Online Advanced Release

Articles appearing in this "Online Advanced Release" section have been peer-reviewed and accepted for publication in Research in Gerontological Nursing and posted online before print publication. Articles appear on this site after copyediting and author corrections, but before final proofing. The content of the article will usually remain unchanged, and possible further corrections are fairly minor. The final published article will specify the issue and page numbers. Once the final version is available in print, the version posted here will be removed from this site.

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Death in the Nursing Home: An Examination of Grief and Well-Being in Nursing Assistants

Keith A. Anderson, PhD; Heidi H. Ewen, PhD

Received: July 17, 2009; Accepted: March 22, 2010; Posted: July 30, 2010

The grief that nurses experience when patients and residents die can be complex and has been linked to both problematic (e.g., depression) and beneficial (e.g., gains in coping) outcomes. In this study, 380 nursing assistants working in the nursing home setting were surveyed to gain an understanding of the relationship between grief and well-being. Findings indicated that participants experienced both distress and growth in their grief. Those who experienced greater distress from grief reported significantly higher levels of burnout and lower levels of psychological and physical well-being. Conversely, participants who experienced greater growth from their grief reported significantly lower levels of burnout, higher levels of psychological and physical well-being, and higher levels of job satisfaction. These findings suggest that grief may be an important determinant of well-being in nursing assistants, which, in turn, may impact quality of care in the nursing home.

doi:10.3928/19404921-20100702-01 [get full text]

Storytelling by Community-Dwelling Older Adults: Perspectives of Home Care Workers

Beth Mastel-Smith, PhD, RN; Brenda Binder, PhD, RN; Gayle Hersch, PhD, OTR; Harriett A. Davidson, MA, OTR; Teresa Walsh, PhD, RN

Received: June 13, 2008; Accepted: March 13, 2010; Posted: July 30, 2010

The purpose of this exploratory, qualitative study was to investigate storytelling by home care clients to their home care workers (HCWs). Specific research questions were: (a) When does storytelling by a care recipient occur during usual care?; (b) How do HCWs engage older clients in storytelling?; (c) How do HCWs respond to the stories told by clients?; and (d) What is the perceived effect of storytelling by older clients on the relationship between the client and the HCW? Two focus groups consisting of 10 HCWs each were conducted. Verbatim transcripts of both focus groups were analyzed using the constant comparative analysis method. Categories and concepts were identified. Characteristics of the HCW and client set the stage for storytelling. The process of storytelling included context, triggers, and temporal aspects. HCWs also shared the content of stories, the impact on their relationship with the client, and the perceived effect on each individual. A visual model depicting the nature of storytelling in association with the care of older clients is presented.

doi:10.3928/19404921-20100702-02 [get full text]

Staff Teamwork in Long-Term Care Facilities: The Influence of Management Style, Training, and Feedback

Denise A. Tyler, PhD; Victoria A. Parker, DBA

Received: July 10, 2009; Accepted: March 19, 2010; Posted: July 30, 2010

The purpose of this study was to describe the organizational factors associated with high and low amounts of teamwork among direct-care workers in long-term care (LTC) facilities. A systematic analysis of observation data collected at 20 LTC facilities was first used to categorize facilities as high-, moderate-, or low-teamwork facilities. Next, qualitative analysis of 59 interviews collected in 4 high-teamwork and 5 low-teamwork facilities was used to identify the organizational factors associated with high and low teamwork. Findings showed that high- and low-teamwork LTC facilities in this study differed in three organizational areas: management style, training, and feedback and recognition. As such, improved teamwork in LTC facilities may result from changes to basic management practices, such as training and employee feedback.

doi:10.3928/19404921-20100706-01 [get full text]

Nursing Diagnoses, Interventions, and Patient Outcomes for Hospitalized Older Adults with Pneumonia

Barbara J. Head, PhD, RN; Cindy A. Scherb, PhD, RN; David Reed, PhD; Deborah Marks Conley, MSN, APRN-CNS-BC, FNGNA; Barbara Weinberg, BS, RN, CCRN; Marie Kozel, RN, BSN, MBA; Susan Gillette, RN; Mary Clarke, PhD, RN, BC; Sue Moorhead, PhD, RN

