospitality, and health care sectors has raised concerns about the variability of AL, the quality of AL, and standards for AL. Although the intent to promote person-centered care and quality of life has remained, those key constructs have become mired under tensions related to models of AL, regulation, financing, resident acuity, and the workforce. These tensions have resulted in a model of care that is not as intended, and which must be reimagined if it is to be an affordable care option truly providing quality, person-centered care in a suitable environment. Toward that end, 25 stakeholders representing diverse perspectives conferred during 2 half-day retreats to identify the key tensions in AL and discuss potential solutions. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living.


Assuntos
Casas de Saúde , Qualidade de Vida , Idoso , Humanos , Assistência de Longa Duração , Instituições de Cuidados Especializados de Enfermagem , Estados Unidos
8.
J Interprof Care ; 25(5): 345-51, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21635181

RESUMO

Rising dementia incidence is likely to increase pressures on healthcare services, making effective well coordinated care imperative. Yet, barriers to this care approach exist which, we argue, might be understood by focussing on identity dynamics at the frontlines of care. In this article, we draw upon findings from an ethnographic study of healthcare assistants (HCAs) from three dementia wards across one National Health Service mental health trust. Data revealed that the HCAs are a close-knit 'in-group' who share low group status and norms and, often highlight their own expertise in order to promote self worth. HCAs' social identity is considered as a barrier to effective teamwork with strong ingroup behaviour suggested as a consequence of their marginalisation. We explore these findings with reference to social identity theory (Tajfel, 1974; Turner, 1978 ) and discuss implications for delivering multiprofessional and interprofessional care.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Demência/terapia , Eficiência Organizacional , Relações Interprofissionais , Assistência ao Paciente/métodos , Identificação Social , Antropologia Cultural , Atitude do Pessoal de Saúde , Demência/psicologia , Grupos Focais , Humanos , Pacientes Internados , Equipe de Assistência ao Paciente , Preconceito , Teoria Psicológica , Autoeficácia , Reino Unido
9.
Gerontologist ; 61(4): 497-504, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32853357

RESUMO

Nearly 4.6 million direct care workers-including personal care aides, home health aides, and nursing assistants-provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce. Recent events and emerging trends have converged, however, to produce new opportunities to address this longstanding workforce crisis, including the unprecedented attention generated by the coronavirus disease 2019 (COVID-19) pandemic and the systemic shifts to managed care and value-based payment in LTC. This Forum article outlines the pressing direct care workforce challenges in LTC before describing these potential levers of change, emphasizing the importance of not just expanding the workforce but also maximizing direct care workers' contributions to the delivery of high-quality services for a growing and evolving population of LTC consumers.


Assuntos
COVID-19 , Assistência de Longa Duração , Idoso , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos , Recursos Humanos
10.
Gerontologist ; 60(1): 89-100, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-30535301

RESUMO

BACKGROUND AND OBJECTIVES: Pain and functional limitations can severely impede older adults' quality of life. In Chinese residential care facilities, limited research suggests that residents potentially have significant unmet care needs with pain and related functional limitations. Therefore, we aimed to explore residents' challenges and self-management strategies in these two areas. This knowledge is essential to developing care interventions to improve quality of care and quality of life in Chinese residential care facilities. RESEARCH DESIGN AND METHODS: We conducted semi-structured open-ended interviews with residents (n = 21) in two facilities in eastern and central China and assessed their pain and functional status using self-report measures from Minimum Data Set 3.0. We applied descriptive statistics to the self-reported data and analyzed the interview data using thematic analysis by drawing on the Adaptive Leadership Framework. This framework proposes that individuals living with chronic conditions need to engage in work to address their complex health concerns and that they need support from the environment to facilitate problem-solving. RESULTS: Residents described significant unmet care needs with pain and functional limitations. To address these care needs, they adopted a substantial number of self-management strategies. While doing so, they faced significant barriers, including service gaps and inadequate direct care. DISCUSSION AND IMPLICATIONS: The findings suggest further research to explore long-term care policy change that is needed to provide comprehensive health and medical services and adequate direct care in these facilities. The importance of establishing various types of long-term care facilities is also highlighted.


Assuntos
Atenção à Saúde/normas , Instituição de Longa Permanência para Idosos/normas , Casas de Saúde/normas , Dor/epidemiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Assistência de Longa Duração/normas , Masculino , Qualidade de Vida , Instituições Residenciais/normas , Autogestão
11.
Health Aff (Millwood) ; 38(6): 973-980, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31158005

RESUMO

Americans generally want to remain in their homes even if they develop chronic health problems or disabilities that qualify them for nursing home care. While family members or friends provide the preponderance of home-based support, millions of Americans use paid personal assistance services (PAS). Inexorable demographic trends are increasing the numbers of people who need paid home-based PAS, with this need rapidly outstripping the capacity of the paid PAS workforce. While many factors contribute to this widening discrepancy, its roots reach back more than eighty years to asynchrony among various policies affecting home-based supports for people with functional impairments and policies affecting home-based PAS workers. Finding solutions to the growing gap between demand for the services and the PAS workforce requires policies that cut across societal sectors and align incentives for consumers, workers, and other key stakeholders.


