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01/2019 journal articles

DEVELOPMENT OF A NEW DEVICE FOR IDENTIFICATION OF NUTRITIONAL NEEDS OF DYSPHAGIC INPATIENTS

F. Bortolazzi, A. Calabrò, M. Pesce, U. Tortorolo, T.F. Piccinno, M. Masini, C. Chiorri

Jour Nursing Home Res 2019;5:27-32

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Objectives: Dysphagia in elderly patients can cause serious health problems. The aim of this study was to investigate the effects of a new method for the identification of the elderly dysphagic patient. We hypothesized that a simple identification device could reduce errors in providing food and therefore reduce negative outcomes. Design: Two group of participants were enrolled (experimental and control). Each patient received a diagnosis of the severity of his/her own dysphagia disorder on a scale ranging from 1 (no swallowing problem) to 5 (unable to swallow). Inpatients of the experimental group only worn a bracelet with a specific color code for each level of the dysphagia disorder. Operators were trained to check the bracelet color and provide the corresponding diet to the patients. Participants were tested three times over a two months period. Setting: The participants were hospitalized in three nursing homes of the same institute. The colored bracelet method was adopted in two of these nursing homes. Participants: Fifty-five participants were enrolled for the study (44 in the experimental group, 78% female, mean age = 88.9±6.6 years). Forty-two operators (86% female, 64% of age between 36 and 55)) filled in an evaluation questionnaire. Measurements: Several measures of nutrition, hydration, and clinical condition were collected. Results: The method significantly improved hydration (p = .002) and BMI (p = .010) and reduced the risk of bedsore (p < .001) of the patients. Conclusion: The colored bracelet method is an effective instrument for managing the diet of elderly dysphagic inpatients.

CITATION:
F. Bortolazzi ; A. Calabrò ; M. Pesce ; U. Tortorolo ; T.F. Piccinno ; M. Masini ; C. Chiorri (2019): Development of a new device for identification of nutritional needs of dysphagic inpatients. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.6

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PROFIT MAXIMIZATION AND NURSE STAFFING STANDARDS/LEVELS IN FOR-PROFIT AND NOT-FOR-PROFIT NURSING HOMES

O.O. Omotowa, L.C. Hussey

Jour Nursing Home Res 2019;5:21-23

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Profit maximization is a significant factor affecting adherence to adequate staffing standards and actual staffing levels of nursing staff in many nursing homes in the United States. Studies have shown that inadequate nurse staffing is worse in the for-profit than not-for-profit nursing homes and, is adversely affecting resident care outcomes. The purpose of this report is to examine the literature and establish the impact of profit maximization on nurse staffing with a focus on the differences between for-profit, not-for-profit, and religious-based nursing homes in the United States. Databases such as CINAHL Plus, Business Source Complete, Medline Complete, Academic Search Complete, ProQuest Nursing, Allied Health Source, and Google Scholar were used as sources for information collection. Compared to other types of nursing homes, findings showed that for-profit nursing homes are doing better financially but worse on care outcomes. It is important that nursing homes regulators enforce strict adherence to staffing standards for optimal quality of care outcomes.

CITATION:
O.O. Omotowa, ; L.C. Hussey (2019): Profit Maximization and Nurse Staffing Standards/Levels in For-Profit and Not-For-Profit Nursing Homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.4

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RISE IN ASSISTED LIVING LAWSUITS INDICATES THE NEED FOR A CONSUMER-CENTERED MODEL OF CARE

M. Fetterolf, P. Kao, N. Castle

Jour Nursing Home Res 2019;5:24-26

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Across the United States, 60% of Assisted Living administrators noticed an increase in legal claims; meanwhile nearly 75% noticed an increase in lawsuits and 71% noticed an increase in settlements. This article asks whether or not the rise in legal pressure may be attributed to a higher proportion of residents with moderate to severe cognitive impairment in Assisted Living. More broadly, the findings indicate that there is a lack of consumer choice and solutions for the elderly in need of long-term services. As a short-term option to mitigate the rise in legal pressure, long-term facilities could explore ways to work with residents in defining various thresholds of care that are safe, sustainable and economically sound whilst preserving certain aspects of residents’ desired lifestyles. Over the long term, the United States needs to develop innovative options for the provision of long-term care services with a focus on redesigning care for older adults with their input. The consequences of such a positive change are examined.