Received: March 17, 2009; Accepted: March 5, 2010; Posted: June 30, 2010

A study was conducted by academic and community hospital partners with clinical information systems that included the standardized nursing language classifications of the North American Nursing Diagnosis Association International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). The aim of the study was to determine the frequency of NANDA-I, NIC, and NOC (NNN) terms documented for older adults with pneumonia who were discharged from three hospitals during a 1-year period. NNN terms were ranked according to frequency for each hospital, and then the rankings were compared with previous studies. Similarity was greater across hospitals in rankings of NANDA-I and NOC terms than in rankings of NIC terms. NANDA-I and NIC terms are influenced by reimbursement and regulatory factors as well as patient condition. The 10 most frequent NNN terms for each hospital accounted for only a small to moderate percentage of the terms selected.

doi:10.3928/19404921-20100601-99 [get full text]

Responding to Poor-Quality Care During Research in Nursing Homes

Melanie R. Krause, MS, RN; Janice L. Palmer, PhD, RN; Barbara J. Bowers, PhD, RN, FAAN; and Kathleen C. Buckwalter, PhD, RN, FAAN

Received: March 22, 2009; Accepted: October 29, 2009; Posted: May 28, 2010

For nurse researchers, responding appropriately to resident abuse is straightforward: The abuse must be reported. However, responding to care that is of poor quality—where care practices are problematic but do not meet the definition of reportable abuse—is not so straightforward. Decision making may be influenced by ethical and professional principles, as well as self-interest to complete a research project. The purpose of this article is to provoke a dialogue about a dilemma faced by many researchers conducting research in long-term care: responding to poor-quality care that does not meet the state’s definition of resident abuse. We will accomplish this by providing a real-life situation faced by a novice researcher conducting her first funded research project, identifying some of the important considerations and possible responses by nurse researchers. Optimally, nurse researchers will develop a plan for responding to poor care before beginning the study.

doi:10.3928/19404921-20100504-04 [get full text]

A Combined, Multimodal Intervention for Individuals with Dementia: Effects on Family Caregiver Outcomes

Sandy C. Burgener, PhD, GNP-BC, FAAN; Sara Marsh-Yant, MSW; and Katie Kosanda Nega, APN, GNP-BC

Received: June 10, 2009; Accepted: February 16, 2010; Posted: May 28, 2010

Few studies have tested the effects of nonpharmacological interventions designed for people in early-stage dementia on the family caregiver. This study tested a multimodal intervention (Taiji exercise and support group) for people with dementia, with some treatment group caregivers choosing to co-participate. Control group caregivers participated in educational programs. Outcome measures included role stress (Relatives Stress Scale [RSS]) and quality of the relationship with the person with dementia. Trends toward positive effects for participating caregivers were found for overall role stress and the Personal Distress subscale and quality of the relationship with the person with dementia. In comparing outcomes between the total treatment group and the control group, treatment group caregivers rated one RSS subscale, Negative Feelings toward the Care Recipient, significantly lower (more positive) than control group caregivers. A within-group difference was found for the quality of the relationship for control group caregivers (increased negativity), with no increase in treatment group caregivers. Findings support the potential benefits of the intervention for both participating and nonparticipating caregivers.

doi:10.3928/19404921-20100504-01 [get full text]

Measuring Risk for Dehydration in Nursing Home Residents: Evaluation of the Dehydration Risk Appraisal Checklist

Janet C. Mentes, PhD, APRN, BC; and Jeng Wang, PhD, RN

Received: June 19, 2009; Accepted: December 9, 2009; Posted: May 28, 2010

The purpose of this study was to evaluate the ability of the Dehydration Risk Appraisal Checklist (DRAC) to measure dehydration risk in nursing home (NH) residents. The DRAC includes items concerning health conditions, medications, fluid intake behaviors, and laboratory abnormalities that have been identified in the literature as risk factors for dehydration. Principal component factor analysis, known group comparisons, and multiple logistic regression were used to evaluate the criterion-related validity and reliability of the DRAC. After reducing the number of items on the DRAC on the basis of a correlation matrix, a single-factor solution with moderate internal consistency was supported. Further validity analysis demonstrated that NH residents with higher urine-specific gravity scored higher than those who had lower specific gravity. The psychometric properties of the DRAC indicate that it has potential in determining dehydration risk in NH residents. Future refinement of the instrument is also discussed.

doi:10.3928/19404921-20100504-02 [get full text]

Older Adults’ and Case Managers’ Initial Impressions of Community-Based Telehealth Kiosks