Assuntos
Cuidadores , Pessoas com Deficiência/legislação & jurisprudência , Política de Saúde , Serviços de Assistência Domiciliar , Visitadores Domiciliares/legislação & jurisprudência , Atividades Cotidianas , Adulto , Idoso , Cuidadores/economia , Cuidadores/legislação & jurisprudência , Pessoas com Deficiência/estatística & dados numéricos , Regulamentação Governamental , Humanos , Medicaid/economia , Pessoa de Meia-Idade , Estados Unidos
12.
J Appl Gerontol ; 38(2): 183-206, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29165004

RESUMO

Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how "person-directed care planning" (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes. Using participatory inquiry, we convened "stakeholder engagement sessions" with residents, families, nursing staff, and managers/administrators in two North Carolina nursing homes ( N = 24 sessions; N = 67 unique participants). Stakeholders discussed current care-planning processes and provided feedback on an emergent conceptual framework of PDCP. Three themes emerged through directed-content analysis: strategies included providing formal and informal opportunities to engage in care planning and ensuring effective follow-through; different roles were required among leadership, staff, residents, and families to accomplish PDCP; and limits on achieving PDCP included competing priorities and perceived regulatory and resource constraints. Results are discussed in terms of the specific competencies required for accomplishing PDCP.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , North Carolina , Pesquisa Qualitativa
13.
Gerontologist ; 58(suppl_1): S88-S102, 2018 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-29361069

RESUMO

Background and Objectives: To draw from systematic and other literature reviews to identify, describe, and critique nonpharmacological practices to address behavioral and psychological symptoms of dementia (BPSDs) and provide evidence-based recommendations for dementia care especially useful for potential adopters. Research Design and Methods: A search of systematic and other literature reviews published from January 2010 through January 2017. Nonpharmacological practices were summarized to describe the overall conceptual basis related to effectiveness, the practice itself, and the size and main conclusions of the evidence base. Each practice was also critically reviewed to determine acceptability, harmful effects, elements of effectiveness, and level of investment required, based on time needed for training/implementation, specialized care provider requirements, and equipment/capital requirements. Results: Nonpharmacological practices to address BPSDs include sensory practices (aromatherapy, massage, multi-sensory stimulation, bright light therapy), psychosocial practices (validation therapy, reminiscence therapy, music therapy, pet therapy, meaningful activities), and structured care protocols (bathing, mouth care). Most practices are acceptable, have no harmful effects, and require minimal to moderate investment. Discussion and Implications: Nonpharmacological practices are person-centered, and their selection can be informed by considering the cause and meaning of the individual's behavioral and psychological symptoms. Family caregivers and paid care providers can implement evidence-based practices in home or residential care settings, although some practices require the development of more specific protocols if they are to become widely used in an efficacious manner.


Assuntos
Sintomas Comportamentais , Terapias Complementares/métodos , Demência , Agitação Psicomotora , Sintomas Comportamentais/etiologia , Sintomas Comportamentais/terapia , Cuidadores , Demência/psicologia , Demência/terapia , Humanos , Administração dos Cuidados ao Paciente/métodos , Agitação Psicomotora/etiologia , Agitação Psicomotora/terapia
15.
Int J Older People Nurs ; 13(4): e12212, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30358099

RESUMO

AIM: Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP). METHODS: A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis. RESULTS: Several themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end-of-life care. Essential elements of PDCP include knowing the person, integrating the person's goals in care planning and updating care plans as individuals' needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies. CONCLUSION: This study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP. IMPLICATIONS FOR PRACTICE: These findings can be used to guide implementation of PDCP.


Assuntos
Casas de Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Idoso , Humanos
17.
J Am Geriatr Soc ; 65(8): 1719-1725, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28369756

RESUMO

OBJECTIVES: Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship. METHODS: Chart review of 260 randomly-selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NHs in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work-up and subsequent clinical events including emergency department use, hospitalization, and death. Analyses described the decision-making processes and outcomes and compared decisions made with Loeb criteria for initiation of antibiotics. RESULTS: Of 260 cases, 60% had documented signs/symptoms of the presenting illness and 15% met the Loeb criteria. Acute mental status change was the most commonly documented sign/symptom (24%). NH providers (81%) were the most common prescribers and ciprofloxacin (32%) was the most commonly prescribed antibiotic. Fourteen percent of presumed UTI cases included a white blood cell count, 71% included a urinalysis, and 72% had a urine culture. Seventy-five percent of cultures grew at least one organism with ≥100,000 colony-forming units/milliliter and 12% grew multi-drug resistant organisms; 28% of antibiotics were prescribed for more than 7 days, and 7% of cases had a subsequent death, emergency department visit, or hospitalization within 7 days. DISCUSSION: Non-specific signs/symptoms appeared to influence prescribing more often than urinary tract-specific signs/symptoms. Prescribers rarely stopped antibiotics, and a minority prescribed for overly long periods. Providers may need additional support to guide the decision-making process to reduce antibiotic overuse and antibiotic resistance.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Prescrição Inadequada/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Infecções Urinárias/tratamento farmacológico , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , North Carolina , Estudos Retrospectivos , Urinálise/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/mortalidade
18.
J Am Geriatr Soc ; 65(1): 165-171, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28111755

RESUMO

OBJECTIVES: To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs). DESIGN: Cross-sectional survey. SETTING: NHs in North Carolina (N = 31). PARTICIPANTS: Nursing staff (n = 182) and medical providers (n = 50). MEASUREMENTS: Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics. RESULTS: All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties. CONCLUSION: Nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship.


Assuntos
Antibacterianos/uso terapêutico , Atitude do Pessoal de Saúde , Prescrição Inadequada/prevenção & controle , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Estudos Transversais , Feminino , Humanos , Masculino , North Carolina , Recursos Humanos de Enfermagem , Médicos , Padrões de Prática em Enfermagem , Padrões de Prática Médica , Relações Profissional-Família , Inquéritos e Questionários
19.
Res Gerontol Nurs ; 9(3): 109-14, 2016 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-26716655

RESUMO

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research. [Res Gerontol Nurs. 2016; 9(3):109-114.].


Assuntos
Antibacterianos/uso terapêutico , Coleta de Dados/métodos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pneumonia/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos/epidemiologia
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