CITATION:
M. Fetterolf ; P. Kao ; N. Castle (2019): Rise in assisted living lawsuits indicates the need for a consumer-centered model of care. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.5

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GER-E-TEC: TELEMONITORING PROJECT FOR ELDERLY RESIDENTS IN NURSING HOMES

A.A. Zulfiqar, A. Hajjam, B. Gény, S. Talha, M. Hajjam, J. Hajjam, S. Ervé, D. Letourneau, E. Andrès

Jour Nursing Home Res 2019;5:20

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CITATION:
A.A. Zulfiqar ; A. Hajjam ; B. Gény ; S. Talha ; M. Hajjam ; J. Hajjam ; S. Ervé ; D. Letourneau ; E. Andrès (2019): GER-e-TEC: Telemonitoring project for elderly residents in nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.3

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EXPLORING THE TRAJECTORIES OF QUALITY OF LIFE AND ITS COVARIATES IN NURSING HOME RESIDENTS: A LONGITUDINAL STUDY

I. Røen, J. Šaltyté Benth, Ø. Kirkevold, I. Testad, G. Selbæk, K. Engedal, S. Bergh

Jour Nursing Home Res 2019;5:8-19

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Background: There is no cure for dementia and appropriate care should be offered to improve or maintain quality of life for those living with dementia. Objectives: To identify groups of residents following similar trajectories of quality of life after nursing home admission, to examine which resident, staff, and organizational characteristics at baseline differ between the identified groups, and to assess the associations between the trend in quality of life and the same characteristics measured at baseline and over the study period. Design: A prospective, observational, longitudinal cohort design over 30 months. Setting: Nursing homes in Norway. Participants: Residents admitted to nursing homes. Measurements: Resident data on quality of life, dementia, pain, activities of daily living, physical health, neuropsychiatric symptoms, medication, and demographic characteristics were obtained by interviews. Unit characteristics and the staff data on person-centered care, psychosocial factors, and job satisfaction were obtained by questionnaires and interviews. The physical environment of the unit was assessed by structured observation. Results: 694 residents admitted to a nursing home and 1161 staff from 175 nursing home units participated. Three resident groups following similar trajectories in quality of life were identified by growth mixture model; good quality of life (53.6%), moderate quality of life (32.9%), and poor quality of life (13.4%). All groups’ quality of life decreased over time. More pain, more severe dementia, and more affective symptoms at baseline were associated with belonging to the poor quality of life group. Overall decline in quality of life was associated with more severe dementia, more pain, poorer function in activities of daily living, more severe neuropsychiatric symptoms among residents, and poorer job satisfaction among staff. Conclusion: Reducing pain, reducing NPS, improving activities of daily living for the residents, and improving the staff’s job satisfaction may be factors of importance to improve the residents’ quality of life.

CITATION:
I. Røen1 ; J. Šaltytė Benth ; Ø. Kirkevold ; I. Testad ; G. Selbæk ; K. Engedal ; S. Bergh (2019): Exploring the trajectories of Quality of Life and its covariates in nursing home residents: A longitudinal study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.2

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THE MEANING OF THE DEATH AND DYING OF TAIWANESE NURSING HOME RESIDENTS: THE NURSING STAFF’S VIEW

S.L. Tsai, J.F. Stocker, C.H. Tsai, S.H. Yeh

Jour Nursing Home Res 2019;5:1-7

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Background: The number of people living in long-term care (LTC) facilities has been rising in many parts of the world, and most current residents will end their lives in LTC facilities. The perceptions of residential care and practices in most current research of nursing homes (NHs) in Taiwan are based on evidence from an ego-centric rather than socio-cultural-centric model. Objectives: This study was designed to address the overlooked cultural aspect in NHs research and thereby advance understanding of how the NH staff in an East Asian setting perceive NH resident death and dying. Design: A qualitative study was designed in line with the hermeneutic phenomenological method. Data were collected via in-depth semi-structured interviews. Setting: The research was conducted in five hospital affiliated nursing homes and seven independent nursing homes in central and southern Taiwan. Participants: Through purposive sampling, twenty-five participants were recruited for interview, twelve registered nurses (RNs) and thirteen nursing aides (NAs). Measurements: An interview guide was used to produce the digitally-recorded contents, which was then transcribed verbatim and translated. The hermeneutic phenomenological analysis was conducted such that authors went back and forth through every interview text (parts) and the research questions (whole) until they reached a comprehensive understanding of the subject matter in terms of reduced, emerging themes. Results: Four themes were identified in the data analysis. They were ‘impact of a resident’s death,’ ‘reflections on entangled feelings,’ ‘insufficiencies.’ and ‘tremendous pressure of informing death.’ Conclusion: This qualitative study confirmed previous findings of non-Asian studies about the significance of ‘assessment of dying’ and ‘family communication’ in quality NH care. In addition, NH nurses were in need of palliative training in dying care. The nurses’ felt pressure due to family requests to send residents home for their ‘last breath,’ which was both the nurses’ most challenging work of care and the most culturally grounded aspect of it.

CITATION:
S.L. Tsai ; J.F. Stocker ; C.H. Tsai ; S.H. Yeh (2019): The meaning of the death and dying of Taiwanese nursing home residents: the nursing staff’s view. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.1

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