Karen L. Courtney, PhD, RN; Jennifer H. Lingler, PhD, FNP; Laurel Person Mecca, MA; Laurie A. Garlock, BBA; Richard Schulz, PhD; Andrew W. Dick, PhD; and Ellen Olshansky, DNSc, RNC, FAAN

Received: February 19, 2009; Accepted: December 9, 2009; Posted: May 28, 2010

Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding such interventions. As a first step in feasibility assessment, we used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults. Participants included residents (n = 6) and community agency case managers (n = 3) of a U.S. Department of Housing and Urban Development-subsidized senior apartment building. Both positive impressions from and concerns of each group are presented. Findings helped guide plans for future telehealth kiosk implementation and training.

doi:10.3928/19404921-20100504-03 [get full text]

Food Expectations-Long Term Care Spanish Questionnaire: Pilot Testing with Older Mexican American Nursing Home Residents

Neva L. Crogan, PhD, GCNS-BC, GNP-BC, FNGNA; Bronwynne C. Evans, PhD, CNS, RN, ANEF, FNGNA

Received: November 13, 2008; Accepted: October 5, 2009; Posted: April 30, 2010

Although little is known about nutrition care for Hispanic older adults in nursing homes, soon at least 4.5 million will reside there because of chronic disease. The purpose of this pilot study was to test the internal consistency reliability of a food and food service satisfaction instrument, the Food Expectations-Long Term Care Spanish (FoodEx-LTCSp) questionnaire with nursing home residents and to examine relationships between satisfaction and food intake, serum prealbumin, and functional status. Only two FoodEx-LTCSp subscales, Cooking Good Food and Providing Food Service, were significantly correlated with one another (r = 0.624, p = 0.002). No significant correlations were found between prealbumin and food intake (perhaps related to the small sample and the short duration of food weight measurement) or between prealbumin and functional status, and no significant difference was found in the subscales of Enjoying Food and Food Service and Exercising Choice. Additional qualitative work may be needed with Hispanic residents to examine items that evolved from interview data obtained from an Anglo population.

doi:10.3928/19404921-20100330-02 [get full text]

Do Personality Traits Predict Work Outcomes of Certified Nursing Assistants?

Christine R. Kovach, PhD, RN, FAAN ; Michelle R. Simpson, PhD, RN; Amy B. Reitmaier, MS, RN; Addie Johnson, BA; Sheryl T. Kelber, MS

Received: September 30, 2008; Accepted: October 5, 2009; Posted: April 30, 2010

The purposes of this study were to describe personality traits of certified nursing assistants (CNAs) employed at nursing homes and explore relationships between personality traits, job satisfaction, and job performance. The sample included 177 CNAs providing direct care to residents in three nursing homes. CNAs with high and low job performance skills were distinguished by the cluster of traits associated with teamwork skills. Overall, 21.3% of the variance in job satisfaction was explained by the personality traits of Adjustment, Prudence, Likeability, Excitable, and Dutiful, F(8, 145) = 4.899, p < 0.001. The links found between personality, job satisfaction, and job performance provide important information about the personality traits of nursing staff who are most likely to enjoy and perform well in the nursing home setting. Knowledge of these links may be useful for hiring the appropriate person for direct care nursing home positions.

doi:10.3928/19404921-20100330-03 [get full text]

Approaches to Resolve Health Challenges in a Population of Older Adults Undergoing Hemodialysis

Debra J. Hain, DNS, GNP-BC; LisaMarie Wands, MS, RN; Patricia Liehr, PhD, RN

Received: April 15, 2009; Accepted: November 5, 2009; Posted: April 30, 2010

Research is lacking regarding the health challenges older adults undergoing hemodialysis face when attempting to make lifestyle changes. The purpose of this study was to identify the health challenges of making lifestyle changes in this population and to identify approaches for resolving these challenges. Story theory guided data collection, and data were analyzed using Liehr and Smith’s story inquiry method. Within these stories of health challenges, three themes captured the essence of what “matters most” to participants: (a) Living a Restriction-Driven Existence; (b) Balancing Independence/Dependence; and (c) Struggling With Those Providing Care. The approaches to resolving the health challenges exist on a continuum, with “unhappy passive acceptance” on one end and “assertive behavior intended to get what you want” on the other. The findings suggest that these approaches may change over time. Identifying health challenges could lead to self-management behaviors that support positive health outcomes for this population.

doi:10.3928/19404921-20100330-01 [get full text]

The Meaning of Home: A Qualitative Metasynthesis

Sheila L. Molony, PhD, RN, GNP-BC

Received: February 17, 2008; Accepted: September 8, 2009; Posted: March 31, 2010

Practice-based initiatives have emphasized the need to provide “homelike” environments in long-term care. This study adds to the discourse on the meaning of home by synthesizing several individual qualitative studies using Noblit and Hare’s method of meta-ethnography. The purpose of this larger synthesis is to bring the findings from several discrete studies into a larger interpretive perspective that will lead to ongoing theory and practice development to enable experiences of home during residential transition, thereby informing nursing praxis in creating and shaping therapeutic environments.

doi:10.3928/19404921-20100302-02 [get full text]

Story Sharing: Enhancing Nurse Aide-Resident Relationships in Long-Term Care

Diane Heliker, PhD, RN; Hoang Thanh Nguyen, PhD

Received: June 18, 2008; Accepted: September 8, 2009; Posted: March 31, 2010

National surveys often report nursing home deficiencies related to the preservation of residents’ dignity and respectful care. Many nurse aides (NAs), who provide the majority of personal care, are unprepared to engage in empathic and meaningful relationships with residents. This article reports the findings of a pilot mixed method study comparing two interventions, Story Sharing (StS) and Communication Skills, on NA levels of mutuality, empathy, job attitude, and self-efficacy and resident levels of empathy and perceived caring behaviors. A quasi-experimental/interpretive phenomenological design was used. Total Mutuality and subscale (Shared Values, Affective Closeness, Shared Pleasurable Activities, Reciprocity) scores were significantly higher in the StS NA groups only, as were postintervention Empathy scores. Other trends are reported as well. StS is one approach toward helping NH staff and residents understand, respect, and connect with one another.

doi:10.3928/19404921-20100303-01 [get full text]

Depressive Symptoms in Community-Dwelling Elderly Korean Immigrants and Elderly Koreans

Mo-Kyung Sin, DSN, RN; Myoung-Ae Choe, PhD, RN; Jeungim Kim, PhD, RN; Young-Ran Chae, PhD, RN; Mi-Yang Jeon, PhD, RN

Received: January 28, 2009; Accepted: July 21, 2009; Posted: January 29, 2010.

Depression among minority older adults is a prevalent underrecognized medical illness. Changes in cultural norms and social conditions because of immigration have a significant influence on mental health. The purpose of this study was to assess the interrelationships between acculturation, geographical location, gender, and depressive symptoms in community-dwelling elderly Korean immigrants and elderly Koreans. In this cross-sectional study, a convenience sample of 88 elderly Korean immigrants and 295 elderly Koreans were recruited separately from senior centers and senior apartments. Depressive symptoms were assessed with the Korean Geriatric Depression Scale-Short Form and acculturation with years of living in the United States. Acculturation had no significant relationship with depressive symptoms (r = 0.01, p = 0.94). Depressive symptoms were highly present in both elderly Korean immigrants and elderly Koreans. The prevalence of depressive symptoms was higher in women. This study provides baseline data for development of culturally specific, community-based intervention programs for better management of mental health of elderly Korean immigrants.

doi:10.3928/19404921-20100108-01 [get full text]

Identifying and Validating the Components of Nursing Practice Models for Long-Term Care Facilities

Christine Mueller, PhD, RN, FAAN; Kay Savik, MS

Received: January 20, 2009; Accepted: July 21, 2009; Posted: December 31, 2009

Nursing practice models (NPMs) provide the framework for the design and delivery of nursing care to residents in long-term care (LTC) facilities and characterize the manner in which nursing staff assemble to accomplish clinical goals. The purpose of this study was to identify and validate the distinctive components of NPMs in LTC facilities and develop an instrument to describe and evaluate NPMs in such settings. The study included validation of the NPM components through a literature review and focus groups with nursing staff from LTC facilities; development and modification of the Nursing Practice Model Questionnaire (NPMQ); and examination of the validity and reliability of the NPMQ through pilot testing in 15 LTC facilities with 508 nursing staff. Five factors—decision making, informal continuity of information, formal continuity of information, continuity of care, and accountability—comprise the five subscales of the NPMQ, a 37-item questionnaire with established respectable validity and reliability.

doi:10.3928/19404921-20091207-97 [get full text]